Inspection on 04/01/06 for Eton Park

This inspection was carried out on 4th January 2006.

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 19/12/07

Eton Park 22/08/07

Eton Park 26/04/06

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 Mrs Gillian Adkin Unannounced Inspection 4th January 2006 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 North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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.V275283.R01.S.doc Version 5.1 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 9899545 0115 9899311 Mr David Hetherington Messenger Mrs Tracy Adams 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.V275283.R01.S.doc Version 5.1 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 12th May 2005 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, first registered approximately seven years ago. 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 service users 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, aged 65 years and over, with nursing and residential care needs, with four beds available for service users with physical disabilities and two beds for those who are terminally ill. Out of 78 single rooms, 18 are ensuite. There are two double rooms, neither of which is ensuite North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected against the Regulations as in the Care Standards Act 2000. This was an unannounced inspection, which took place over one day and commenced at 09.30 am on 04/01/06.The inspection took 8 hours. The administrator facilitated the inspection in the registered managers’ absence. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they received. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. During this inspection a tour of the accommodation occupied by those case tracked took place along with other areas of the home as deemed necessary and the inspector viewed internal records, and care plans. The inspector spoke to residents, nurses, care and ancillary staff. A number of relatives were available during this inspection for comments. Additionally discussion took place with a community nurse regarding the care being provided to a specific resident who was case tracked. There were 69 residents accommodated at the time of this inspection of which many had been assessed as having medium /high dependency needs. Conversation with two of the service users tracked was limited due to communication difficulties, however other comments were received about the service which are detailed below Typical comments included: “I have a lock on my drawer but it doesn’t lock” “Sometimes a resident comes into my room at night and uses my commode” “Staff are very polite and respectful” “We have a new activities girl, she is doing her best and we had a good Christmas, we know to look on the board (in the lounge) for today’s activities” “Sometimes when the tea trolley gets to us it is cold, we rarely have a hot cup of tea” “ Sometimes it is difficult to get a doctors appointment” “I an diabetic and we cannot get an early drink which I need, sometimes it is well after we have finished eating breakfast before we get one” “Some of my clothing has gone missing and has not been replaced” “The food has improved recently but can be a little salty” “ Some of the staff do not understand us very well” North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 6 “We have a high turnover of staff and regularly have to use agency staff if they are available” “Not really sure how I would make a complaint but think I would choose to talk to the care co-ordinator or the matron” “There are not enough towels and flannels in the home we are always short” “There are not enough hoists and slings to provide residents with the care they want, they often have to wait a long time until someone else has finished before we can use the hoist. One hoist is broken and we have been led to understand that it is too costly to repair” “The turntables are very heavy to use especially when a residents is standing on them, it hurts our backs” “ We cannot get simple maintenance jobs done quickly as there is no maintenance man on site” What the service does well: What has improved since the last inspection? What they could do better: The registered person must ensure an accurate plan of care is implemented based on the assessment carried out by the home and the Care Management summary which clearly states how staff should deliver individual service users needs. The registered person must accurately update risk assessments in accordance to service users changing needs The registered person must ensure service users individual wishes are respected and valued. The registered person must ensure the home is well maintained. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 7 The registered person must respect service users privacy and dignity: Two way approved safety door locks must be fitted. The registered person must complete the provision of emergency lighting throughout the home and in accordance with the fire officer’s report prior to the last inspection. The registered person must ensure all water outlets are monitored and recorded. To ensure the safety and protection of residents the registered provider must not employ staff to work in the home without all relevant documentation and CRB/POVA 1st checks being obtained and in place prior to employment commencing. The registered person must ensure all documentation is obtained in accordance with Schedule 2 of the Care Homes Regulations 2000 The registered person must ensure staff are supervised, to identity shortfalls in practise and give staff the opportunity to speak about professional and other related issues with the manager. The registered person must implement health and safety maintenance throughout the home: Weekly fire alarm testing, monthly emergency lighting checks, and annual portable appliance tests. It is also recommended that bedrail maintenance checks are conducted at least monthly to ensure the safety of residents. The registered provider must ensure the safety of residents by fitting a lock to the sluice door as identified. The registered manager must ensure that staff rostered on duty are suitably experienced and able to meet the needs of residents. A more experienced member of staff should be allocated to have responsibility for supervising staff who are newly appointed on a shift. Where identified, as nutritionally at risk: accurate weight monitoring records must be kept in care plans these should be reviewed frequently. Nursing staff should ensure that all identified and holistic needs are included in care plans (including sensory needs). The method of administration and recording of refused medication must be improved to prevent errors occurring and ensure practise is within the Nursing and Midwifery Council Code of practise. The privacy and dignity of residents must be preserved and toilet doors closed in corridors when they are using toilets. Specific requirements regarding residents’ wishes must be fully documented in care plans. Visitors to the home should be made aware of these arrangements to prevent embarrassment. The registered provider should ensure that resident’s personal choices regarding requests for early morning drinks are met. This is particularly important where a medical condition dictates the need and in order to demonstrate choice and positive outcomes for residents. The registered provider should consult with residents to ascertain if they understand and can read the current complaints procedure. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 8 Where identified as unsuitable, alternative arrangements and documentation should be provided to ensure they have clear instructions about how to make a complaint. A formal plan of decoration and maintenance should be developed and undertaken to ensure the home remains adequately decorated and maintained. The registered provider should ensure that the environment provides the necessary equipment and facilities required by those with sensory difficulties or Dementia such as appropriate signs. Advice re the environment must be sought from an appropriate authority such as Trent Dementia Care services regarding good practise and current facilities provided. Provision must be made in the home for storage of wheelchairs to ensure residents safety. The registered provider must complete the fitting of locks to residents’ drawers to provide a safe place to store their valuables and preserve dignity. Locks fitted to drawers must be appropriate to meet individual needs and disability. The ventilation systems in place in bathrooms and toilets must be regularly maintained to ensure adequate ventilation is provided. Bathrooms and toilets should be kept at an ambient temperature to ensure residents and staff are comfortable whilst in there. Suitable arrangements should be made to ensure that staff comply with basic hygiene procedures such as covering commode pots when emptying them. Suitable arrangements could be made to ensure that clinical waste is disposed of according to policy and bins are used and emptied appropriately. Suitable arrangements should be made to keep the home free from offensive odours. The registered provider should consult with the Environmental Health Authority to discuss the appropriateness of the current arrangements for cleansing and sterilisation of bedpans. Appropriate disinfecting equipment i.e. (sluice machine) must be provided if deemed necessary to prevent the spread of infection and to ensure satisfactory sterilisation of bedpans and urinals. In accordance with the GSCC codes of practise the registered provider/manager must make robust arrangements to ensure that staff are appropriately supervised at regular intervals. The registered provider must make suitable arrangements to ensure that access around the home is free from hazards such as unrequired furniture. A suitable place must be provided for excess equipment such as televisions currently stored in sluices. 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. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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 North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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. Core Standard 6 is not applicable. A pre admission assessment is undertaken to ensure that the home can meet a resident’s needs. A more rigorous process of identifying individual risks would ensure that appropriate documentation is put in place and that staff will be aware of the risks and safely able to manage them. EVIDENCE: Three service users care plans were tracked during this inspection. Two of the three care plans contained an initial assessment. No residents were able to confirm their involvement in the assessment. The registered manager before admission undertakes assessments. One resident tracked who had recently been admitted had been assessed with previous self-harm history/risk No evidence of risk assessments was found. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11 Resident’s medical needs are met by the provision of a care plan. Outcomes would be improved by inclusion of, holistic needs and specialist requirements and more robust risk assessments. Regular auditing of medicines procedures and record keeping would ensure the system is safe and would reduce the potential for errors occurring and harm to residents EVIDENCE: Three residents were cast tracked and all had a care plan in place. All three care plans identified the medical needs of residents but were minimalistic in content and did not address the specialist needs of the persons tracked, such as sensory care, and behaviour management etc. Residents tracked were unable to discuss or confirm their involvement in their plan of care. Care plans had been evaluated monthly. Daily entries were made in each care plan describing care given. A resident identified as nutritionally at risk was found to have incomplete weight monitoring records in place and no care plan to describe how care would be given and monitored. Several residents spoken with described how they had difficulty in obtaining General Practitioner appointments and discussion with staff indicated that this North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 12 was due to their residential status. It was confirmed that this has been an outstanding issue with GPs for a long time. The chiropodist was seen attending to the podiatry needs of a number of residents during this inspection. Nurses were working in the home during this inspection and are on duty 24 hours a day, they provide care to nursing residents, discussion took place with a Community nurse regarding care provided to a newly admitted resident. Staff talking to the Community nurse demonstrated a good level of awareness of the person. Nurses are responsible for the administration of medication. The system was inspected in relation to those residents tracked and although the system appeared to be reasonably well managed it was noted that the medication records (of an individual who required high doses of an epileptic medication and who had refused) had not been signed for. When questioned the nurse responsible signed the chart in front of the inspector but stated she had disposed of the tablets earlier in the day and had not signed accordingly as she had been distracted. Risk assessments for nutrition and moving and handling were in place in each plan. Case tracking of one individual identified that she had recently sustained a fall out of bed and had been identified as at risk of falls before admission. Although no injuries occurred the risk assessment had not been evaluated immediately following the fall. Evidence was found to suggest that the bedrails had not been correctly placed on the bed. This resident had been admitted as an emergency and it was not clear from the care plan what the status of this person was. There was some indication that the Intermediate care team had been previously involved however the care plan did not reflect any further involvement or identify any rehabilitation goals as would be expected with this type of admission. This person was being nursed predominantly in bed due to behavioural issues. Staff when spoken with were unsure of what was expected of them and what the residents care needs really were. Concerns were raised over the privacy and dignity of a number of residents during this inspection. One resident stated “a person had come into her room at night and used her commode”. Another resident said, “ I have had clothing go missing and it is never replaced, the cardigan I’ve got on today is not mine” The inspector witnessed two incidents where residents were using the toilet without the door being closed. Whilst it is acknowledged that residents with Dementia may not understand the principles of privacy and dignity any longer,all reasonable attempts must be made to preserve this where practicable and toilet doors closed in corridors when toilets are being used by them. Neither resident was able to make comments about their dignity being maintained. Specific requirements regarding residents wishes must be fully documented in care plans if residents do not wish to have doors closed. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Service users are mostly satisfied with the lifestyle of the home and food provided. Resident’s individual needs and requests for drinks are not always met this has lead to dissatisfaction with the service provided. More frequent monitoring of those residents who wander and appropriate action taken to address this would ensure that residents are not disempowered and are still able to retain and element of maintain control over their lives. EVIDENCE: Discussions with a large number of residents during this inspection indicated that overall they were satisfied with the lifestyle they experienced in the home. Minutes of a recent residents meeting were seen which identified that they were given the opportunity to advocate for themselves and to choose activities, and many stated they enjoyed the recent activities at Christmas. One resident expressed concern to the inspector at not being able to have an early morning drink, stating that night staff ignored requests for drinks. Three other residents also identified this as an area of dissatisfaction at the residents meeting, (minutes seen) The registered provider must ensure that residents personal choices regarding requests for early morning drinks are met.This is particularly important when the medical diagnosis of an individual requires regular fluids (diabetics etc). North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 14 Other residents raised concerns over the continual visitation to their rooms at night by residents who were confused. Significant improvements had been made to the menus since the last inspection and discussion with the cook indicated that she was informed via residents meetings of any concerns or complaints about food. The cook was fully aware of specialist diets and stated she would seek advise from the nurses or a dietician if she was unsure about how to manage a new diet. All requirements made by the EHA had been implemented since the last inspection. Discussion with residents about food provided indicated that in the main they were happy and satisfied with food. One resident stated that she was not happy with the tea, which was “always luke warm or nearly cold when it arrived” Adequate food was seen prepared in the kitchen ready for the mid-day meal. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 Complaints are managed adequately and responded to within given time scales. The outcomes of complaints should be recorded for reference and to demonstrate satisfaction by the complainant. An adult protection procedure is in place and staff are confident in responding to suspicion or allegation of abuse this ensures the protection of residents in the home. EVIDENCE: During this inspection complaint records were inspected and it was noted that some improvements had been made to the system. A limited number of complaints had been received since the previous inspection and none were outstanding. It was noted however that the outcomes of each complaint were not documented and therefore it was not possible to ascertain if the complainant had been satisfied. The complaints procedure is fully described in the service user guide and Statement of Purpose. When questioned a large number of residents were unable to relate to the actual procedure. One resident said “ I am not sure really but think I would talk to the care coordinator” another said “Is there a special procedure” The home is a multi-category home accommodating residents with diverse needs including Dementia and it cannot therefore be assumed that all can read or understand a standard document. It was unclear from discussion if anyone had attempted to speak with residents about their understanding of the procedure. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 16 No relatives were able to confirm that they had seen the procedure but one stated she would see the matron if she had a concern. The registered provider must consult with residents or their representatives (where practicable) to ascertain if they understand and read the current complaints procedure. Where identified as unsuitable, alternative arrangements and documentation must be provided to ensure they have clear instructions about how to make a complaint. Discussion with care and nursing staff demonstrated that they were fully aware of the whistle blowing policy and reporting procedures and had received training. An ancillary staff member however informed the inspector she had not been given this training and thought it would be very helpful. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 17 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): 22.23.25.26 No formal maintenance plan is in place; this in addition to the lack of an on site maintenance person has resulted in delays with general maintenance being attended to and gradual deterioration in the fabric of the home. Standards of cleanliness and hygiene are not sufficiently well managed to ensure that the home is always pleasant and hygienic to reside in. Equipment provided is not always appropriate to meet the needs of individuals accommodated and is not routinely audited to ensure its state of repair; this may potentially lead to residents’ dissatisfaction with the home. EVIDENCE: A number of concerns were raised during this inspection regarding general maintenance issues, the environment and associated record keeping and responsibilities. Four requirements were not met from the previous inspection in relation to: 1.The overall maintenance of the home. 2. Respecting service users privacy and dignity by fitting of two way approved safety door locks. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 18 3.The provision of emergency lighting throughout the home (this had been partially completed) 4.The testing and recording of water outlets to ensure they remained within safe limits. On this occasion it was noted that there was no plan of decoration and maintenance in place and although overall reasonably maintained required a further redecoration in places such as the dining areas and bedrooms, bathrooms etc. Some of the dining room furniture was badly scratched although still usable. The inspector toured the home and found that lighting in the residential area was not working and lighting has been an ongoing issue in the home since the last inspection. The maintenance man attended the home to rectify this however as he is not based on site the lighting was not fully functional in one corridor for approximately 3 hours. The journey from the maintenance person’s base takes approximately one and a quarter hrs. Several comments were made by residents at a recent meeting about lights in their rooms not working and the availability of light bulbs. Two residents were concerned about the lighting in the car park at nighttime and their personal safety as the area is surrounded by trees and woodland. The home is a multi category site and accommodates those with significant physical and mental health difficulties. No evidence was seen to suggest the environmental issues had been discussed or had been put in place such as appropriate signs, coloured door frames, single colour carpeting etc as would be recommended by specialist advisors. The home is a large home with long corridors and could be confusing for those who have Dementia. Concerns were raised by residents regarding specific residents who consistently wandered into others rooms whilst looking for the bathroom. Inspection of the premises identified that there is no specific storage area for wheelchairs and a number of lounge and wheelchairs were found outside the lift entrance thus restricting further access and egress and causing potential hazards to those who were more mobile or residents who were confused. It was further noted that both sluice rooms were very small and did not contain any bedpan washer or disinfector for sterilisation of equipment. which would be considered appropriate in a large nursing home. Staff described how they manually cleaned bedpans with a bleach type solution. One sluice was further blocked by two television sets, which were being inappropriately stored there. A sluice was found to have no lock on the door despite containing chemicals and also having a slippery floor which posed a trip hazard to any resident able to wander in there. Bathrooms were inspected and found to be very hot and lacked adequate ventilation or natural light. Discussion with care and ancillary staff indicated North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 19 that extractor fans were not routinely inspected or cleaned and appeared to be covered in dust and fluff. Observation of a member of staff at work demonstrated poor hygiene management when the inspector witnessed that a used commode pot was carried down a corridor without a lid to the sluice room. The care assistant stated, “She should have covered it” A number of commodes have been replaced since the last inspection but others were still in a poor and unhygienic state and still required replacement. Staff stated that a high percentage of residents used a commode at nighttime. Certain areas of the home namely bathrooms and some corridors were found to have unpleasant odours present which could not be accounted for, however further investigation found that clinical waste bins in one bathroom were being used to dispose of continence pads without using a bin liner and the lid was open. A further sluice contained a full yellow clinical waste bag which had not been put outside. On the day of inspection rosters indicated that adequate domestic staff were on duty. Staff stated they had all had infection control training and were noted to wear appropriate clothing for personal care tasks. It was recommended that checks of bedrails are routinely undertaken at least monthly as maintenance records did not include this task and the maintenance man was not on site regularly enough to do this. Discussion with care staff indicated that that the current standaids /hoists are not wholly adequate for the task and were heavy to use when a resident was on them. It was further identified that although hoists are provided for moving and handling that they were not appropriate to meet individual/ specific needs. There was some indication in a care plan tracked that the home did not have an appropriately sling to enable a resident to safely be hoisted into a bath; this was refuted by the registered manager after the inspection. No evidence was found to demonstrate how a resident was being moved in bed. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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): 27.29.30 The homes recruitment process is not sufficiently robust to prevent the possibility of harm to residents. Staff recruitment does not always include the registered manager and therefore the suitability of staff cannot be assessed. EVIDENCE: A calculation of staffing hours was undertaken by the inspector and although it was demonstrated that the home were working towards meeting the recommended hours as in the Department of Health Residential Forum guidance on the day of the inspection two members of care staff were off sick and furthermore two members of staff who had only recently been employed in the home and on induction had been rostered to work a double shift on the nursing floor. It was difficult to ascertain their level of understanding due to communication difficulties. No other staff (bank, agency) had been brought into the home to cover the deficit in care hours. Discussion with the registered manager after inspection indicated that although she is supernumerary, most of her time is spent on clerical duties. No deputy or clinical manager is employed to support the manager. The registered manager stated that staffing levels are dictated by the organisation and do not necessarily consider the dependency of residents. A number of residents and relatives commented on the levels of sickness and use of agency staff. This was also well evidenced in staff meetings and complaints. Significant concerns were raised over recruitment practises in the home, which resulted in an Immediate requirement notice being issued. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 21 This matter is to be fully investigated by the Commission for Social Care Inspection with the registered provider under separate correspondence. The registered provider employs a diverse staff group and has recently employed a number of staff from Eastern Europe. Staff spoken with were very polite and residents spoken with indicated they were very hard working however they were concerned at their level of understanding their needs due to their limited command of English. Two members of staff on duty during this inspection were new to the home and only one was able to understand questions asked by the inspector. Discussion with the registered manager stated that she was not actively involved in recruitment of staff supplied from external sources and was not usually informed of their appointment until just before their arrival at the home. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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): 36.38 EVIDENCE: The registered manager was not in the home during this inspection and it was indicated by staff that currently no formal supervision /appraisal of staff takes place. This was confirmed with the manager after the inspection. She stated that she does not have time. This was raised as a requirement at the last inspection but had not been actioned. A tour of the home identified that in two specific areas outside the lift excess furniture was being stored additionally wheelchairs. It is recommended that was also noted that two TV sets were stored in a sluice. Staff stated that this was as there were no specific storage areas available. This prevented suitable access and egress to and from the lift and was considered to be hazardous to those who are confused or who independently mobilise around the home. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 23 The registered provider must make suitable arrangements to ensure that access around the home is free from hazards such as unrequired furniture. A suitable place must be provided for excess equipment such as televisions currently stored in sluices. Concerns were raised at the last inspection regarding the monitoring of health and safety maintenance, In particular weekly fire alarm testing, monthly emergency lighting checks, and annual portable appliance tests. At this inspection records inspected indicated that the registered manager was testing fire alarms monthly and that the maintenance man checked emergency lighting monthly. No water temperature tests were being undertaken other than in baths or showers and no records kept (the home is fitted with thermostatic valves). No records were available for inspection. Accident records inspected identified that a resident had sustained a fall due to the failure of bedrails, upon discussion with the resident it was confirmed that the rails had gone down and she had fallen as a result. The maintenance person checked the rails upon request and noted they were incorrectly fitted. No routine bedrail checks are undertaken. Staff confirmed that they had had fire training although records were not inspected. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 2 3 2 1 2 STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 1 North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 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 OP3 Regulation 15(1) Requirement The registered person must ensure an accurate plan of care is implemented based on the assessment carried out by the home and the Care Management summary. Requirement not met from last inspection. The registered person must produce care plans which clearly state how to deliver individual service users needs. Requirement not met from last inspection. The registered person must accurately update risk assessment in accordance to service users changing needs. Requirement not met from last inspection. The registered person must ensure service users individual wishes are respected and valued. Requirement not met from last inspection. The registered person must ensure the home is well maintained. Requirement not met from last inspection. The registered person must respect service users privacy and DS0000060190.V275283.R01.S.doc Timescale for action 04/01/06 2 OP7 15(1) 04/01/06 3 OP8 12 04/01/06 4 OP14 12 04/01/06 5 OP19 23 04/01/06 6 OP24 12 04/01/06 North View Care Home Version 5.1 Page 26 7 OP25 8 OP25 9 OP29 10 OP29 11 OP36 12 OP38 13 OP29 14 OP25 dignity: Two way approved safety door locks must be fitted. Requirement not met from last inspection. 23 The registered person must provide emergency lighting throughout the home and in accordance with the fire officers report Requirement not fully met from last inspection. 13 The registered person must ensure all water outlets are monitored. Requirement not met from last inspection. 19 The registered person must carry out POVA checks on all staff including overseas care staff. Requirement not met from last inspection. 19 The registered person must ensure all documentation is obtained in accordance with Schedule 2 Requirement not met from last inspection. 18 The registered person must ensure staff are supervised. Requirement not met from last inspection. 13,23 The registered person must implement health and safety maintenance throughout the home: Weekly fire alarm testing, monthly emergency lighting checks, and annual portable appliance tests. Requirement not fully met from last inspection. 19(1)a.b.c The registered provider must not Sch 2 employ staff to work in the home without all relevant documentation and CRB/POVA 1st checks being obtained and in place prior to employment commencing. 13(4)c The registered person must DS0000060190.V275283.R01.S.doc 04/01/06 04/01/06 04/01/06 04/01/06 04/01/06 04/01/06 04/01/06 04/01/06 Page 27 North View Care Home Version 5.1 15 OP25 13 16 OP27 18(1) 17 OP8 14(2) 18 OP7 12.15 19 OP9 13 20 OP10 12 21 OP14 12(2)(3) 22 OP16 22 ensure all water outlets are monitored and recordings of temperatures kept for inspection purposes. The registered provider must ensure the safety of residents by fitting a lock to the sluice door as identified. The registered manager must ensure that staff rostered on duty are suitably experienced and able to meet the needs of residents. Where identified as at risk nutritionally accurate weight monitoring records must be kept in care plans which are reviewed frequently. The registered provider must ensure that all identified and holistic needs are included in care plans (including sensory needs) The method of administration and recording of refused medication must be improved to prevent errors occuring and ensure practise is within the NMC code of practise The privacy and dignity of residents must be preserved and toilet doors closed in corridors when toilets are being used by them. Specific requirements regarding residents wishes must be fully documented in care plans. The registered provider must ensure that residents personal choices regarding requests for early morning drinks are met. The registered provider must consult with residents to ascertain if they understand and can read the current complaints procedure. Where identified alternative arrangements and DS0000060190.V275283.R01.S.doc 04/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 North View Care Home Version 5.1 Page 28 23 OP19 23 24 OP22 23 25 26 OP22 OP22 23 23 27 OP25 13 28 OP26 16 29 OP26 16(2) k 30 OP26 16(2) k documentation must be provided to residents to ensure they have clear instructions about how to make a complaint. A plan of decoration and maintenence must be developed and undertaken to ensure the home remains well decorated and maintained The registered provider must ensure that the environment provides the necessary equipment and facilities required by those with sensory difficulties or Dementia such as appropriate signs. Advice re the environment must be sought from an apprpriate authority reagrding good practise. Provison must be made in the home for storage of wheelchairs. The registered provider must complete the fitting of locks to residents drawers to provide a safe place to store their valuables. Locks fitted must be appropriate to meet individual needs and disability. The ventilation systems in place in bathrooms and toilets must be regularly maintained to ensure adequate ventilation is provided.Bathrooms and toliets must be kept at an ambient temperature. Suitable arrangements must be made to ensure that staff comply with basic hygiene procedures such as covering commode pots when emptying them. Suitable arrangement s must be made to ensure that clinical waste is disposed of according to policy and bins are use and emptied appropriately. The registered provider must make suitbale arrangements to DS0000060190.V275283.R01.S.doc 31/01/06 31/01/06 31/01/06 28/02/06 31/01/06 31/01/06 31/01/06 31/01/06 Page 29 North View Care Home Version 5.1 31 OP26 16(2)j 32 OP36 18 33 OP38 13 keep the home free from offensive odours. The registered provider must consult with the EHA to discuss the appropriateness of the current arrangements for cleansing of bedpans. Appropriate disinfecting equipment ie ( sluice machine) must be provided as deemed necessary to prevent the spread of infection and to ensure satisfactory sterilisation of bedpans and urinals. In acordance with the GSCC codes of practise the registered provider must make robust arrangements to ensure that staff are appropriately supervised at regular intervals The registered provider must make suitable arrangements to ensure that access around the home is free from hazards such as unrequired furniture. A suitable place must be provided for excess equipment such as televisions currently stored in sluices. 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 2 3 Refer to Standard OP29 OP25 OP10 Good Practice Recommendations It is recommended that the registered manager is fully consulted with when recruiting staff introduced by an agency and is involved in interviewing them. It is recommended that the fitting of emergency lighting in the home is completed as agreed at the last inspection. To monitor missing clothing and ensure all items are labelled North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 30 4 5 6 7 8 OP12 OP19 OP27 OP36 OP27 9 10 11 OP27 OP3 OP8 12 13 14 15 OP8 OP16 OP18 OP19 16 17 OP19 OP22 18 19 OP36 OP27 To provide 1:1 interaction for service users that are unable or choose not to participate in a group The Registered Provider need to take appropriate action to establish maintenance in the home The Registered Provider needs to take appropriate action to establish clinical supervision To implement formal supervision which should be conducted at least six times a year The registered manager should ensure that staff are fully able to converse with and understand residents care needs and wishes and are supervised/monitored until such a time that a satisfactory level of understanding is achieved. It is recommended that a deputy manager or senior sister is appointed and given responsibility for monitoring care provision and clinical supervision of nursing staff. Where a resident has been assessed with previous self harm history/risk appropriate risk assessments should be put in place on admission and regularly evaluated. It is recommended that more flexible arrangements are made with visiting GPs to ensure that requests for appointments are managed in a timely manner and suitable to the needs of the individual concerned. It is recommended that the oral hygiene needs of residents are included in personal care plans. It is recommended that the outcomes of complaints are fully documented and kept in the complaints file. It is recommended that adult protection /abuse training is provided for ancillary staff working in the home. It is strongly recommended that the registered provider consider the employment of an on site maintenance person to meet the day-to-day running repairs and maintenance of the home. It is recommended that checks of bedrails be routinely undertaken at least monthly. It is recommended that the current standaids /hoist are assessed for there suitability and action taken to replace them if deemed unsuitable for the residents who use them. This audit should include staff discussion re equipment and its suitability. It is recommended that the registered manager receives regular clinical supervision by a line manager at least monthly. It is recommended that regular monitoring of dependency levels is undertaken by the registered manager and used as a guideline for staffing the home. North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 North View Care Home DS0000060190.V275283.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!