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Inspection on 30/05/07 for Old Gates Nursing & Residential Home

Also see our care home review for Old Gates Nursing & Residential Home for more information

This inspection was carried out on 30th May 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A number of people using the service and several relatives expressed satisfaction about the staff and the care they provided. One person said, "I like it here very much, everyone is so kind and friendly." Another said, "If I was royalty I could not be looked after better." A relative wrote that staff, "Provide a caring and friendly atmosphere", and another said, "It is all about approach and they know how to deal with people." People using the service said that staff were polite and respectful and the inspector observed people being treated with respect and dignity. Visitors to the home were satisfied with the open visiting policy, which meant that there were no restrictions on people using the service being able to see their relatives. One visitor said that they felt as welcome as if they were all one family. The routines in the home centred around the people using the service. People said there were no rules, for example about getting up and going to bed. Oneperson said, "I have a choice in everything, the nice thing is there is always someone around to help." The majority of people using the service said they liked the meals. One person said, "the meals are very good, they always try to give you something you like," and another person commented, "the meals are usually five star, it`s only very occasionally I don`t enjoy them." There was a clear complaints procedure. Records showed that formal complaints were investigated and acted upon. People using the service said they knew who to speak to if they were not happy about something. Relatives said they knew how to make a complaint and that any concerns were acted upon by the manager and staff. Fire safety equipment and electric and gas systems were serviced regularly. This helped to make the home safe for the people who lived and worked there. The company carried out a survey earlier in the year to make sure the home was providing a good quality service. People living at the home and their relatives were also able to put their views forward at meetings and make suggestions for changes.

What has improved since the last inspection?

Senior staff from the home assessed people who were thinking of using the service. This meant that staff had a better understanding of what care the person might need and whether it could be provided at the home. The care plans were more personalised. This meant that staff had more information about the person`s needs and how they wanted to be helped. The plans also told staff about the person`s likes, dislikes and preferences. This helped the staff to be able to make choices and decisions for people who were not able to do so themselves. There had been improvements to the environment. All three houses had been, or were in the process of being, refurbished. When completed the refurbishments will add to the comfort of people living at the home. People said they were satisfied with their rooms, which they described as, "comfortable," and "very nice." They were also satisfied with the cleanliness and odour control, both of which had improved since the last inspection. Over half of the care staff held an NVQ in care, which is a nationally recognised qualification. This meant that the majority of the staff team had the relevant training, knowledge and skills to look after the people living at the home.

What the care home could do better:

Care plans for people using the service must be kept up to date so that staff have accurate information about the care the person needs and what support they are to give. Staff must make further improvements to the way they manage peoples` medicines in order to reduce the risk of errors. Although there had been some improvements, there were still not enough suitable activities organised to help people who were not able to occupy themselves. This meant that there were a number of people whose social and recreational needs were not met. Not all background checks had been carried out on new staff. This meant that there was a small risk that staff who were not suitable to work with vulnerable people could be employed. The training for new staff was not always completed or assessed by their manager. This could result in people living in the home being cared for by staff who do not have the relevant knowledge and skills. Although new staff had fire safety training, this was not always followed up to make sure they understood and remembered what they should do in the event of a fire.

CARE HOMES FOR OLDER PEOPLE Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU Lead Inspector Jane Craig Unannounced Inspection 30th May 2007 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 Old Gates Nursing & Residential Home DS0000022478.V335504.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. Old Gates Nursing & Residential Home DS0000022478.V335504.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) Limited vacant post 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) Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. Within the overall total of 90, a maximum of 30 service users requiring personal care who fall into the category of OP Within the overall total of 90, maximum of 29 service users requiring nursing care or personal care who fall into the category of DE(E) Within the overall total of 90, a maximum of 30 service users requiring nursing care who fall into the ctegory of PD(E) Within the overall total of 90, a maximum of 5 service users requiring nursing care who fall into the category of PD Within the overall total of 90 a maximum of 2 service user requiring personal care who falls in the category of PD Staffing for those service users requiring nursing care on Holly House will be in accordance with the Notice issued dated 25 May 1999 Staffing for those service users on Rowan House to be maintained as agreed 28.8.03 The Registered Provider should, at all times, employ a suitably qualified and experienced Manager who is registered with the Commission for Social Inspection Within the overall total of 90, one named service user requiring nursing care who falls into the category of DE When the named person (see conditions 9 above) no longer resides at the home an application for a variation to registration must be made. 6th June 2006 9. 10. Date of last inspection 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 Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 5 Old Gates is situated in a residential area, close to local amenities, including a Post Office, churches, public houses and shops. It stands in landscaped grounds with several garden and patio areas. There are adequate car parking spaces. A brochure with some specific information 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 30th May 2007 ranged between £354 and £594.68. Additional charges are made for hairdressing, newspapers and toiletries. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Old Gates on the 30th and 31st May 2007. On the day of the inspection visit there were 85 people living at the home. The inspector met with a number of people living in each of the three houses and talked to them about their views and experiences of living at Old Gates. Some of their comments are included in this report. Five people living at the home and six family carers had returned surveys prior to the inspection. The majority of their views about various aspects of the home were positive. Discussions were held with the registered manager and twelve other members of staff with various roles in the home. The inspector also spoke with four visitors and a visiting professional. A partial tour of the premises took place and a number of documents and records were viewed. This report also includes information submitted by the registered manager prior to the inspection visit. One additional visit had been made to the home since the last key inspection. This was a random inspection conducted on 6th February 2007. The purpose of the inspection was to monitor whether requirements in respect of health and personal care, and health and safety had been complied with. Improvements were found in both areas. What the service does well: A number of people using the service and several relatives expressed satisfaction about the staff and the care they provided. One person said, “I like it here very much, everyone is so kind and friendly.” Another said, “If I was royalty I could not be looked after better.” A relative wrote that staff, “Provide a caring and friendly atmosphere”, and another said, “It is all about approach and they know how to deal with people.” People using the service said that staff were polite and respectful and the inspector observed people being treated with respect and dignity. Visitors to the home were satisfied with the open visiting policy, which meant that there were no restrictions on people using the service being able to see their relatives. One visitor said that they felt as welcome as if they were all one family. The routines in the home centred around the people using the service. People said there were no rules, for example about getting up and going to bed. One Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 7 person said, “I have a choice in everything, the nice thing is there is always someone around to help.” The majority of people using the service said they liked the meals. One person said, “the meals are very good, they always try to give you something you like,” and another person commented, “the meals are usually five star, it’s only very occasionally I don’t enjoy them.” There was a clear complaints procedure. Records showed that formal complaints were investigated and acted upon. People using the service said they knew who to speak to if they were not happy about something. Relatives said they knew how to make a complaint and that any concerns were acted upon by the manager and staff. Fire safety equipment and electric and gas systems were serviced regularly. This helped to make the home safe for the people who lived and worked there. The company carried out a survey earlier in the year to make sure the home was providing a good quality service. People living at the home and their relatives were also able to put their views forward at meetings and make suggestions for changes. What has improved since the last inspection? What they could do better: Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 8 Care plans for people using the service must be kept up to date so that staff have accurate information about the care the person needs and what support they are to give. Staff must make further improvements to the way they manage peoples’ medicines in order to reduce the risk of errors. Although there had been some improvements, there were still not enough suitable activities organised to help people who were not able to occupy themselves. This meant that there were a number of people whose social and recreational needs were not met. Not all background checks had been carried out on new staff. This meant that there was a small risk that staff who were not suitable to work with vulnerable people could be employed. The training for new staff was not always completed or assessed by their manager. This could result in people living in the home being cared for by staff who do not have the relevant knowledge and skills. Although new staff had fire safety training, this was not always followed up to make sure they understood and remembered what they should do in the event of a fire. 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. Old Gates Nursing & Residential Home DS0000022478.V335504.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 Old Gates Nursing & Residential Home DS0000022478.V335504.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, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process ensured that people had enough information to make a decision as to whether the home was suitable for their needs and staff had a clear understanding of the individual’s needs and how they were to be met. EVIDENCE: The welcome packs in each bedroom included up to date information about the home. One family carer said they had flicked through the document and it seemed to have all the information anyone could want. There was a new set of terms and conditions of residency that had been given out to everyone living at the home. Health or social services professionals generally assessed people before referring them to the home. The manager or other senior staff also carried out assessments with people who were thinking of using the service so that they could be sure that the staff and facilities at Old Gates could meet their needs. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 11 Staff also made sure that any aids or equipment the person needed were available to them on admission. Care-workers said they received enough information from the assessment to understand the person’s needs before they were admitted. Intermediate care is not provided at Old Gates. Old Gates Nursing & Residential Home DS0000022478.V335504.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. Care was planned and delivered in a way that met the needs and wishes of most of the people who use the service. Medication practices did not completely safeguard people using the service. EVIDENCE: The improvements in care plans noted during the random inspection had been built upon. The care plans generally provided staff with more detailed information about the support they needed to provide to meet peoples’ health and personal care needs. The organisation was in the process of introducing new care planning documents and there were some good examples of person centred plans written in the new format. For example, one care plan to assist with personal hygiene was very specific about the person’s preferences for clothing and how they wished staff to assist them with their appearance. Another plan advised staff how they could assist a person to meet their cultural needs with the help of reminiscence, music and food. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 13 People using the service were not generally involved in drawing up their care plans. However, there were records to show that families were invited to reviews where care plans were discussed and agreed. There were still some shortfalls in how care plans were reviewed. The review notes did not always indicate the person’s progress towards meeting their goals. Plans were not always altered when the needs of the person using the service changed. For example one plan had not been amended to reflect changes in the person’s mobility, which could result in incorrect care being given, especially by staff who do not know the person well. Care plans that were looked at included health care risk assessments. However, two people who were identified as being at high risk of falls did not have any care plans to address the risk. The assessments of another two people highlighted that they had poor appetites and were not eating well, but their nutritional screening did not reflect this. As previously required, the use of bed rails was risk assessed. However, staff on one house said that they sometimes used Kirton chairs to prevent people who were at risk of falls from getting up and walking round unsupervised. There were no assessments in place to support this practice, which meant that staff were not balancing the potential benefits of using the chairs against the potential risks associated with this type of restraint. Four out of five people who completed surveys indicated that they received the care and medical support they needed. Most people during the inspection confirmed this. One person said, “when I came here I walked with a frame and now I don’t even use my stick.” Another said, “The staff know what to do if I am not well.” One person commented that they would like more walking and exercise to help them. Two relatives said that staff knew exactly what care their relatives needed and another said, “Knowing she is here gives me peace of mind because she is so well looked after.” There were records to show that people were referred to other professionals whenever necessary. A district nurse said that staff were “on the ball” and she received timely referrals. She also confirmed that care-workers always acted upon any advice they were given. Improvements in the management of medicines continued. Medicines were stored securely and at the correct temperature. There was no excess stock and out of date medicines had been disposed of. People who needed to have their blood glucose monitored had their own monitoring devices, which reduced the risk of cross infection. Handwritten instructions on Medication Administration Record (MAR) charts matched those on medicine containers and were double signed to reduce the risk of errors. There were very few gaps on MAR charts and if medicines were not given then the reason was recorded. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 14 However, there were still some shortfalls. For example, the records of medicines received into the home were not complete on all houses. This meant that the stock audits carried out every week were not effective. A minor error in the records and administration of a controlled drug was not highlighted immediately. Staff were not always recording what dose they administered when the MAR chart directed one or two tablets. This meant that they could not give information to the prescriber about how effective the medicine was. Medication for one person who was recently admitted to the home had run out because staff had not ordered it on time. There were also discrepancies between the number of tablets received and the number administered. Staff said they received training on privacy, dignity and respect during their induction training. Issues about privacy and dignity were noted in several care plans. People using the service said that staff were polite and respectful. One said, “they are always very polite and always give a knock before they come in.” During the course of the visit staff were heard to address people respectfully. All personal care and treatment was provided in private. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 15 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 had choice and control over their daily lives and others were assisted by staff who had some knowledge of their wishes and preferences. The social and recreational needs of some people living at the home were not always met because of a lack of appropriate activities. EVIDENCE: There were mixed views about the activities in the home. A number of people spoken to during the visit said that they occupied themselves most of the time but occasionally enjoyed a game of dominoes or other entertainment. Some people commented that there were more activities on offer just recently but others said they did not have enough to do. One person wrote on their survey that they would like a bit of company now and again. One person who preferred to stay in their room said they felt very lonely sometimes. Another said that they did not want to join in activities but they would like the staff to have time for a chat. Staff said that the activities arranged by the coordinators had increased but they still did not have the time to provide any social or recreational activities. One care-worker said, “it would be nice to have some quality time with residents.” The manager acknowledged that Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 16 further improvements needed to be made and had plans to allocate more hours to providing activities. Religious services were held at the home and anyone could attend if they wished to. One person said, “My own vicar comes to see me but I also see the Catholic priest and the Methodist minister.” People’s individual religious and cultural needs were recorded on their plans. People using the service said that there were no rules in the home and they could get up and go to bed when they wanted, they could do what they wished and spend time in their rooms or in the lounge. One person said that they could make their own choices about everything. The new care plans contained information about peoples likes, dislikes and preferences in a number of areas. This meant that if staff had to make choices or decisions on behalf of people they had some background information to help them. Staff talked about the importance of helping people to keep their independence and enable them to have as much control over their lives as possible. There was an open visiting policy. One relative said they were made to feel as welcome as if they were family. Visitors were able to stay and have a meal with their relatives if they wished. Most people tended to go out with relatives although staff said there had been a recent increase in outings organised by the activity co-ordinators. One person said he was very happy that his dogs were allowed to come and visit him. Most people said they liked the meals. One person said, “It is usually five star, only very occasionally I don’t enjoy it.” Another person said the food was excellent and another commented that the staff always tried to get them something they like. The record of meals served showed that people often requested and were given meals that were not on the menu. The chef ensured that there were at least five portions of fruit and vegetables for people to choose on each daily menu. He had also introduced a points system into the menus to ensure that they were nutritiously balanced. People could choose where they wanted to eat their meals. The atmosphere in the dining rooms was relaxed and unhurried. Staff provided supervision and assistance sensitively. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 17 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. People using the service were protected by the policies of the home. EVIDENCE: There was a copy of the complaints procedure in the information pack in every bedroom and there was a large print summary on display in key areas of the home. The procedure indicated how to make a complaint and to whom. Records showed that complaints were investigated and responded to within the agreed timescales. People who completed surveys indicated that they knew how to make a complaint and people spoken with during the visit named members of staff they would talk to if they had any complaints. One person said, “if there is anything wrong they do their best to put it right.” Relatives also indicated that they were aware of the complaints procedure and that any concerns were acted upon. The organisation had issued new guidance on recognising and reporting abuse, which dovetailed with the local authority procedure. At the time of the visit the policy had not been given out to all staff and not all staff had received training in safeguarding adults. This could result in the guidance not being incorporated into practice. However, all staff spoken with at the time of the visit were clear about their responsibility, and how to report any allegations of abuse. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained. The standard of décor and furnishings provided people with a safe, comfortable and homely place to live. EVIDENCE: Improvements to the environment noted at the last inspection had continued. Cherry House had been redecorated and had new furniture and soft furnishings and Rowan House had been partially decorated. The corridors and communal areas in Rowan House were decorated with memory boxes, pictures and activity boards designed to provide visual and tactile stimulation for the people using the service. A programme to replace the worn and scuffed vinyl floors on Holly House had commenced. The home was well maintained and any minor repairs were attended to immediately. The gardens were very well kept and accessible to everyone Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 19 using the service. The manager stated that the aim for the next year was to make the home more personal and to renew furniture throughout. People using the service said they were happy with their bedrooms. One said “the bedrooms are good, plenty of drawers and wardrobe space.” Another commented that she was happy with her room as she had all her own things in. People said they could have locks put on if they wished, one person said he had his put on because another resident went into his room when he was out. There was no evidence that people were told they could have locks on their doors when they were admitted. The same was true of bedside lights, which were not routinely available, but the manager said could be purchased if people requested. It was evident from a tour of the premises that there were improvements in the cleanliness of the home. People using the service said that it was, “cleaned thoroughly every day,” and “always very clean.” One person said that the bathrooms could be a bit better sometimes. On further inspection the bathrooms were generally clean but there were some areas with rusty pipes, chipped paint and discoloured toilet seats, which gave them the appearance of looking dirty. At the time of the visit there were no offensive odours. A relative said that odour control had been discussed in a resident and relative meeting and as a result new, automatic sprays had been put in the houses. She said this had improved the situation. People using the service were satisfied with the laundry. One said, “full praise for the laundry; a great service.” Staff had access to guidance on infection control procedures and they were seen to be wearing protective clothing when necessary. Guidelines for cleaning and handling potentially infectious material were on display in staff areas. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels did not meet everyone’s needs and recruitment and training did not completely safeguard people using the service. EVIDENCE: Extra nursing staff had been rostered on Holly and Rowan since the last inspection. A “twilight” shift had also been introduced on Cherry House to provide extra support to people during the evening and at bedtime. The manager stated that she had some flexibility to make further increases to staff on Holly House to meet the complex needs and dependencies of the people admitted for continuing care. The manager continued to reduce the number of shifts covered by agency staff. A number of people using the service said that they thought the home was short of staff. One person said that when they pressed the buzzer staff didn’t come as quickly as they used to. Another person said, “they work jolly hard and sometimes they are a bit pushed.” One person, who was at the home on a temporary basis, said they would not stay because they had to wait too long for help to go to the toilet. They acknowledged it wasn’t the fault of the staff, just that they were too busy. Other people also mentioned problems in having to wait to be assisted to use the toilet. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 21 The files of three new members of staff were inspected. The manager stated that any staff who commenced work following a satisfactory POVA first check were supervised by senior staff until their CRB disclosure was returned. All staff had two written references. However, not all other pre-employment checks to safeguard people had been completed. For example, one member of staff had not provided an explanation for gaps in their employment history. The reason given by another applicant for leaving their previous job in care differed from that given by their referee. There was no evidence on two out of the three files that staff had received any initial induction to the home. The induction portfolios for three other staff showed that they had worked through an induction programme that met the common induction standards. However, none had had their competency assessed or been signed off by their mentor. It was not possible to see which staff had completed training in health and safety topics and dementia care because the training matrix for each house was not up to date. The manager stated that the information could be found on individual files but this was not the most practical way to audit training activity. A member of staff had been identified to co-ordinate training and complete records, which the manager said should address the problem. Information submitted by the manager prior to the visit showed that 55 of care staff were qualified to NVQ level 2 or above. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was run, by a competent manager in the best interests of the people living there. EVIDENCE: The manager was recently registered with the Commission for Social Care Inspection. The manager is a registered nurse and has experience of managing nursing homes. She keeps her clinical knowledge and skills up to date by attending training courses and she has completed the NVQ 4 in management. The manager is supported by a clinical services manager who shares some of the responsibility for monitoring and improving the standards of care in the home. Each house and other department in the home had an identified manager who is involved in the development of the service. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 23 There were a number of ways that the quality of the service was monitored and improved upon. The organisation sent out surveys to people using the service and their relatives. The results of the most recent survey showed that the level of quality had been maintained or improved in most areas. Any shortfalls were included on an action plan, which formed part of the manager’s objectives for the year. There were internal audits for procedures and processes such as care plans, medication and complaints. The manager had recently won a gold award from the local authority for making reasonable adjustments to employ and support people with disabilities. Records showed that most staff were receiving formal supervision from their line manager. Annual appraisals were also carried out to monitor staff performance and highlight further training needs. The organisation acted as appointee for four people. Transactions carried out on their behalf were recorded and audited. Personal allowances managed on behalf of other people living at the home were banked in the resident account. Receipts were provided for any monies handed over for safekeeping. A monthly statement provided information about current balance and interest accrued. People could ask for information about their personal balance at any time. A new fire procedure was on display in key areas of the home. It reflected the overall procedure to be followed in the event of a fire but did not go into detail about staff roles and responsibilities. Most of the staff spoken with were aware of which grades of staff attended the fire panel and who would stay with residents. However, two of the newer staff were not clear about what their roles were. They had received information about the fire procedure on their initial induction but had not been involved in any practice drills or follow up training. All fire safety equipment had been serviced. Certificates were available to evidence maintenance of other installations and equipment in the home. Some environmental risk assessments had been brought up to date. Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2) Requirement 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 30/06/05 not met) People using the service and/or their relatives must have opportunities to be involved in drawing up their care plans so that they can have a say about how their care is to be provided. (Timescale of 30/06/05 not met) 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 30/06/06 not met) Accurate records must be kept of medicines received into the home to ensure effective stock control and to provide an audit trail. Timescale for action 31/07/07 2. OP7 15(1)(2) 31/07/07 3. OP8 13(4) 30/06/07 4. OP9 13(2) 22/06/07 Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 26 5. OP12 16(2)(nm) The registered person must 31/08/07 ensure that people using the service have access to a range of activities appropriate to their diverse interests and abilities. (Timescale of 31/12/05 not met) In order to ensure that new staff are fit to work with vulnerable people the registered person must complete all preemployment checks and obtain all the required information and documents before a member of staff commences work at the home. (Timescale of 31/03/07 not met.) All staff must receive sufficient fire safety training and practice drills to ensure that they are completely clear about their role in the event of a fire. 22/06/07 6. OP29 19(4) Schedule 2 7. OP38 23(d)(e) 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Staff should make sure that identified risks to people’s health, such as risks of falls or nutritional risk are addressed within their care plan. 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. There should be adequate supplies of medication so that everyone receives their medicines as they are prescribed. DS0000022478.V335504.R01.S.doc Version 5.2 Page 27 2. OP9 3. OP9 Old Gates Nursing & Residential Home 4. 5. 6. OP9 OP18 OP26 Weekly medication audits should be robust enough to identify any discrepancies in administration. Staff should have training in safeguarding adults to assist them to recognise and deal with suspected abuse. The bathrooms should be included on the programme of redecoration and renewal to improve the overall environment for people who live at the home. Staffing levels throughout the home should be reviewed to ensure that there are sufficient staff on duty at all times to meet the needs of people using the service. The training records should be brought up to date and any shortfalls in training should be addressed. Induction training programmes should be signed off when staff have attained the required level of knowledge and skill to work with people living in the home. 7. OP27 8. 9. OP30 OP30 Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Old Gates Nursing & Residential Home DS0000022478.V335504.R01.S.doc Version 5.2 Page 29 - 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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