Inspection on 27/05/08 for Old Gates Nursing & Residential Home

This inspection was carried out on 27th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Old Gates Nursing & Residential... 04/02/10

Old Gates Nursing & Residential... 12/08/09

Old Gates Nursing & Residential... 30/05/07

Old Gates Nursing & Residential... 06/06/06

Old Gates Nursing & Residential... 01/11/05

Old Gates Nursing & Residential... 03/06/05

Old Gates Nursing & Residential... 09/11/04

Old Gates Nursing & Residential... 18/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU Lead Inspector Jane Craig Unannounced Inspection 27th May 2008 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 DS0000022478.V362649.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. DS0000022478.V362649.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Gates Nursing & Residential Home Address Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU 01254 209924 01254 200948 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) www.bupa.com BUPA Care Homes (CFHCare) Ltd ****Post Vacant**** Care Home 90 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (29), Old age, not falling within any other of places category (30), Physical disability (7), Physical disability over 65 years of age (30) DS0000022478.V362649.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Holly House Old age not falling within any other category - Code OP, (maximum number of places: 30). Physical disability - Code PD, (Maximum no of places 5). Rowan House Dementia over 65 years of age - Code DE (E) (maximum number of places: 29) Dementia - Code DE, (maximum no of places: 1) Cherry House Physical disability over the age of 65 years - Code PD (E), (Maximum no of places 30). Physical disability - Code PD, (Maximum no of places: 2) The maximum number of people who can be accommodated is: 90 Date of last inspection 30th May 2007 Brief Description of the Service: Old Gates Nursing and Residential Home is owned by BUPA Care Homes Limited. The home provides long stay and respite care for up to 90 adults who require help with personal care or who have nursing care needs. The home is a purpose built, single storey building. It comprises one reception area and three separate houses. Holly House accommodates people with nursing and personal care needs. Rowan House accommodates people who have a diagnosis of dementia and Cherry House accommodates people who require assistance with personal care. Each house has its own lounge/dining area and small kitchen. There are 30 single bedrooms in each. The bedrooms do not have en-suite facilities but there are sufficient bathrooms and toilets close to bedrooms and communal areas. Old Gates is situated in a residential area, close to local amenities, including a DS0000022478.V362649.R01.S.doc Version 5.2 Page 5 Post Office, churches, public houses and shops. It stands in landscaped grounds with several garden and patio areas. There are adequate car parking spaces. An information pack about Old Gates is sent out to anyone making enquiries about the home. The latest Commission for Social Care Inspection report is on display in the foyer and copies are available from the manager on request. The weekly fees as of 27th May 2007 ranged between £341.00 and £479.00 Additional charges were made for hairdressing, newspapers and toiletries. DS0000022478.V362649.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Old Gates Nursing and Residential Home on the 27th and 28th May 2008. There had been one additional visit since the last key inspection. This was carried out on 8th January 2008 and was to check on the progress towards meeting the requirements from the key inspection. We found that little progress had been made at that time. At the time of this visit there were 74 people living at the home. The inspector met with a few and asked about their views and experiences of living at Old Gates. Some of their comments are included in this report. Six people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to people living and working at Old Gates. There was quite a good return from both. During the visit discussions were held with the manager, members of the staff team and visitors. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: Most people who returned surveys indicated that they were given enough information about the home to help them to make a choice about whether it was suitable for them. Before anyone moved in senior staff visited them to assess what care they needed and to make sure that their needs could be properly met at Old Gates. People using the service said that staff respected their privacy. Two people said that staff always knocked on the door before going into their rooms. One said, “Staff have a basic respect for everyone.” A member of staff said that she tried to treat everyone how she would expect her mother to be treated. DS0000022478.V362649.R01.S.doc Version 5.2 Page 7 Routines in the home were flexible to meet people’s individual needs. One person said, “It seems to be very relaxed, they don’t seem to have many rules.” Another person said that they chose to have their meals in their room. There was open visiting which meant that people could see their families at times that suited everyone. Visitors said they felt welcome in the home and were offered refreshments. The home was well maintained. With the exception of one or two areas, it was nicely decorated and well furnished. People living at the home were happy with their bedrooms and many had brought in some of their own furniture and other personal items. People living at the home said they got on well with the staff. On person described staff as “compassionate.” Another person said they could have a laugh with them. A relative said that staff were always helpful. What has improved since the last inspection? What they could do better: A large number of people did not have a statement of terms and conditions of residence. This could lead to misunderstandings about the rights and responsibilities of the resident and the provider. Care plans must be in place to tell staff how the individual needs of each person using the service can be met. Assessments of risks to people’s health, for example, nutritional risks, must be kept up to date. Staff must also make sure that there are plans in place to help to reduce any risks. To make sure that all staff work to the same standard, plans must be updated whenever there are any changes in the person’s health or any changes in care to be given. DS0000022478.V362649.R01.S.doc Version 5.2 Page 8 There were not always enough staff around to help people when they needed it. The manager should look at the staffing levels on each house and make sure that there are enough staff, especially at busy times of the day. The manager should bring all the training records up to date and draw up a training plan. At least half of the care staff should have an NVQ. 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. DS0000022478.V362649.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022478.V362649.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most people who moved into the home received enough information to help them to make a decision about whether it was right for them and staff received sufficient information to help them to understand the needs of the person moving in. EVIDENCE: The service user’s guide and statement of purpose were being updated with details of new manager and other personnel. The service user’s guide, or information pack, told people about the facilities and services available at Old Gates. There was also a newsletter, which gave information about events in the home. DS0000022478.V362649.R01.S.doc Version 5.2 Page 11 The manager said she usually took an information pack when she went to meet a prospective resident. Most people who completed surveys said they received enough information about the home prior to moving in. People who were funded by social services were no longer issued with a statement of terms and conditions of residency by BUPA. This could result in a lack of understanding about what services are to be provided and the rights and obligations of the person moving into the home. People who funded their own care had a contract with BUPA. People were generally referred to Old Gates after they had been assessed by health or social care professionals. Copies of those assessments were on files. Senior staff also assessed anyone thinking of moving into the home to ensure that the facilities at Old Gates and the skills and experience of the staff team were sufficient to meet the person’s needs. The pre-admission assessments of the people who were case tracked were generally tick boxes with brief comments. The way staff used the comment section varied. Some staff only focused on the person’s needs whereas other staff also commented on strengths and abilities. The more positive information was generally transferred to care plans to support people to maintain their independence. Standard 6 was not applicable. Intermediate care was not provided at Old Gates. DS0000022478.V362649.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Inconsistencies in care planning and delivery could compromise people’s safety and result in their health and personal care needs not being met. EVIDENCE: Six sets of care records were inspected as part of the case tracking process and others were looked at to check specific issues. The standard and detail in plans were not consistent. For example, there were some very individualised plans, especially those to support people to carry out personal care routines. A number of these included specific instructions to make sure that staff helped people in the way they wished and in a way that encouraged them to remain independent. However, there was one person who did not have a plan to assist with personal care and another did not have a plan to assist with specific continence needs. DS0000022478.V362649.R01.S.doc Version 5.2 Page 13 Plans were not always in place to meet health care needs. For example two people had potentially serious mental health needs but there were no plans to direct staff how to monitor or when to refer on. Plans were in place to assist two people who exhibited anxious and agitated behaviour. However, in both cases the directions for staff were vague, which had the potential for care to be givien in an inconsistent manner. This was apparent on the day of the inspection when two members of staff told one resident completely different, and untrue, reasons why she was not able to go home. This did not help to relieve her anxiety. People were reassessed following a major change in their health or care needs. For example, one person’s moving and handling assessments and plans had been re-written following a change in their mobility. Another person had been reassessed after a stay in hospital and some of their plans had been updated. All care plans were reviewed every month and some showed amendments when the person’s needs changed. This was not always the case. For example, one person’s wound care plan had not been updated, which could have been part of the reason why the person did not have the correct wound dressings applied. There was a set of health care risk assessments on all the files seen. The standard of assessments and management strategies varied. One person’s records showed a slight but steady weight loss. Their nutritional risk assessment was not complete. This meant the potential risks had not been identified and there was no plan to ensure closer monitoring. More than one person was assessed as having a very high risk of developing pressure sores but there were no specific plans to help minimise the risk. A small number of people accommodated on Rowan House and Holly House regularly sat in chairs that, because of their design, prevented them from getting out of the chair unaided. Despite a previous requirement there were no risk assessments to show that the chairs were the most appropriate solution to minimise the risk of falls. In addition there were no assessments to show that risks associated with restricted movement had been assessed. Despite these shortfalls residents and family carers spoken with were happy with the care they received. One person talked about staff helping her towards her goal of walking again and another said that staff looked after her extremely well. One person who returned a survey commented, “Staff discuss with myself and my family if I have any health issues and contact the relevant professionals always.” A family carer said their relative was, “well attended to,” and another said his wife had everything she needed. There had been improvements in the way medication was managed since the last inspection. There was a complete set of medication policies. Medicines DS0000022478.V362649.R01.S.doc Version 5.2 Page 14 were stored safely. There were no excess stocks and medicines no longer in use were disposed of. Records of medicines received were usually in place. However, records of medication carried forward from the previous month were not always accurate. This meant that it was not always possible to audit whether medicines had been given correctly. There were records of medicines disposed of but on Cherry House the records did not indicate whom the medicines belonged to which meant there was not a complete audit trail. Records were not signed by two staff, which increased the risk of mishandling. On Rowan House single doses of medicines disposed of were not always recorded in the book. There was also an open box of medicines waiting for disposal in the treatment room, which was potentially unsafe. There were no gaps on Medication Administration Record (MAR) charts. Appropriate codes were used when medicines were omitted. Staff carried out regular stock counts of medication. A number of MAR charts were checked against the stocks. The stocks on the day of the inspection all matched the records but the previous calculations were not always accurate, which meant that medication might not always be given as prescribed. Where variable doses of medicines were prescribed the amount administered was not always recorded. This meant that staff could not evaluate how effective the dose was or carry out accurate audits. With the exception of one MAR chart on Cherry House, handwritten entries matched the medication labels. They were usually double signed by staff, which helped to reduce the risk of transcribing errors. Controlled drugs were stored, recorded and administered according to policy and good practice guidance. Staff received training on core values during their induction and NVQ training. Staff talked about respecting people’s privacy by knocking on doors and promoting dignity by giving choice and control. A member of staff said, “I treat people as I would expect my mother to be treated.” People using the service confirmed that staff respected their privacy. One said, “if I am in my room and they want to see me they ask if I am free – they don’t just walk in.” Another person said the staff “have a basic respect for everyone.” One person wrote on their survey, “I have lived in Old Gates for three and a half years; I have always been treated with respect and have a good relationship with staff.” During the course of the inspection there were some excellent examples, particularly on Cherry House, of staff speaking to people with respect and empathy. However, some practices were observed that compromised people’s DS0000022478.V362649.R01.S.doc Version 5.2 Page 15 dignity. For example, one person was seen wearing the same stained jumper for two days. There was nothing to show that staff had made any attempt to help them to change. Conversely, a family carer said their relative was “kept clean and tidy.” DS0000022478.V362649.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most people living in the home had some choice and control over their daily lives. Improvements in the level of activities meant that more people were being assisted to meet their social and recreational needs. EVIDENCE: The small number of people spoken with during the inspection expressed satisfaction about their life at Old Gates. One person, who was recently admitted said, “On the whole I am much happier here than I expected to be.” Another person said, “I am very happy here.” A family carer wrote that her mum had settled in well. Each person had a lifestyle profile, which included information about his or her preferred routines and rituals. Staff said that people had choice in all aspects of their daily routines. Some of the comments from residents confirmed this. One person said, “It seems to be very relaxed, they don’t seem to have many rules.” Another said, “We can go to bed and get up when we want.” DS0000022478.V362649.R01.S.doc Version 5.2 Page 17 Staff working with people with communication difficulties said they always gave people choices. If they had to make choices on their behalf they watched body language to make sure people were happy with their decision. The profiles and life maps also included information about people’s social care preferences. For example, past interests and whether they preferred activities in a group or liked their own company. However, none of the people who were case tracked had a specific plan about how staff could support them to meet their individual needs for social contact and occupation. People’s views about activities were mixed. The level of activities had improved and there was something every day somewhere in the home. Several people regularly joined the group activities. Two people commented that there was not enough going on for them. Others said there were activities on offer but they did not wish to join in. One person wrote, “It is my choice to remain in my own room mostly.” Records showed that people who did not like groups had individual time with the activity co-ordinators. One person said, “They come in for a chat and sometimes do my nails.” The activity co-ordinators discussed some unusual group activities they had done or were planning. For example, one group focused around fruit and included aspects of reminiscence as well as giving people the opportunity to try new tastes. The co-ordinators were also trying to get people out as much as possible and were in the process of planning a trip to the pub for Father’s Day. The annual quality assurance assessment (AQAA) indicated that the manager was intending to develop a service user planning group to help with activity planning and get feedback from other people living in the home. Interdenominational Church services were held in the home and one person said they received Communion twice a week. There was an open visiting policy. Visitors were seen chatting with staff and being offered refreshments. Two people regularly stayed for meals. Visitors said they felt welcome in the home and one said, “I have always been treated very well.” There were mixed views about the meals. Positive comments included, “The food is alright,” “150 better than hospital food,” and “good chef.” However, a lack of variety seemed to be a possible theme that was emerging. One person said, “We get offered sandwiches an awful lot as an alternative.” Another said, “Food isn’t bad but the menu doesn’t vary much.” People who returned surveys also commented on this. Two wrote, “Chicken and turkey are the main meats plus mince which all tastes the same,” and, “Although the food is usually good I would like a bit more variety.” The Chef discussed a new initiative by BUPA where each daily menu was checked to ensure that people are offered a nutritionally balanced diet of DS0000022478.V362649.R01.S.doc Version 5.2 Page 18 recommended portions. For example, five portions of fruit and vegetables a day. DS0000022478.V362649.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concerns and complaints were listened to and acted upon. Procedures were in place to ensure that people using the service were protected from harm. EVIDENCE: The complaints procedure on display in the home was in large print. It was clear and included information about how complaints would be dealt with. The procedure conveyed to the reader that the service had an open attitude to complaints and suggestions. In contrast, the information about complaints in the service user’s guide was less informative and less encouraging. People who returned surveys indicated that they knew how to make a complaint. Relatives said they could speak to staff if they had any concerns. All the staff who completed surveys indicated that they knew what to do if a resident or relative raised any concerns with them. However, it became apparent that a complaint about poor practice had not been passed on to the manager. The staff on the unit had dealt with the complaint to the satisfaction of the resident but there were implications for other people should the member of staff continue to practice in this way. The incident was reported to the manager during the inspection and she said she would undertake an investigation. DS0000022478.V362649.R01.S.doc Version 5.2 Page 20 Records showed that verbal complaints that were passed on to the manager were investigated as thoroughly as written complaints. There were copies of correspondence to people who had made complaints telling them what action had been taken. Staff had access to the Blackburn with Darwen policy and procedure relating to safeguarding adults. There was also a policy and guidance specific to Old Gates. Staff received training during their induction and NVQ but not everyone had received refresher training. Information included in the AQAA indicated that training was planned in the next twelve months. All staff who were asked were able to discuss their role in recognising and reporting abuse. They were also aware of the whistle blowing policy and how they could report poor practice outside the home. The manager said she was familiar with the local authority procedure. DS0000022478.V362649.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained. The standard of décor and furnishings in most areas provided people with a safe, comfortable and homely place to live. EVIDENCE: The home was generally well maintained and minor repairs were carried out when they were reported. The gardens were well maintained and used regularly by residents and relatives. There was a new summer house for use by people on Rowan House. There had been some redecoration and renewal of furnishings since the last inspection. Some carpets had been replaced and people on Cherry House all DS0000022478.V362649.R01.S.doc Version 5.2 Page 22 had new beds in an effort to make bedrooms more homely. The communal areas on all three houses were decorated and furnished to a good standard. The manager said the home was due for full refurbishment soon. However, during a walk round the building it was apparent that some areas needed attention sooner. For example, there was evidence of water damage on a few bedroom ceilings. The manager said the cause of the problem had been rectified but the stained patches were unattractive for the people living in the rooms. Walls in several bedrooms needed cleaning or re-painting because of staining from spillages. Some of the worn and discoloured toilet seats identified during the last inspection had been replaced but others still looked unsightly. One toilet had unsightly rusty patches on the radiator and pipes. People who were asked said they liked their bedrooms. One said, “They keep it nice and clean,” and another said, “The rooms are not bad at all; I like the patio and courtyard view. At the time of the inspection the home was generally clean and tidy. There were no unpleasant odours. Most people who returned surveys indicated it was always like that. It was noted that deep cleaning was needed in a few places, for example, paintwork and carpets. The AQAA indicated that the manager plans to develop a more structured programme for cleaning carpets, which should resolve the problem. There had been no changes to the laundry since the last inspection. It was tidy and organised. One resident commented that the laundry was, “unbelievably efficient.” The AQAA indicated that there was an infection control assessment and policy and over half the staff had received infection control training. An infection control link nurse had been identified. Part of her role was to ensure that staff had up to date training and guidance. DS0000022478.V362649.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service were protected by the recruitment practices but there were not always sufficient staff, with appropriate training, to meet their needs. EVIDENCE: The manager and some staff said that recent difficulties with low staffing levels had improved. One member of staff said, “There was a difficult period with staffing but now management understand the high dependency it is better.” Another said, “We never drop below minimum levels; there are usually enough staff.” Staff who returned surveys indicated that there were always or usually enough staff but then commented on restrictions on staffing levels and lack of cover when staff phoned in sick. Other staff maintained that staffing numbers were still not always adequate. One person said they felt let down by management when they were short staffed. Another person said that there was no flexibility to increase staff. More than one member of staff said that, although people did not miss out on personal care, staff did not have as much time to spend with them as they would like. One person said that the levels were not great and sometimes had an impact on residents. The views of people using the service were mixed. At the time of the inspection three residents said they sometimes had to wait for attention but DS0000022478.V362649.R01.S.doc Version 5.2 Page 24 one said it was not for long. Of the seven people who returned surveys, two said staff were always available when needed, four said usually and one said sometimes. One person, who had answered ‘usually’ wrote, “Not enough staff on duty. The staff are overworked at busy times not getting the breaks they need.” A relative said that there were sometimes not enough staff in a morning. During the course of the inspection the inspector observed two incidents at lunch time on Holly House that could indicate that there were not enough staff on duty or they were not deployed efficiently. On a recent survey carried out by BUPA a resident indicated that they felt that 2 male care staff on duty at night were not appropriate. Duty rosters showed that this was still happening about once a week on two of the units. Although there was a female nurse with them, she would not always be present when they were delivering personal care. The manager took steps to address this at the time of the inspection. Several residents commented about their good relationships with the staff. One said, “Nurses and care staff are equally as good; all brilliant.” Another said, “Staff are compassionate,” and a third said, “Nine out of ten are all right.” A relative said that staff were most helpful. The files of three new staff were seen. All files included the information and documents to show that the required pre-employment checks had been carried out. However, a member of staff currently working at Old Gates had provided a reference for one applicant, which meant that the testamonial might not be impartial. All employees received a contract of employment. New staff went through an induction training programme that was relevant to their level of qualifications and experience. Registered nurses and care staff with NVQ had a six-week induction which focused on their role at Old Gates. Staff without qualifications went through the Skills for Care twelve-week induction programme. All new staff were supernumerary for a week and were mentored through their induction programme. All staff had individual training records but at the time of the inspection there was not a central record. This meant it was not possible to get an overall picture of where the staff team as a whole were up to with training. The manager said most mandatory training was up to date and she was in the process of compiling a training matrix. Staff said training opportunities were good. Several said they had attended courses that were considered mandatory, such as fire safety and moving and handling. There was also other training available to assist people to help support clients with specific needs such as dementia care, although not everyone working on Rowan House had done the course. DS0000022478.V362649.R01.S.doc Version 5.2 Page 25 The AQAA showed that less than half of the care staff were qualified to NVQ level 2. Several staff were part way through the course which should increase the percentage to over 50 . DS0000022478.V362649.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new manager was working to improve the management and administration of the home for the benefit of the people living there. EVIDENCE: A new manager had been in post for three months. She is a registered nurse and has several years experience of management and is nearing completion of the Registered Manager’s Award. The manager said she will be applying to register with the Commission for Social Care Inspection in the next few weeks. The Manager is supported by a management team of the heads of departments. She is aware that there are some areas of the home where DS0000022478.V362649.R01.S.doc Version 5.2 Page 27 standards need to improve. From information submitted in the AQAA and discussions during the inspection it was apparent that the new manager has some plans for future developments. The service had not regained the Blackburn with Darwen quality assurance award but was due to be reassessed quite soon. There were no other external quality monitoring systems in place. BUPA carried out an annual survey for residents and relatives. Both surveys showed mainly positive responses with improvements in most areas, except staffing, over the past year. The manager has an action plan to work on any areas where improvements can be made. Other systems were in place to monitor processes and procedures. The organisation acted as appointee for one person. Transactions carried out on their behalf were recorded and audited. Personal allowances and other money handled on behalf of other people were banked in a resident account. Receipts were given for any money handed over for safekeeping and invoices were generated for any payments to be made on their behalf, for example to the hairdresser. The system did not allow for any money to be kept in the home. This meant that people would not be able to withdraw any money outside of office hours. Staff had received fire safety training and staff spoken with knew what to do in the event of fire. The procedure was on display throughout the home and practice drills took place every six months. Records of fire drills included any problems encountered and actions to be taken. Servicing of fire alarms and equipment was up to date. The AQAA showed that maintenance and servicing of other appliances and equipment in the home was up to date. DS0000022478.V362649.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 3 2 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000022478.V362649.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 OP7 Regulation 15(1) Requirement Care plans must clearly identify personal and health care needs and provide sufficient directions for staff to meet those needs. Timescale for action 31/08/08 2. OP7 3. OP8 3. OP8 4. OP9 The registered person must ensure that wherever necessary care plans are amended so that staff have up to date and accurate directions about the care to be provided. (Timescale of 29/02/08 not met) 13(4)(b-c) In order to protect the health and safety of people living in the home, risks to health must be accurately assessed and plans to control the risks must be put into place. 13(4) People must not be restrained in Kirton chairs unless their assessment clearly indicates that this is the most appropriate way of controlling the risk of falls. (Timescale of 29/02/08 not met) 13(2) Accurate records must be kept of medicines for disposal to complete the audit trail and to reduce the risk of mishandling. 15(2) 31/08/08 31/08/08 31/07/08 30/06/08 DS0000022478.V362649.R01.S.doc Version 5.2 Page 30 5. OP27 18(1)(a) In order to ensure that people using the service have the amount of support they need, when they need it, the manager must review the staffing levels on each house and review how the staff are deployed at various times of the day. 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations Everyone should receive a statement of terms and conditions of residency so that there is no potential for misunderstandings to occur about what services will be provided. Where variable dose medication is prescribed staff should keep a record of what dose they have administered so that they can evaluate the effectiveness of the dose. Weekly medication checks should be robust enough to identify any discrepancies in administration. Any discrepancies identified should be reported to the person in charge and investigated to prevent errors occurring. In order to improve the comfort of the people living at the home the areas in need of maintenance, or redecoration or deep cleaning that were identified with the manager during the tour of the building should be addressed. The training records should be brought up to date and the manager should draw up a plan to address any shortfalls in training. 2. OP9 3. OP9 4. OP19 5. OP30 DS0000022478.V362649.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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