Inspection on 19/12/07 for Eton Park

This inspection was carried out on 19th December 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Eton Park 18/06/08

Eton Park 22/08/07

Eton Park 26/04/06

Eton Park 04/01/06

Eton Park 11/10/04

Eton Park 21/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE North View Care Home Owthorpe Road Cotgrave Nottingham NG12 3PU Lead Inspector Joanna Carrington Unannounced Inspection 19th December 2007 9.00 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 North View Care Home DS0000060190.V355057.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. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service North View Care Home Address Owthorpe Road Cotgrave Nottingham NG12 3PU 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) 0115 989 9545 0115 989 9311 Mr David Hetherington Messenger Vacant Care Home 82 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (76), Physical disability (4), of places Terminally ill (2) North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 82 (OP) That include 4 (PD), 2 (TI) & 50 (DE 55 years & Over) Date of last inspection 22nd August 2007 Brief Description of the Service: North View is a large purpose built home on the outskirts of Cotgrave five miles to the south of the city of Nottingham. There are no amenities within walking distance of the home, which is situated at the top of a hill, not far from the A46. North View has a Mini bus service to provide transport to and from the home for residents’ families and a small fee is charged. In the village there is a library, health centre, shopping precinct, restaurants and café, churches and a leisure centre plus other sporting facilities. The home provides for up to eighty-two people with nursing and residential care needs, with four beds available for residents with physical disabilities. There are seventy-eight single rooms, of which eighteen are en-suite. There are two double rooms, neither of which is en-suite. The fees, at the time of this inspection range from £290 to £360 per week. This is dependent on whether residents are placed needing nursing care or residential care. Copies of inspection reports are available to residents and other stakeholders upon request. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit, as part of the home’s key inspection took place on 19th December 2007. The previous key inspection took place on 22nd August 2007. The main purpose of this inspection was to follow up on issues identified at the previous inspection and to make sure the required progress is being made in order to improve outcomes for people that use the service. The main method of inspection used was ‘case tracking’ which meant four residents were selected and their care was tracked through discussion with them and with staff, checking their care records and observing practice. Altogether, four staff members, seven residents and one relative were spoken with during the course of the inspection. A sample of staff records were also looked at to make sure staff get the necessary training and that checks are carried out on staff before they start working at the home. Information about a home that is collected before the inspection is also used to make judgements about a service. This information could include notifications, information from other professionals and users of the service or their relatives, and also from any surveys that are sent out. Services are now required to fill in a document called an AQAA (Annual Quality Assurance Assessment) in which the registered manager identifies from their own quality monitoring what the service does well at and what they need to improve on. The AQAA was not used to plan this inspection because it was used for the last key inspection, in August 2007. Six relative surveys, six resident surveys and two care staff surveys were all returned following the key inspection and have been used as evidence and to support judgements made in this report. What the service does well: What has improved since the last inspection? North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 6 Complaints management has improved, with new documentation for recording complaints received and action taken. There is a revised Complaints Procedure for residents and other stakeholders to access. This will help ensure residents’ complaints are taken seriously and acted on. Some further work has been carried out to the environment, with new furniture provided in communal areas and bedrooms re-decorated. This ensures the environment is kept homely and comfortable for residents. There are now moving and handling plans on care files, which comply with health and safety legislation. Using these plans will ensure that staff have all the information they need to be able to move and transfer residents safely. Improvements are being made to staffing arrangements. More staff members have been recruited and problems with communication between the staff team are being resolved. This means the standard of care for residents should get better and help ensure their needs are met. What they could do better: All staff members need to be aware of their responsibility to alert the manager of all allegations of abuse or to whistle-blow. If they don’t all know this then there is the risk that residents are not adequately protected from harm. Despite some improvements with staffing noted there are still some issues around staffing that mean poor outcomes continue for residents. The training records seen indicate that not enough staff are yet to be adequately trained in health and safety and in dementia care. Not enough staff members have first aid training, which could place residents at risk. Some staff members do not have two written references on their file, which means residents could potentially be cared for by staff members that are not suitable to work with vulnerable people. Some shifts are being run below safe staffing levels and observation and discussion with staff indicates that staffing arrangements at meal times are not appropriate to the needs of residents. Medicine management is still in need of further improvement in order to promote the safety of residents and to ensure residents are getting their medicines as prescribed. The use of physical restraint (bed rails and lap belts on wheelchairs) still needs to be risk assessed for all individuals to make sure that the measure is safe and also the last resort in securing residents’ welfare. Otherwise, residents’ human rights are not being protected and residents could be at risk of injury from the actual method of restraint used. Care plans still need further work so that they include more specific information about individual residents’ needs and preferences. This will make the care provided more person-centred. Care plans should reflect best practice in caring for people with dementia. The environment could be better by North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 7 making the décor more enabling for residents with dementia, so that they can orientate themselves around the home. Residents that need assistance with eating and drinking must not be called ‘feeders’ because this is a degrading and undignified term to label people. 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. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 (the home does not provide intermediate care) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure is good in that prospective residents do not move to the home until their needs have been assessed, to ensure the home is suitable. But residents and their relatives still do not have enough information about the home to make an informed decision to move there. EVIDENCE: The placing authority’s community care assessment was seen on residents’ files and the dates on the assessments indicate that these were obtained before residents’ were offered a place and moved into the home. A resident that was spoken with recalled someone from the home visiting him to discuss his needs. There was evidence on the resident’s file of a pre-admission assessment carried out by a staff member at the home but the date of the assessment had not been recorded. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 10 Three residents state in their survey that they did have enough information about the home to decide to move there while one resident said they could not remember and another two residents said they did not have enough information. One relative commented in their survey that “virtually no information has been provided about the home or the services if can offer.” The current Service User Guide has been updated but it is reported that a new brochure is in the process of being developed, which will be sent out to new and current residents. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor care planning arrangements continue, which mean residents’ do not get person-centred care and cannot be ensured that their care is safe, ethical and consistent. Needs around dementia are not being adequately met. Despite some improvement, medicine management is still not effective in promoting the safety of residents. EVIDENCE: Like at the last key inspection, care plans are still not reflective of residents’ individual needs. For example, a resident, that was reported by a staff member, to on occasion take their clothes off in public (due to their dementia) this is not included anywhere in their care plan on how to support the resident with this behaviour. The staff member also reported that the resident can on some days dress with minimal assistance while other days requires full assistance, but the care plan for personal care does not mention what level of assistance with dressing and undressing is needed. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 12 The care plans seen contain very little information specific to individuals because a general care plan for different needs- such as mobility, communication and dementia care- is used, with the name of the resident added in. A care plan for communication identifies the resident’s behaviour as ‘quiet’ but the evaluations of this care plan keep referring to the resident as “noisy …shouting out for no apparent reason.” There is no further information on how to support the resident with this behaviour or any exploration as to why the resident may do this. Some care plans seen have not been reviewed since September / October 2007 and two case tracked residents did not have any daily records since September 2007. A relative that was spoken with did confirm that he is involved in six-monthly reviews of his wife’s care. At the last key inspection it was found that a resident was being restrained without any records of this in a care plan or risk assessment. At this inspection, another resident was case tracked because of the use of a lap belt on their wheelchair. The use of the lap belt is recorded on both the mobility care plan, history of falls care plan and falls risk assessment, however there is no further evidence to indicate whether an occupational therapist or specialist falls prevention service have been involved in the decision to adopt this measure. There is no risk assessment for the actual use of the lap belt, to ensure that it is the last resort and a safe measure that will not cause injury. Good care plans were seen for the treatment of pressure sores and the care plans and daily records indicate that the tissue viability nurse is involved when necessary. A resident spoken with said that whenever she is not feeling well the staff will call for a doctor who will come out and visit her. Five of the six returned resident surveys state that they always or usually get the medical assistance they need. Residents spoken with made positive comments about the staff team, describing them as “very good” and “can’t do enough for you.” They also said that staff treat them with dignity and respect and there was some observation of staff members interacting respectfully with residents. However, through discussion with staff the term ‘feeders’ was referred to when talking about residents that have assistance with eating and drinking. This is not a dignifying term to use. A staff member was asked how she assists residents with eating and drinking if she is doing this single-handed, to which she explained that they are assisted all at the same time, a spoonful to each person. This practice is not dignifying. On 1st October 2007 a specialist pharmacist inspector carried out an unannounced random inspection at the home. Since this inspection there have been some improvements. Ointments and eye drops are now dated when opened and residents spoken with who were able to give an opinion confirmed they are able to look after their own medication if they wish, but they choose not to. Medicines with variable doses were recorded correctly, along with a good audit trail of the amount administered. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 13 There is still some unsafe practice however. During a lunchtime drugs round a nurse was observed signing the medication administration record to say residents have been administered their medicines before they had actually been given it. During a breakfast drugs round a staff member (on the residential unit) was observed leaving the medicine trolley open and out of her view, while administering medicines to residents. The medication administration records examined revealed that pharmacy labels are still being used and a significant number of gaps where a code or staff signatures are required. Although a notification was sent to the Commission in October 2007 regarding poor recording, tablets being lost and drugs not being administered according to the drug chart, the evidence above indicates that poor practice and similar errors are continuing despite the management being aware. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ lead a lifestyle in which they can choose to participate in planned social and recreational activities however, choice and control on a day-to-day basis is limited. Residents receive wholesome nutritious meals but arrangements at mealtimes are not enabling residents to enjoy their meals. EVIDENCE: Residents spoken with said that there are planned activities in the home. One resident talked about how he enjoyed going out for lunch with the activity coordinator but he chose not to go to the pantomime or watch the carol singing. Another resident said she chose not to attend the recent Christmas party. Another resident explained how she prefers to spend time alone reading and doing crosswords. The December Newsletter for the home shows a range of activities including church services in the home and out in the community. There is a board in the home, which displays some of the artwork done by residents. During the inspection some residents were observed spending time in a communal lounge. Both the television and music were switched on at the North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 15 same time. No one was watching the TV and when residents were asked why, one resident replied, “the picture is so bad I can’t see anything’, whilst another said, ‘I can’t hear it (the TV) with the music on’. The music finished and approximately five minutes later a staff member came in and switched it on again without asking anyone living there if this was what they wanted. Two staff members were seen to sit down for short periods and attempt to chat with a couple of people living there, whilst others engaged in ‘banter’, which was well received by the individuals involved. A relative was spoken with, who confirmed that he can visit whenever he wants and that he is made welcome. Residents spoken with also talked about their regular visits from family and friends. Mixed comments were received about the quality of meals. In the returned surveys some positive comments by residents include “the food is good”, “plenty of nice food” and a resident spoken with said there were “good soups” and “you can ask for more and staff will get it for you.” Negative comments in surveys include, ‘never’ liking the food, and that “the soups at [the hospital] are much better.” Another resident writes in their survey, “I don’t always like the meal served but I am not hungry.” Three residents spoken with during the inspection reported that there are no alternatives available even if they don’t like what is on offer. No one spoken with knew what was being served that day. There was no menu on display anywhere in the communal areas. The menu records seen indicate that residents are offered three choices of meal the evening before but on the day of the inspection a staff member was observed asking people at the dining table and then writing it down on a scrap piece of paper. A resident remarked, “that only happened because you (inspectors) are here.” One resident spoken with said that residents have to sit there waiting before they get their meal and there is not a lot of staff to serve out food. Some residents were actually observed having to wait at the dining table for up to forty-five minutes without any stimulation or interaction from staff. One resident was given a plate of mashed potato and gravy with no source of protein or vegetables. The resident wasn’t offered any explanation and appeared confused about whether to start eating. The resident was not offered help or support from a staff member until the food must have been cold, some twenty minutes after serving. Overall, the meals served did look appetising and the menu records seen show that wholesome nutritious meals are provided, including vegetarian options. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the management of complaints mean that residents are assured their complaints are taken seriously and acted on. Residents cannot be assured, however that they are fully protected from abuse unless all staff know of their responsibility to alert the manager of allegations and to ‘whistleblow’. EVIDENCE: Out of six relative and six resident surveys returned, two relatives and two residents stated they don’t know how to make a complaint. Three residents spoken with during the inspection confirmed they do know how to complain and feel confident that the manager would respond appropriately. A relative that was spoken with said the manager is very easy to talk to. Since the last key inspection the Commission has not received any complaints about the service, except a phone call from a relative sharing dissatisfaction with certain aspects of care and activities provided but the relative agreed to approach the manager of the home directly. There was no record of this complaint and when asked about it, the manager had no knowledge of what or whom this was about. The complaints records seen show that there are new and improved complaints forms, but there are still some unresolved complaints, from before the appointment of the current manager, that still need concluding. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 17 Following the last key inspection a safeguarding referral was made to the local authority in response to information supplied by a staff member during the inspection. This was not accepted as a referral due to lack of information. Another safeguarding adults referral was made to the local authority in December 2007 when the Commission received information from an anonymous source about practices in the home. This is currently subject to investigation and the manager has been informed of the issues with the expectation to investigate and report back to a case conference. The manager reported in the improvement plan following the last key inspection that more than seven-five percent of the staff team have now attended training in safeguarding adults, and a training matrix was seen which confirmed this. Nonetheless, two staff members spoken with did not demonstrate an adequate understanding of their responsibilities in protecting residents from abuse. When presented with scenarios and asked how they would respond both staff members said it would depend on the resident because some residents make things up. Both staff members also said they would therefore probably have a word with the care assistant that the allegation was about. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is clean, comfortable and homely for residents but it is not an enabling environment, or in other words, not appropriate to the needs of residents with dementia. EVIDENCE: Residents commented in their surveys that the home is “always fresh and clean”. On walking around the premises the home was clean and smelled fresh. General décor is pleasant and well maintained and there is adequate lighting throughout the home. The bedrooms seen are personalised to suit individuals’ taste with residents’ own furnishings and pictures and ornaments. Residents spoken with confirmed they are happy with their bedrooms. Some bedrooms have recently been refurbished and some new furniture is being provided in communal areas. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 19 The home is registered for people with dementia but décor does not comply with good practice guidance regarding supporting people with dementia to orientate themselves. All corridors and hallways have a similar colour and wallpaper pattern scheme and there are no pictures or subtle signs to enable people to find their bedrooms. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although improvements to staffing arrangements are being made these improvements are not yet at a stage where it can be said residents are now in safe and competent hands. EVIDENCE: All staff members spoken with were a lot more positive about the staffing arrangements at the home, mainly commenting on improvements with staffing levels and relations within the staff team. A lot of new care assistants have been recruited. One staff member commented, “Linda (the manager) has helped integrate and intermingle the staff, feel its helped communication between teams and understand each other.” Another staff member reported, staffing levels do have off days when people call in sick but much better.” Two residents and three relatives, either when spoken with or in a survey remarked that staffing levels are at times still a problem. The manager reported that the current staffing arrangements are, in line with occupancy levels, on the early shift one nurse and five care assistants on the residential unit (downstairs) and one nurse and five care assistants on the nursing care unit then the late shift and night shift are lead by one nurse. The rota for the preceding couple of weeks was examined and showed some days in which shifts were run with as little as six or seven care staff. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 21 Observations made during lunchtime (as stated under outcome area Lifestyle) and the accident records seen showing a high number of falls that are not witnessed does suggest that staffing numbers / deployment of staff is not appropriate to the needs of residents. Staff members spoken with reported that they have been on various training courses including their mandatory health and safety training. The manager explained that training is ongoing and since she has been in post she has developed a training matrix and up to date records on what training each staff member has had. This information was not freely available to the manager, when she started her post around the time of the last inspection. The training matrix indicates that there are still significant proportions of staff that do not have the required training. For example, less that half of the staff team have completed moving and handling training, less than one sixth of the staff team have basic food hygiene. According to the matrix, less than one sixth of the staff team have first aid training despite only one qualified nurse working the late shift and night shift and bearing in mind the size, layout of the home and number of residents the home can accommodate. The files of four staff members, including two staff members that have commenced employment since the last inspection, were examined. Two files only contained one written reference when there should be two. The manager was advised that the management could write references for employees that have worked at the home for a long period, in order to comply with the regulation. There was evidence seen indicating that all four selected staff members have had a criminal record bureau check (CRB) but the check itself is contained on each individual file, which is against CRB guidance and the Data Protection Act. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements are being made to the running of the home, and although the views of residents and stakeholders are underpinning improvements, the home is still not being run in their best interests while their health and safety is compromised. EVIDENCE: The Commission has not yet received the manager’s application for registration. The manager reported that she had sent in her application but this will have not been accepted because it was done incorrectly. Positive comments were made about the efforts of the manager. For example one staff member said, “Linda is changing things for the better.” North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 23 Since the last inspection there are now regular resident and relative meetings and the manager has sent out surveys to residents and relatives asking their views about different aspects of the service. Reports have been completed on the results of these surveys; which are available to residents and other stakeholders. The reports do include what action is being taken to make improvements, such as ordering curtains for conservatories, and new heated trolleys so that food is served hot. But, when asked, the manager reported that the home does not have a Development Plan in order to monitor continuous improvements to the service. Reports of unannounced monthly (regulation 26) visits undertaken by a senior manager were seen. An issue regarding care plans not including residents’ wishes in the event of their deaths is raised at three separate visits but there is no evidence within the reports to confirm that this issue has been dealt with. The accident records seen show a high number of falls in months October and November but there is no reference to any evaluation of these findings in the Regulation 26 reports or of any management overview recorded within the accident / incident records. At the last inspection it was identified that residents did not have moving and handling risk assessments that complied with health and safety legislation. At this inspection, the documentation in place is better because it now provides for information on what equipment is used and how the resident is assisted. However, on the records seen the information contained on this documentation is not specific or detailed enough and it is still not clear enough from these records what level of assistance a resident requires. Two staff members spoken with said different things about a how a case tracked resident is assisted to move. The care files seen indicate that the use of bed rails is still not being risk assessed for each individual resident, to ensure this is the safest and most appropriate measure to protect their welfare. Fire safety records were examined and according to these records fire alarm testing is not being carried out as required. Weekly fire alarm tests were last tested 14th November 2007 then previously 4th September 2007. Emergency lighting was last tested in December 2006. Records of notifications made under Regulation 37 of the Care Homes Regulation 2001 were examined and demonstrated that notifications are now being made as required. North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 24 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 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 1 North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15(1) Requirement Residents must have care plans that contain information about their individual needs and how these needs are to be met. This is to ensure care is personcentred and takes into account individuals’ wishes and preferences. This is an outstanding requirement, initial timescale 01/12/07 not met. Care plans must be kept under review and updated to reflect support being given. This is to ensure residents’ receive the care they need in an appropriate and consistent manner. This is an outstanding requirement, initial timescale 01/10/07 not met. There must be suitable arrangements for the recording, handling and safe administration of medicines. This is to ensure residents are given their medicines as prescribed, This requirement is outstanding, initial timescale DS0000060190.V355057.R01.S.doc Timescale for action 01/02/08 2 OP7 15(2) 01/02/08 3 OP9 13(2) 01/04/08 North View Care Home Version 5.2 Page 26 of 14/9/07 has not been met. 4 OP10 12(4) Staff members must ensure that the dignity and respect of residents is upheld at times. This refers to not labelling residents as ‘feeders’ and making sure assistance with meals upholds residents’ dignity. When any form of physical restraint is used this must be risk assessed beforehand and evidence of consent from the resident or relative / representative. This is to ensure this is the only means to protect the safety and welfare of the resident and is not used inappropriately. This is an outstanding requirement, initial timescale 10/09/07 not met. Staff members must be fully aware and understand their responsibilities to alert all allegations of abuse and to ‘whistle-blow’. This is to ensure residents are adequately protected from abuse. 01/02/08 5 OP10 13(7) 01/02/08 6 OP18 13(6) 01/03/08 7 OP19 23(2)(a) The design of the home must be 01/06/08 appropriate to meeting the needs of residents. This refers to décor that will enable residents to orientate themselves around the home. The numbers of staff on shift and 01/03/08 the deployment of staff must be kept under review. This is to ensure residents are safe and that their needs are being met. Staff members must not commence employment until the DS0000060190.V355057.R01.S.doc 8 OP27 18(1) 9 OP29 19(4) 01/02/08 Page 27 North View Care Home Version 5.2 return of two written references. 10 OP30 17 The staff team must be appropriately trained in mandatory health and safety training as well as essential training to meet the needs of residents. Training this refers to, but is not an exhaustive list, includes dementia care training, first aid and moving and handling. The use of bed rails must be risk assessed for each resident that uses them. This is to ensure this is the safest measure for that individual. This is an outstanding requirement, initial timescale 01/10/07 not met. Fire safety tests must be carried out and fire safety records appropriately maintained. This is to promote and protect residents’ health and safety. 01/04/08 11 OP38 13(4) 01/02/08 12 OP38 23 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations All residents should be given a copy of the new brochure, when it is completed, so that all current and new residents have all the necessary information about the home. Handwritten medication administration records should be signed by the person making them and countersigned by another suitably qualified person, so that errors can be minimised. DS0000060190.V355057.R01.S.doc Version 5.2 Page 28 2 OP9 North View Care Home 3 OP14 Staff members should ensure that when appropriate, their actions are determined by the choices and wishes of residents. This refers to not turning the TV on in residents’ own communal space without asking them first. Arrangements at meal times must be reviewed to ensure residents are getting appropriate choices and assistance to enable them to enjoy their meals. To assist in Regulation 26 visits and quality monitoring overall an Annual Development Plan / Continuous Improvement Plan should be implemented. This is to monitor action being taken to improve and develop the service. 4 OP15 5 OP33 North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI North View Care Home DS0000060190.V355057.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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