Inspection on 25/10/05 for Nicholas House Care Home

This inspection was carried out on 25th October 2005.

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 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

Nicholas House Care Home 05/06/08

Nicholas House Care Home 05/06/06

Nicholas House Care Home 15/03/06

Nicholas House Care Home 18/02/05

Nicholas House Care Home 12/07/04

Nicholas House Care Home 08/12/03

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Snydale Care Home

Hawkhills

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Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Nicholas House Care Home 11 Church Street Haxey Doncaster South Yorkshire DN9 2HY Lead Inspector Beverley Hill Unannounced Inspection 25th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 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. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nicholas House Care Home Address 11 Church Street Haxey Doncaster South Yorkshire DN9 2HY 01427 752862 01427 752251 islecare@bntintrenet.com 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) Isle Care (Axholme) Limited Mrs Alison Victoria Turner Care Home 41 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (41), Physical disability (20), of places Physical disability over 65 years of age (20), Terminally ill (5) Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 10 day care places available The home, after discussions with service users and their families, confirms in writing that the service users are in agreement to continue sharing the three-bedded room. The three-bedded room in its current form to be used only for the three existing service users. Any vacancies that occur will be filled up to a maximum of two people sharing the room in order to comply with Standard 23. 22nd February 2005 Date of last inspection Brief Description of the Service: Nicholas House is situated in the village of Haxey, North Lincolnshire. The home is close to local amenities in Haxey, including shops, public transport and public houses. The home has its own mini bus. The original building is listed and opened as a residential home in 1988 with twenty-five bedrooms. The West Wing, an extension of six bedrooms, was completed in 1989 and The Coach House extension added a further nine bedrooms in 1993. In 2005 three en-suite single bedrooms were provided. Accommodation is provided over two floors and the home offers residential and nursing care for up to forty-one service users who may have needs associated with old age, dementia and physical disabilities. The Upper East Wing has nine bedrooms designated as a separate unit for people with complex needs associated with dementia. It has a separate lounge/dining room and dedicated staff. There are four other lounges, one of which is designated for smokers and a pleasant conservatory. The home also has two dining rooms set out with separate tables and chairs. The home has twenty-eight single bedrooms and six shared bedrooms. The home has sufficient bathrooms and toilets to meet the needs of people who live there. Outside the building there are garden and courtyard areas. Car parking is provided to the front of the home. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Initially the inspection took place over one day and was unannounced. The Inspector was unable to examine particular records in relation to training, complaints, supervision and staff recruitment because the manager was not present and they were advised that the documents were locked in the managers’ office. Other records, for example assessments, care plans, medication, risk assessments, menus and staff rotas were examined. The Inspector carried out a tour of the building and spoke to seven service users, two relatives, one nurse, two care staff and a cook. The day after the inspection a care staff member contacted the CSCI and made allegations of abusive practice by three staff members. The allegations related to moving and handling, verbal abuse, and access to staff assistance and medication. Other allegations were related to laundry and staffing levels. The allegations related to incidents over the last four to five months. The allegations were forwarded to the Local Authority for investigation under the Protection of Vulnerable Adults Policy and Procedures. A team of investigators consisting of two social services care managers and two CSCI regulation inspectors made ten visits to the home between 27/10/05 and 24/11/05 and interviewed service users and staff and examined documentation. The findings from the visits are recorded throughout the report and especially in the section on complaints and protection. At the time of writing the report the manager and proprietors had already addressed a number of the issues. What the service does well: The home provided a pleasant environment. It was clean and tidy and had a welcoming, homely feel. It was carpeted and decorated to a good standard. There were areas throughout the home where people could sit quietly and plenty of lounges in which to congregate for activities. There was a core group of nurses and care staff that had worked at the home for several years and knew the service users well. Some people who lived at the home said that the staff members were caring, looked after people well and made their relatives feel welcomed. The home always made sure that people had an assessment prior to being admitted to the home. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 6 Nursing staff managed medication well. They stored medication correctly and always signed the record sheet when it was delivered to the home and after administration. What has improved since the last inspection? What they could do better: People who live at the home must be protected from abuse. Staff must report any concerns to the manager and they must deal with them immediately. The manager must write down any discussion she has with staff about concerns or any disciplinary measures she takes with staff. Staff must receive extra training in how to protect people from abuse. Staff members need to have a better understanding of peoples’ needs so they can provide the right care and support. Staff must follow policies and procedures, care plans and risk assessments and not move and handle people without the correct equipment or using the correct techniques, as this will cause injuries. Care plans need to contain all the points in the assessment and when these needs change the staff must update the care plan. This also applies to risk assessments. The staff must make sure that they write down all the care that they provide to people and that information follows on to the next shift. This is important to make sure that care is not missed. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 7 The home must ensure that the privacy and dignity of all service users is maintained. The preparation and presentation of food could be improved to prevent it looking bland on occasions. Attention was drawn to this from the inspectors’ observation and a comment made to them on the day of the inspection. A discussion could take place with any service user who does not always like to eat meat and a list could be made of their preferences. Two people who live at the home sit in special chairs, which have a sloping seat backwards and this makes it difficult for them to get out of. Use of such chairs should only be on the recommendation of a qualified occupational therapist following assessment. There are eight people with dementia who live in a unit within the home. Staff members stay on the unit during the day but the residents are only checked every two hours at night. As they would be unable to use the call bells themselves they need to have more monitoring during the night. The formal supervision that staff members receive needs to include time for one to one discussions so staff can talk about any concerns they have. Direct observation of practice takes place and this is a good means of monitoring staff skills. The home must make sure that all accidents/incidents are recorded and when inspectors visit the home they must be able to see any documents they need to inspect. People who live at the home can go into the main kitchen and this could be dangerous when staff members are not using it, as there is a hot water boiler near the entrance. The home could make the kitchen safer. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 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 Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Assessments, risk assessments and care plans were produced that detailed service users needs. EVIDENCE: There was evidence of in-house assessments of service users’ needs prior to their admission to the home. The home obtained assessments completed by care management prior to admission and the inspector had seen evidence of them on a previous visit. The assessments were important as they provided vital information for the care planning stage and also determined whether the home could meet the service users needs. Any assessments for nursing care were completed by the local primary care trust. Service users spoken to confirmed that the initial stay was regarded as a trial basis before a final decision had to be made. One person told the inspector that they had been at the home for over a year but had only just decided to stay permanently. The service user appreciated the extended trial time for them to make a measured decision. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 11 The home had the capacity to support people for day care and respite care when vacancies allowed. Staff regarded this as enabling service users to see what the home was like prior to permanent admission. Some staff members did not consistently use their skills and knowledge, about service users needs, available to them via training courses, supervision, care plans, risk assessments and moving and handling assessments. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 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 and 10 Generally care plans and risk assessments were good however not all had been updated as needs changed which meant that service users were at risk of inadequate care. Service users health, welfare and dignity were compromised on occasions by staff not consistently following care plans and risk assessments. EVIDENCE: Generally care plans specified service users needs and were evaluated monthly by nursing staff. However the detailed examination of four care plans during the inspection and four care plans during the investigation highlighted that changes in need were not always reflected in care plans and risk assessments and staff did not always follow them. For example, one person’s health had deteriorated and their needs had increased. They were very frail, unable to communicate their needs verbally and all support was provided whilst they were nursed in bed. Whilst it was acknowledged by most staff that the person would always be bed-bathed this had not been updated in the care plan. One care plan examined stated that gentle exercises needed to be completed but there was no evidence to back up that these had been done. In one care Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 13 file a service user scored high risk for pressure sores on both the pressure area and nutritional risk assessments but no preventative care plan was formulated. Three of the four care files examined during the inspection indicated that the service users received a body wash in the main rather than an immersion bath. This was also confirmed in a discussion with a relative. The care plans detailed support in and out of the bath but this appeared to be infrequent in bathing records for those examined and the care plan did not indicate this had been due to service user choice. Daily recording was completed in different areas. For example, bathing, activities, fluid monitoring and pressure relief were recorded on separate charts. Fluid monitoring and pressure relief charts were held in service users bedrooms. The daily progress notes were basic and did not give a full picture of the care provided over the full day and night, nor followed on consistently issues highlighted during one shift to the next. For example, one person’s progress notes during a two-week period stated, ‘poor diet taken’ but not what the staff had done to address the situation. The care plan for that period had been updated with instructions for staff to offer food supplements but this was not recorded as having happened during the two-week period. There was evidence that the staff had contacted the GP to change medication in this case and the inspector was informed that a dietician was to be involved but had not yet visited. Medication was well managed, stored appropriately and signed into the home and on administration. Some service users spoken to said that staff knocked on their doors prior to entering their bedrooms and they helped with personal care in a ‘nice way’. Other responses to a question on respect for privacy and dignity were, ‘I can’t fault anything like that’, ‘Yes they do alright by me and always knock on doors’, ‘More or less, they knock then pop their head around the door’, ‘They assist with personal care and are well trained’. Despite the completion of assessments, risk assessments, moving and handling assessments, care plans and staff training in moving and handling, the investigation found that inappropriate and unsafe moving and handling techniques had occurred and privacy and dignity was compromised. See complaints and protection. During one of the visits the inspector noted a children’s music tape playing, ‘the wheels on the bus’ and ‘horsy horsy’. Service users did not appear to be listening and, when challenged, staff did not appear to recognise the inappropriateness of the choice and needs of the service users in this area. Staff stated, ‘we do exercises to it’. No exercises were taking place at the time. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 Service users nutritional needs could be more fully met by improvements in preparation, presentation and in some cases choice of the food provided. EVIDENCE: Discussions with service users, relatives and staff confirmed that visitors could come at any time and were made to feel welcome. One relative stated that the staff always kept her informed. The home is located within a small village and is close to local shops and facilities. Community links have been made with local churches for monthly services and schools for special events. The home has its own mini bus and trips this year had been organised to local venues such as garden centres, ice cream parlours, Cleethorpes, Leeds Armoury and shopping trips. A library delivers a selection of books regularly. One staff member stated that the home has quite a few poorly people at present so it can be the same people that go out each time but they do try to ensure everyone who is able and wants to, have the opportunity to go out. The home had five-weekly rotating menus that showed a variety of choice and alternatives. These were mainly jacket potatoes and salads as alternatives for the main meal. One service user spoken to did not eat a lot of meat and felt Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 15 the choices on offer for them were rather limited. There was evidence of fresh fruit and vegetables, a cooked breakfast as required and two choices at the main meal and at teatime. The cook advised that kitchen staff visited the service users each morning to establish their choice for the day. There appeared to be plenty of food and evidence of home baking. Service users said they had enough to eat and drink and food supplements were used for one or two people with poor appetites. Two service users were fed via percutaneous endoscopic gastrostomy and one person had a naso-gastric feeding tube insitu. The nurses provided support for these service users. Comments about the preparation and presentation of meals varied. For example, ‘its quite good’, ‘ its very good’, ‘it could be better’, ‘its ok but sometimes it could do with being a bit varied’, and ‘the presentation is not always good and the food is bland looking’. The inspector sampled a meal on the day of inspection and the sprouts were overcooked and the custard on the dessert was cold. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home failed to protect service users from abuse by two staff members and put service users at risk by poor moving and handling. EVIDENCE: The inspector was unable to assess complaints as they were advised the file was locked away in the manager’s office. This will be assessed at the next inspection. The CSCI received information from a staff member that led to an investigation under the protection of vulnerable adults policies and procedures. Staff members who disclose allegations do so with the protection of ‘whistle blowers’ policies and are to be praised for their actions. The allegations concerned the actions of three staff members. All were suspended during the investigation and one has since been reinstated, as the allegation against them was not upheld. There was evidence from the investigation to suggest that staff at all levels had insufficient understanding of adult protection procedures to follow in the event of alleged or actual abuse. The allegation about moving and handling a service user without appropriate equipment and causing a skin tear was admitted to by staff and upheld. The allegation about a service user sustaining a bruise to their leg and eye due to poor moving and handling did not have sufficient evidence to prove, Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 17 however two staff did lift the service user in an undignified and unsafe way to complete a personal care task that was unnecessary. An allegation about a named staff member placing a service user’s call bell out of their reach was upheld. The allegation of verbal abuse to service users and swearing in front of service users by one staff member was corroborated and upheld. Other allegations related to laundry, staffing and two staff members locking themselves in at night and watching videos were not upheld. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 26 The home provided a clean environment for people. The home used chairs that restrained people without professional assessment to ensure they were appropriate for their needs. EVIDENCE: During the inspection and further visits for the investigation it was noted that the home was very clean and tidy. The domestic staff obviously worked very hard to maintain standards. Service users spoken to were happy with the laundry, the cleanliness of their bedrooms and the home in general. Two service users were sitting in ‘Kirton’ chairs in the lounge that had not been assessed for their specific use. As the chairs were restrictive in that the seat sloped backwards and limited the persons ability to get out unaided they were a form of restraint and the people using them must be assessed by occupational therapists to ensure this is the most appropriate form of seating for them. One of the chairs had the arms taped and looked unsightly. It was also placed near a radiator and when two inspectors sat in it independently Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 19 they both banged the back of their heads on the radiator, which could mean that the person using it may do the same. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 The home had sufficient numbers of staff, however service users with dementia were placed at risk by not being monitored appropriately at night. Vulnerable service users were placed at risk due to staff dynamics and an inability of some staff to put into practice the training they had received. EVIDENCE: The inspector was unable to examine recruitment files and training records on the day of inspection as they were locked away in the manager’s office. These will be assessed fully at the next inspection. During the investigation the team examined training records in relation to moving and handling. There was evidence that staff had received moving and handling training from external providers and they were monitored using the hoist. However several staff within the home admitted they did not use moving and handling equipment with service users who had been assessed as needing it. Staff had received training but some were not competent at moving and handling and they paid little heed to care plans and risk assessments. This is unsafe for both the service user and the staff involved and moving and handling risk assessments must be followed and compliance monitored by the manager. The home had a four-week rota that showed who was on duty and in what capacity. During the morning there were six carers and two nurses, in the afternoon, five carers and two nurses and at night three carers and one nurse. The home used agency nurses to fill any gaps due to sickness or holidays. There appeared to be sufficient domestic and catering staff. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 21 The home provided support for eight people with dementia in the upper east wing. There was always a staff presence on the unit during the day but at night the connecting door to the main unit was locked with a code and staff checked the service users approximately every two hours. The service users would be unable to use their call bells and two people had sensor mats to alert staff when they were out of bed. Staff spoken to stated they could hear people walking around and would go up to support them. This ad hoc approach to nocturnal support was insufficient for service users with dementia and must be reviewed to ensure a staff presence and closer observation. During the investigation it became apparent that staff dynamics affected the smooth running of the home. There were separate groups within the team. Some staff members said they were fearful of upsetting others and of being harassed and bullied. This ultimately led to serious incidents not being reported to the manager or outside agencies. Professional relationships need to be developed between staff and they must be made aware of their duty of care towards the vulnerable people residing in the home. During the inspection and investigation the manager advised that one care staff member had reached the final of the carer of the year competition and was down to the last two. The NVQ Assessor put the staff member forward for the award. Service users spoken to used a range of comments about the staff, ‘ very good, they generally help you’, ‘very good, no doubt about it’, ‘alright’, ‘very nice, I get on with some more than others’, ‘the staff treat me well, they fly in and out’, ‘they are fine on the whole, sometimes doesn’t feel like there is enough of them’. Those service users verbally abused by a staff member were people with memory impairment. One relative spoken to stated that there were more younger staff than there used to be and the older staff were generally more mature and were easier to have a rapport with. They reported that staff had different approaches but were kind and caring. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 22 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, 36, 37 and 38 Service users were physically harmed by poor moving and handling and placed at risk by inadequate management skills, staff deployment at night and staff not following risk assessments and policies and procedures. EVIDENCE: The manager is a State Registered Nurse and has recently completed the Registered Managers Award. During the investigation it was noted that the manager had not kept a full record of discussions held with staff that were of a disciplinary nature. Staff stated to the investigation team that the manager had been made aware of one of the allegations, of difficult staff dynamics and the bullying of some staff members by others. The manager confirmed she was aware of these issues but had not documented them other than to have a staff meeting. Staff reported they had not received any feedback to how their concerns had been dealt with Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 23 and some stated a reluctance to complain about particular staff members as confidentiality had been breached in the past. This was strongly refuted by the manager. Staff and service users described the manager as a very nice person, approachable and caring. However it appears there is a need for the manager to further develop leadership and guidance skills and to increase awareness of adult protection and disciplinary policies and procedures in order to manage the home effectively and protect service users from harm. Care staff received formal supervision, which took the form of observed practice of a particular care task and then a discussion about their competency with it, for example using the hoist or bed bathing. Staff may or may not be aware that they were being observed. The observation was documented and signed by the supervisor and the staff member. The supervision form had scope to document other topics discussed, such as training and development, and service user issues, however during the investigation and interviews with staff it appeared that further discussions about these issues was limited. Care staff perceived supervision to be just the observation of their practice. The manager supervised the nursing staff, who in turn supervised the care staff. During the investigation it became apparent that one care staff received formal supervision from a close relative. This was unnecessary as the staff member did not always work shifts with their relative and could have been supervised by an independent member of staff. The majority of records were in place and stored securely. However during the inspection the inspector was unable to access some documentation that was vital to the assessment of standards within the home, for example complaints and training records. It is a requirement that certain documents must be available for inspection. A range of issues compromised the health and safety of service users within the home: The verbal abuse of service users by one staff member. The unsafe moving and handling techniques used on service users and the moving of service users without designated equipment causing injuries. Staff not following policies and procedures with regards to moving and handling and adult protection. Staff not updating care plans and risk assessments when needs changed. Staff not completing accident reports consistently. Accessibility of the kitchen when not in use. The deployment of staff at night in the upstairs unit for people with dementia. During the investigation it was noted that a further service user did not have access to a call bell. The lead had been removed and the risk assessment stated this was for safety reasons. Extra checks through the night were not part of the support plan. Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 24 Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 1 x x x 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x x x x 2 2 1 Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 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 OP7 Regulation 15 Requirement The registered person must ensure that all assessed needs are reflected in care plans. (previous timescale of 31/05/05 not met) The registered person must ensure that passive exercise routines for one service user are clearly recorded when completed. The registered person must ensure that all staff members have sufficient skills and knowledge to meet the full range of service users needs. This is in relation to, moving and handling, care practices, adult protection, knowledge of needs, philosophy of the home, the values expected of them, general respect for choice, dignity and privacy and duty of care responsibilities. The registered person must ensure that care plans are updated as needs change and that staff follow care plans when providing support. The registered person must DS0000002794.V262463.R01.S.doc Timescale for action 31/01/06 2 OP7 12(1)(a) &15 31/01/06 3 OP4 12(1)(a) & 13(6) 31/03/06 4 OP7 12(1)(a) & 15(2)(b) 12(1)(a) 31/01/06 5 OP7 31/01/06 Page 27 Nicholas House Care Home Version 5.0 6 OP8 13(4) 7 OP8 12(1)(a) & 13(4) 12(1)(a) 8 OP8 9 OP10 12(4)(a) 10 OP15 16(2)(i)& 24(1)(b) 11 OP15 16(2)(i) 12 OP18 13(6) 13 OP18 10 & 13(6) 14 OP22 13(1)(b) ensure that daily recording reflects the care provided over a twenty-four hour period. The registered person must ensure that risk assessments are updated as needs change and that staff follow what is written in them. The registered person must ensure that service users are bathed in accordance with risk, choice and need. The registered person must ensure that service users are moved and handled appropriately and in accordance with risk assessments to prevent skin tears and other injuries. The registered person must ensure that the privacy and dignity of all service users is maintained. The registered person must ensure that a quality monitoring system is built into the preparation and presentation of meals. The registered person must ensure sufficient alternatives for those service users who do not like to eat meat. The registered person must ensure that service users are protected from abuse. All staff must receive further awareness training in their duty of care responsibilities and adult protection alerting and referral procedures. The registered person must ensure that all levels of staff are knowledgeable of, and use when required, adult protection referral and investigation procedures. The registered person must ensure that the two service users using the kirton chairs have their DS0000002794.V262463.R01.S.doc 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/03/06 31/03/06 31/01/06 Nicholas House Care Home Version 5.0 Page 28 15 OP27 12(1)(a) 16 OP30 12(1)a &18(1)c (i) 17 OP31 9(2)(b)(i) & 10(3) 18 OP31 Schedule 4 (6)(f) 19 OP31 12(5)(b) 20 OP36 18(2) 21 OP37 17(3)(b) seating needs assessed by occupational therapists. Application for assessment to be made by the timescale for action date. The registered person must ensure that service users with dementia have more effective supervision by staff at night. The registered person must ensure that all staff put into practice their moving and handling training. The manager must audit moving and handling training and ensure that all staff have a current up to date certificate in moving and handling by an accredited trainer. The registered manager must take note of the findings of the investigation and further develop leadership and guidance skills to ensure the effective management of the home and the safety and wellbeing of service users. The registered manager must ensure good record keeping particularly in relation to discussions of a disciplinary nature with staff and advice and guidance from proprietors. The registered manager must encourage and assist staff to maintain good personal and professional relationships with service users and each other. The registered person must ensure that formal supervision process is expanded to include regular one to one discussions relating to care practices, service user and team issues, and the values expected to be upheld within the home. The registered person must ensure that all records required DS0000002794.V262463.R01.S.doc 31/01/06 13/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 Page 29 Nicholas House Care Home Version 5.0 22 23 OP37 OP38 17(1)(a) 13(4) 24 OP38 13(4) 25 OP38 12(1)(a) for examination during inspections are available. The registered person must ensure that all accidents are recorded. The registered person must ensure that the risk assessment for the service user without a call bell is expanded to address extra monitoring throughout the night. The registered person must ensure that the kitchen area, which is accessible to service users when not in use, is risk assessed and steps taken to minimise any risks identified. The registered manager must ensure the health and safety of service users within the home by improving care practices and documentation, ensuring staff follow care plans and risk assessments, adherence to policies and procedures and reviewing deployment of staff at night. 31/01/06 31/01/06 31/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The manager should review the use of the children’s music tape, which was playing during one of the inspector’s visits. Service users choices and wishes to be audited and taken account of regarding music to be played throughout the home. The manager should record the nocturnal checks carried out on people with dementia who live in the separate unit. The manager should forward the two staff members’ names to the manager of the pova register for consideration of inclusion onto the register. DS0000002794.V262463.R01.S.doc Version 5.0 Page 30 2 3 OP7 OP18 Nicholas House Care Home Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Nicholas House Care Home DS0000002794.V262463.R01.S.doc Version 5.0 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. 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