Inspection on 30/10/07 for Northleach Court Care Centre

This inspection was carried out on 30th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Northleach Court Care Centre 08/03/09

Northleach Court Care Centre 13/10/08

Northleach Court Care Centre 31/03/08

Northleach Court Care Centre 12/06/07

Northleach Court Care Centre 22/06/06

Northleach Court Care Centre 12/12/05

Northleach Court Care Centre 16/12/04

Northleach Court Care Centre 12/05/04

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

CARE HOMES FOR OLDER PEOPLE Northleach Court Care Centre High Street Northleach Cheltenham Glos GL54 3PQ Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 30th October 2007 08:00 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 Northleach Court Care Centre DS0000016515.V352796.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. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northleach Court Care Centre Address High Street Northleach Cheltenham Glos GL54 3PQ 08453 455746 01451 861179 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) Mrs Sally Anne Manby Roberts Mr Jeremy Walsh Mrs Nicola Louise Warman Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary variation to client categories OP (Old Age) for 1 (one) named service user. The Home will revert to the original client categories when this service user no longer resides at the home. To accommodate one named service user under 65 years of age with Dementia 12th June 2007 2. Date of last inspection Brief Description of the Service: Northleach Court is situated close to the centre of Northleach, which is about 12 miles from Cheltenham and 10 miles from Cirencester. The Home is a registered Care Home with nursing and has 60 beds with a category of dementia care for predominately older people. Accommodation is on two floors; on the ground floor there are a number of communal rooms including a conservatory, dining areas and lounges. The home has grounds comprising of a number of enclosed courtyard areas and small lawns. Current fees are £389.25 to £662.00 less any Registered Nurse Care Contribution. Hairdressing, chiropody, escort and personal toiletries are charged extra. People are able to ask the home for a copy of their Statement of Purpose and Service Users Guide. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors carried out this inspection over two days in October 2007. One of these inspectors was a Pharmacy inspector and the reason for this inspection was for a pharmacist inspector to follow up issues identified at the key inspection in June 2007 relating to the arrangements for handling medication (National Minimum Standard 9 Care Homes for Older People). It was again as part of a key inspection. This included looking at some stocks and storage arrangements for medicines, some records relating to medication and the medicine policy and procedures. There were discussions with the manager, deputy manager and two registered nurses. The way medicines were given to some people in the home was observed. The inspection took place over 6½ hours on one day and the outcome is as follows: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The Registered Manager was available during the inspection as were other members of the home team. A total of 25 standards were inspected. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided. Surveys have been left at the home for relatives/representatives of the people living at the home to return to us. A number of visitors to the home were spoken to during the inspection. There views have been used in the report. The Registered Manager, deputy manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feed back on the inspection findings was given on completion and were received in a constructive and positive way by the Registered Manager. Eight requirements have not been complied with fully since the last inspection. What the service does well: The home has procedures in place to ensure that prospective people have an assessment of their needs prior to admission to ensure they can be met by the home. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 6 Relatives of people who use the service who were spoken to complimented the staff at this inspection saying they are very good and helpful. The home has more than 50 of care staff trained to the minimum level of NVQ level 2. What has improved since the last inspection? What they could do better: Medicines must always be in stock to give to people living in the home. Medicines must be given to people living in the home with the correct intervals between doses so that they gain the benefit from their medicines and reduce the risk of harmful side effects. The way in which medicines are administered to people living in the home must respect their privacy and dignity. The home still needs to monitor its staffing levels as at times they have been working under their agreed numbers and this can have an impact on the care the people receive at the home. The home still needs to demonstrate that they have effective management arrangements in the home in the absence of the Registered Manager and deputy manager to ensure the health and welfare of people who use the service are met. Training for qualified staff in specialist skills still remains outstanding and this can have an impact on the care of some people when the Registered Manager and deputy manager are away from the home. The home must ensure they are disposing of incontinence pads as directed by the Waste Regulations. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 7 The actions of some staff could place people at risk of cross infection if they do not place soiled linen and incontinence pads out of the reach of people who use the service. Whilst improvements with the environment have taken place, a number of areas with odours and areas that need maintenance work were found and this does not make for pleasant home for people to live in. The home needs to ensure that the recruitment procedures used are robust and all the required information is obtained to minimise the risk to people who use the service. 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. Northleach Court Care Centre DS0000016515.V352796.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 Northleach Court Care Centre DS0000016515.V352796.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): 3, 4 & 6 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective people will have their needs assessed and confirmation that they will be met, however in the case of some people their needs are not being met due to staff not having the specialist skills. EVIDENCE: The home has had a number of admissions to the home that were ‘emergency’ admissions. The Registered Manager said that any person referred to the home as an emergency admission would if funded by Adult and Community Care Directorate (CACD) have a care plans and assessment completed by them. This would be faxed to the home and then a decision would be made if this person is suitable or the home. Either the Registered Manager or deputy manager would speak to a member of their family prior to admission to obtain further information. This was witnessed during the inspection. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 10 The Registered Manager confirmed that people who are admitted to the home as planned admissions are always assessed prior to them moving in by herself or the deputy manager. The letters sent confirming that the needs of a new person can be met are sent from Blanchworth Care Group head office and therefore were not inspected at this visit to service. At the last inspection a requirement was issued for the home to ensure their qualified nurses were able to undertake male catheterisation and venepuncture skills so the needs of the people who use the service could be met. The Registered Manager and deputy manager have received the training for these courses and are competent to undertake male catheterisation but not venepuncture are they still need to practice of this skill. The homes remaining qualified staff have not completed the training for these courses. The Registered Manager booked two qualified nurses on to a male catheterisation course for mid November but they will then need to be observed using this skill then will need to be passed as competent. One of these qualified nurses is new to the home and is in the process of undergoing their induction programme. The homes improvement plan said that one nurse had been booked to attend training in September but did not go due to holiday and this plan makes no reference to venepuncture training for other qualified staff only the Registered Manager and deputy. When the Registered Manager and deputy manager are away from the home as they both have the same time off, none of the nurses in the home will be able to undertake male catheterisation or venepuncture. One qualified nurse is an agency nurse and has not completed training in either male catheterisation or venepuncture. The homes Annual Quality Assurance Assessment (AQAA) says ‘that if any person requires specialist input, this is either accessed via outside professionals, or staff members attend additional training to meet this need’. As this training relates to people who are receivng nursing care in the home the responsibility for any nursing tasks lies with the home. Therefore the home has failed to meet this requirement and ensure their qualified staff can meet the assessed of the people who use the service. Another requirement was issued at a key inspection last year and remained outstanding at the inspection in June 2007 was for the home to ensure staff are able to use pressure relieving equipment correctly. The Registered Manager now checks pressure-relieving mattresses on a weekly basis to ensure they are set on the correct level and this responsibility has been passed to the qualified nurses on duty. During the inspection other areas were highlighted about the competencies of members of staff in the home. The Registered Manager and deputy manager reviewed the situation during the inspection and had a plan in place to address the situation. Since the last inspection in June 2007 there have been ten incidents that have been reported to us where the home has worked under their allocated Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 11 numbers of staff. This impacts on the care people receive who use the service. Intermediate care is not provided at Northleach Court. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. Quality in this outcome area regarding medication is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care that most people receive is based on their individual needs. However the actions of some staff mean the principles of respect; dignity and privacy are not always put in to practice for everyone living at the home. Although some of the arrangements for managing medicines are adequate with some good points, this inspection also identified some particular poor aspects in the arrangements for handling medicines that can put people living in the home at risk. EVIDENCE: Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 13 Care Records for all people who use the service were examined to find out if they had all been updated and care plans in place for all assessed needs. Four were found that needed to be completed. Care records relating to two people who use the service were examined in detail. Both had been reviewed and new care plans added. However our Pharmacist inspector found that the care plans were up to date with the changes in medication. Risk assessments were in place both in a set format and hand written, however one person required a risk assessment for entrapment and asphyxiation as they have bedsides. The Registered Manager completed this during the inspection. At the last inspection it was identified that people were not receiving mouth care, at this inspection during a tour of the environment rooms belonging to people were randomly chosen and equipment for mouth care checked. It appeared that some people are still not receiving mouth care; however the Registered Manager was able to find out which care staff had cared for people to ask them why people had no received mouth care. One member of care staff said she had provided mouth care but shook the toothbrush afterwards, however one person did not receive mouth care as they had run out of toothpaste. The deputy manager did explain to the care staff that there are other ways of cleaning people’s teeth. The homes improvement plans said the Registered Manager will be carrying out spot checks on a daily basis to check people are receiving mouth care and it also states that residents mouth care will be checked on a random basis prior to them consuming any food to ensure their teeth and dentures have been cleaned properly. No records were seen relating to the Registered Manager undertaking daily checks. Key workers have now been given the responsibility of ensuring people have equipment available for staff to perform oral hygiene. Whilst the staff in the home including the cook are aware of people who are nutritionally at risk it was observed by our Pharmacist inspector that one person was having their breakfast at 10.50 am and then lunch is served at about 12.30pm which means that some people who use the service could not be having any food from the time they are put to bed until they are assisted to get up. If a person is put to bed between 8pm and 10pm then not having their breakfast until 10.50 am they are going over 12 hours without any food. Also their appetite will be reduced if they have eaten less than two hours before lunch is served. The home will need to review this. The Registered Manager was spoken to about this following the inspection and said this person takes along time to eat their meals and that they wish for them to remain independent. They weigh this person on a frequent basis and they have not lost any weight and they are monitoring this situation. One person who has been assessed as being nutritionally at risk was without their prescribed food supplement drink as it was recorded as being out of stock. This should not happen as this places this person at risk. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 14 Three of the four requirements about medication made at the last inspection were judged as met but the fourth requirement was only partly met so has been repeated. A medicine policy is available to staff on the computer so that they have direction as to how the home expects them to handle medicines safely. The deputy manager also updated the paper copy in the agency handover file with the April 2007 version during the course of the inspection. The section on covert administration of medicines needs to reflect provisions of the new Mental Capacity Act. The homely remedies medicine list needs reviewing as the copy on display was authorised in 2002. Blanchworth medicine policy says this is reviewed each year. We found some homely remedies in stock but no records to keep account of these medicines. Registered nurses administer the medicines to people living in this home. One nurse who had recently started working at the home told us she had some medication training at an induction course when she first started. The supplying pharmacy provides printed Medication Administration Record (MAR) charts each month on which staff record the medicines received into the home and each time they administer a dose to a resident. We found the following issues for attention on the records – • One prescribed medicine and one prescribed food supplement for one person were not in stock to administer as prescribed by the doctor. Eight doses of the medicine had been missed and the lack of this medicine is a risk to this person from a deterioration of his condition. Eleven doses of the prescribed food supplement had been missed. The care plan for this person says he is at risk from malnutrition so the failure to administer this food supplement is of particular concern and risk to this person’s health. We left an immediate requirement form about urgently obtaining this medication. The lead inspector checked the following day that these had arrived during the evening of the inspection day. The homes improvement plan from the last inspection says that ‘registered nurses will be vigilant to when medication is due to run out and will diarize 3 days prior to this to request a prescription for a supply of this medication’. It also says the Registered Manager and deputy manager will spot check that the medication supply in the home meets the expected need. • Most administration records were completed properly but we saw one chart where there were gaps but the tablets had gone from the blister packs for those days. On another chart the number of doses signed as given did not agree with the number of tablets remaining in the packet. Administration records did not always state the dose given when a variable dose was prescribed. • The dates of opening packs of medicines were not always written on medicine containers so we could not carry out audit checks. This is an important check, as at the last inspection some tablets could not be Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 15 • • • • • accounted for. The manager said she carries out random checks of sleeping tablets but does not record this. We could not always tell from the records what prescribed skin treatments had been used. In some cases the carers who apply the skin treatments tell the nurses who then sign the records. Consideration needs to be given to a better method of recording and the responsibility of the nurse in signing when they have not seen the treatment used. Quantities of medicines received for one person recently admitted were missing and some information on the handwritten medicine chart was confusing. Some of the medicines supplied by the family when this person was admitted were poorly labelled but staff had needed to use these over the weekend. There was not enough information about using one medicine with a direction ‘as required’ as the frequency of use and maximum dose each day were missing. Staff confirmed that new supplies of medicines were already ordered from the doctor. These issues can put people at risk of receiving the wrong medication. We saw some care plans containing information about how to use medicines that are prescribed for administration ‘as required’. More detail is needed in some plans, as information such as the dose and frequency of use were not always included. Some important printed information about the medicines is damaged by the holes punched on the left hand side of the medicine charts. When staff have to handwrite medicines or changes on the charts this was not always done very well with information missing such as the date and signatures of the staff or a second check signature. We saw nurses administering medicines to people living in the home during the morning and at lunchtime. We are concerned that the medicines due at 8am were given up to three hours later. This same issue was raised at the last inspection. This means that for some people the interval between their doses may be too short as the lunch doses were administered around 1pm. We found for one person there was only about 2½ hours between doses. This could result in the person suffering more side effects from the medicine. It is particularly critical for paracetamol-containing medicines where there must be at least 4 hours between doses. We suggested to the nurse to delay one dose of paracetamol at lunchtime as we had seen a dose given to a particular person at 10.30am. Another person was already given a paracetamol containing medicine at 1.20pm and had received another dose at breakfast, which may have been too short an interval. Locked cupboards and trolleys are provided for the safe storage of medicines. The storage arrangements for creams and ointments have improved since the last inspection. We found suitable arrangements in place for managing controlled medicines. The medicine fridge was not indicating the correct temperature range (2-8°C) for safe storage of medicines. The fridge may need adjusting or the thermometer may be faulty. We found the storage area for Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 16 medicines awaiting return was not locked and even when locked it was possible to get at the medicines, as part of the area under the bench was open and only blocked by a filing cabinet. There were a lot of medicines in here awaiting return to the pharmacy, as this had not been done for over two months. The deputy manager was taking action to deal with this as soon as we told him. On the whole staff were observed treating people with respect and dignity, however our Pharmacist inspector observed a person having their eye drops administered at the breakfast table; this is poor practice and must cease as this does not respect the privacy and dignity of the people and is an infection control risk as this is a room where food is being served and eaten and people are walking about. Also if the nurse was knocked whilst administering the eye drops this could have caused an injury to the person’s eye. Care plans should reflect what choices people have made about how they wish to have their medicines administered. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are assisted by the staff to make choices about their daily lives. The service now provides a range of recreational activities that all people who live in the home can take part in. EVIDENCE: At this inspection the activities coordinator was on duty as he was annual leave at the last inspection. He said activities are planned a year in advance and he spends his time between both communal areas as well as spending time with people who are unable to join in group activities. Pictures are on display in the home that have been produced by people who use the service. A poster is displayed on the notice board advertising the week’s activities for visitors to read. Televisions were on in all communal areas on arriving at the home but they did have adult programmes and not children’s as was found at a previous inspection. One person was watching the news. The Registered Manager felt that since the last inspection a lot of hard work has gone into the activities they provide. On the second day of the inspection the home was having a Halloween party and decorations were seen with staff joining in. Hot Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 18 dogs were on offer and the cook had made some for people who require a soft diet. A selection of drinks was also on offer. People were observed to be enjoying the party. The hairdresser was also visiting on both days of the inspection and the activities coordinator said a church service takes place every month. The homes improvement plan says the Registered Manager will monitor the activities provided to ensure they are of the appropriate standard and Blanchworth Care will ask the views of visitors and people who use the service where able. One person who uses the service is able to go out independently. Visiting to the home is not restricted and a number of visitors were spoken with. Staff were observed offering people choices and this included choices over meals and drinks. Several rooms belonging to people who use the service were observed during the tour of the home and their personal belongings were on display. The home is able to provide people who use the service where able and relatives/friends with information about advocacy services. The majority of people at the home would not be able to manage their financial affairs and provision would have been put in place for this. Since the last inspection the home has a new cook in place. He is not a qualified chef but has undertaken training. He has detailed lists about people’s likes, dislikes and people who require a special diet. For people who are nutritionally at risk he is able to add extra calories into their food and protein if required. During both days of the inspection people were seen eating snack food, which included crisps and fruit and people are able to help themselves. Homemade afternoon cakes are provided and people were seen to enjoy them. Birthday cakes are made and the cook has started to keep a photograph of each cake he makes. Cooked breakfasts are also provided on certain days. People who require soft diets have each part of the meal individually blended for presentation. Records were seen in the kitchen for health and safety checks and food, however the home needs to document when an alternative is provided. People were seen enjoying their meals and one person spoken with said they have improved. Staff are also able to have a meal and those that were asked felt they were very good. One inspector tried a slice of the Halloween party cake and it was very good. As mentioned in Health and Personal care the home must review the routines of the home to ensure people are not going without food for long periods of time. Care staff were observed assisting people with their meals in a dignified way and were all sat down. Drinks were seen being offered to people who use the service at frequent intervals. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Relatives/representatives of the people who use the service have access to a complaints procedure. Whilst the service has procedures in place to protect people from possible abuse and harm, for some people they have not been put into practice. EVIDENCE: Since the last inspection the home has received two complaints. One was verbal complaint that was dealt with by the Registered Manager and we sent the other complaint to Blanchworth Care Group for investigation. Records were seen for both complaints. A number of visitors who were at the home were asked if they know whom to contact if they had any concerns and they all said they would go the Registered Manager or deputy manager. The home has polices and procedures for staff to access in relation to abuse and as part of the Blanchworth induction training staff undertake training is abuse and challenging behaviour. At the last inspection it was noticed that several members of staff received this training in 2003 and 2004 and since then there has been changes to local reporting procedures. No records were seen at this inspection as evidence that these staff members have received an update. The Registered Manager said she and the deputy manager are qualified trainers and are looking to plan training for staff in this area. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 20 Consideration should be given to accessing the Protection Of Vulnerable Adults training through the county’s Adult Protection Team in order to broaden staffs’ understanding on this subject. Since the last inspection three people who use the service have been referred to the Adult Protection Agency. One of these was by Blanchworth Care Group and this is still being investigated. Two other referrals were made by outside health care professionals relating to the standard of care they were receiving. One referral has been investigated and closed. The other referral is still being investigated. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst improvements to the environment have improved the service for people, there are still areas that need to be addressed to make the home a safe and pleasant place to live. EVIDENCE: A tour of the some of the environment took place and several rooms belonging to people who use the service were seen. Areas that were identified at the last inspection as needing improvement were followed. Three of these remain outstanding and include:• Room 17 water damage to ceiling above windows • Room 39 wardrobe doors are loose • Badly scratched door on landing near room 50 Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 22 During this inspection two new areas were identified as needing urgent attention as they could place people who use the service at risk. • The fire door near room 9 has no hammer to break the glass. • The laminate flooring by room 37 is coming apart and this could pose a risk to people who use the service and staff. Two other areas need attention and these are: • Room 18 there is a hole in the door where a lock should be. • The armchair in room 27 was very stained. The requirement for the registered person to ensure the home is kept in a good state of repair has been outstanding for the last three inspections. Therefore we will require that a written plan of when these will be addressed is sent to us. This plan must also include how the home will address the odours found during the inspection. During the tour the communal lounge and dining area that used to be a secure area was cold and one person said they felt cold. Staff had left a window open. Staff need to be mindful that they may feel hot as they are moving around but for people who are not able this may not be the case. Improvements were noted in this area, as there were new chairs and tables. Improvements were seen in the other dining area with pictures on the wall and table clothes. During the tour of the home on the first day of the inspection whilst the Registered Manager and deputy manager were not on duty staff were seen to be leaving open bags of linen that were soiled on the floor as well as an open black bin liner which contained incontinence pads waiting for disposal. This is poor infection control practice and could place people who use the service at risk of cross infection. The Registered Manager said that staff are meant to be using trolleys to prevent this from happening. The home is still disposing of incontinence bags in black bin liners and this is not complying with the Lists of Waste Regulations 2005, which include the European Waste Catalogue Codes. The Registered Manager said a new policy was due out during the inspection and plans to start this from Monday 5th November 2007, however no evidence was seen of the policy or start date during the inspection. During the tour several areas were found to be odorous, the Registered Manager said that they are working hard to address the problem and new flooring has been provided in several rooms. The laundry area was inspected and it was noticed that this door does not have a lock on it and as a number of people who use the service could go into this room. The deputy manager said he was not sure if this was a designated fire escape for the rooms in the vicinity but would look into it. A procedure is in place for managing soiled linen and protective clothing is available. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that they have sufficient numbers of staff to meet the needs of the people in the home. However at times they are working under these numbers which impact on the care of people who use the service. Whilst improvements with training of staff have taken place; some staff require further training to ensure people who use the service are not put at unnecessary risk. EVIDENCE: Since the last inspection the number of people who use the service has risen and the Registered Manager said staffing levels have also gone up to meet the needs of people who use the service. The home is still using agency staff that know the home and have worked there on a number of occasions. The care staff are allocated people who they will look after and they are also allocated areas in the home to supervise. This ensures all care staff know what they have to do each shift. Ancillary staff are available to support the care staff. Since the last inspection in June 2007 there have been ten incidents that have been reported to us where the home has worked under their allocated numbers of staff, and on two of these occasion the home worked two members of staff below their allocated numbers. Following the inspection there have Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 24 been a further six incidents where they have again worked under their allocated numbers. This will impact on the care people who use the service receive. Relatives who were visiting the home and were spoken to all praised the staff saying they are hard working and very good and they felt their relative was well looked after. Staff spoken with said they enjoy working at the home and feel the standards in the home are improving. At the last inspection the homes AQAA stated that twelve care staff have NVQ 2 or above out of a total of twenty-three care staff and three care staff are working towards this qualification. The Registered Manager at this inspection said two members of staff have now also registered to undertake NVQ 2 training. The personnel files of three recently appointed staff were viewed via the home’s computer system. It was difficult at times to read the information. Criminal Records Bureau Disclosures (CRB) and POVA firsts were not viewed only the reference numbers issued. All the required recruitment checks were in place except that a full employment history was not in place for one member of care staff as they had only listed the years of their employments and not more specific dates. We will be visiting Blanchworth Care Group head office to view some of these documents. The training matrix for the home was seen and this highlights when training is due and when the member of staff last had training. A practical moving and handling session is required for a number of staff. The Registered Manager is aware of this. The Registered Manager said the Care Home support team have been in to the home and have provided staff with training in assisting people with eating and drinking, communication and dementia. There are plans for them to provide more training for staff in other areas to include pressure area care and equipment and wounds for qualified nurses. The home uses an induction book based on the Skill for Care common induction standards for care staff. The Registered Manager or deputy manager supervises new staff. All new staff undertake a three-day induction training with Blanchworth Care Group and qualified nurses do an extra session on medication. Records were seen of induction training using the Blanchworth Care Group format. One new member of staff confirmed they had undertaken induction training. The issue with qualified nurses being trained and competent with male catheterisation and venepuncture remains outstanding as the Registered Manager and deputy manager are competent in male catheterisation but not as yet for venepuncture and the other qualified nurses need to undertake this training for both. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 25 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, 36 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A qualified and competent person now supervises the management and administration of the home. However when this person is away from the home there is still no effective management arrangements in place to ensure the health and welfare of people who use the service will be met. EVIDENCE: Since the last inspection the Manager has been registered with us. She is still waiting for verification in relation to her NVQ 4 training. The Registered Manager and deputy manager feel they are working hard to improve the standards in the home and other members of staff spoken with said they feel this is also the case. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 26 A concern raised at the last inspection related to the lack of effective management cover when the Registered Manager and deputy manager were out of the home. The Registered Manager feels confident that the qualified nurses they now have at the home will be able to manage the home effectively in her absence. However the qualified nurses lack the specialist skills to care for a number of people who use the service so they will not be able to provide effective management cover. An issue was also found by the Pharmacist inspector where medication had not been obtained for one person who must have their prescribed medication, this again was whilst the Registered Manager and deputy manager were away from the home. The Registered Manager was making changes to the duty rota during the inspection but this does not cover the issue of specialist skills, which leaves a lack of effective management cover. Staff and visitors to the home felt they would approach the Registered Manager or deputy manager if they need to discuss issues or concerns with them. Since the last inspection Regulation 26 visits have been taking place and reports sent to us. The Registered Manager has not completed any further environmental audits, as the home is still working through the one completed prior to the last inspection. The Registered Manager said she audits care plans but no records are maintained. They are able to audit the care people receive as staff are allocated people daily and have to sign records detailing what they have done. Accident records are also audited. The home needs to look at devising audits for other areas, as other Blanchworth Care Group homes have access to a format for this purpose. The home manages monies for a number of people who use the service. Records, receipts and an ongoing total are maintained. Records were seen of checking of the monies and two staff signatures are required for safety. A secure facility is provided and the home is able to store certain valuables for people. Supervision records were seen for a number of staff and the supervisor and supervisee sign each session. The Registered Manager said she is behind with the recommended six times a year but has just started clinical supervision sessions. Records were not seen of these sessions. Since the last inspection the home has a full-time maintenance person and records were seen for areas that were missing at the last inspection. This includes wheelchair maintenance fire equipment checks and records relating to fire training. Records relating to monthly checks on hot water temperatures were also seen. The Registered Manager confirmed that the fire risk assessment has not been completed. Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 27 Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 28 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 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 29 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 OP4 Regulation 18(1) (c) (i) Requirement Timescale for action 31/12/07 2. OP8 12(1)(b) 3. OP9 13(2) The home must provide training and make ensure the staff are competent is specialist skills needed so that the needs of the people who use this service are being met. (This refers to male catheterisation and venepuncture). This requirement remains outstanding from the last inspection. The home must ensure that staff 31/10/07 are supporting/supervising people to meet their care needs, in particular maintenance of their oral hygiene. This requirement remains outstanding from the last inspection. 31/10/07 Obtain a supply of a particular medicine and prescribed food supplement for one person so that he can continue his prescribed treatment. An immediate requirement was made. When medication is DS0000016515.V352796.R01.S.doc 4. OP9 13(2) 31/10/07 Version 5.2 Page 30 Northleach Court Care Centre administered to people living in the home safe procedures must be followed with correct intervals between doses. Medicines must always be in stock to administer in accordance with the prescribers’ directions. There must be up to date documented information for each person (where applicable) to clearly describe how to use any medication prescribed for use ‘as required’. This is to make sure that people receive the correct levels of medication. This requirement was partly met – the original timescale for action was 31/07/07. 5. OP9 13(2) 6. OP9 13(2) 7. OP10 12(4a) 8. OP19 23 (2b) & 16 (k) When medication is administered to people living in the home it must be clearly and accurately recorded to make sure that people receive the correct levels of medication. All medicines must always be kept securely so as to prevent the risk to people living in the home of gaining access to medicines. This relates particularly to the storage area for medicines awaiting return to the pharmacy. People must not have their eye drops administered at the breakfast table, as it does not respect their privacy and dignity. The registered person must send to us a plan detailing how the areas of the environment identified in the report will be address and with timescales for completion. This plan must also include how the home will address the areas that have odours. This will ensure that people live in a safe and wellmaintained environment. DS0000016515.V352796.R01.S.doc 15/12/07 15/12/07 31/10/07 31/12/07 Northleach Court Care Centre Version 5.2 Page 31 9. OP26 16(2)(k) 10. OP26 13(3) 11. OP29 19 12. OP30 18 (1) (c) (i) The home must make suitable arrangements for the appropriate disposal of clinical waste (this is with relation to the Lists of Waste Regulations 2005 and the European Waste Catalogue Codes). This requirement has been repeated from the last inspection. The staff must not leave open bags of soiled linen or bags containing soiled incontinence pads on the floor; as this places people who use the service at risk of cross infection. The home must obtain a full employment history on all proposed staff with written explanation of any gaps in employment to ensure people who use the service are not put at risk. This requirement has been repeated from the last inspection. The home must ensure that persons working in the care home receive training appropriate to the work they are to perform (this refers to staff receiving training/update in moving and handling to prevent people who use the service and staff from being put at risk). The home must demonstrate that effective management arrangements are in place when the Registered Manager is away from the home. This is to ensure people at the home receive proper provision for their health and welfare. This requirement has been repeated from the last inspection. 30/11/07 31/10/07 31/10/07 31/12/07 13. OP31 12 (1) (a) 31/10/07 Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations The home needs to review their mealtimes as people are either going too long without food or not having enough time in between meals. Care plans should reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff handle their medicines. The staff in the home should consider attending the Protection Of Vulnerable Adults training provided by Gloucestershire County Council. 3. OP18 Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Northleach Court Care Centre DS0000016515.V352796.R01.S.doc Version 5.2 Page 34 - 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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