Inspection on 06/06/06 for Old Gates Nursing & Residential Home

This inspection was carried out on 6th June 2006.

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

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

Other inspections for this house

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

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

Old Gates Nursing & Residential... 27/05/08

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

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Old Gates Nursing & Residential Home Livesey Branch Road Feniscowles Blackburn Lancashire BB2 5BU Lead Inspector Jane Craig Unannounced Inspection 09:30 6 and 7th June 2006 th 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.V287484.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 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 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.V287484.R01.S.doc Version 5.1 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 category 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. 1st November 2005 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 modern, purpose built, single storey building. It comprises one reception area and three separate houses. Holly House accommodates service users with nursing care needs. Rowan House accommodates service users 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.V287484.R01.S.doc Version 5.1 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 BUPA brochure with some specific information about Old Gates is sent out to anyone making enquiries about a placement. The Commission for Social Care Inspection reports are available from the manager on request. The weekly fees as of 8th June 2006 ranged between £354 and £475 for residents funded by they local authority and £446 and £559 for residents who fund themselves. Additional charges are made for hairdressing, newspapers and toiletries. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place over 2 days and was carried out by 2 inspectors. Six of the comment cards, sent out to residents or visitors before the inspection, were returned. At the time of the visit there were 85 residents accommodated in the home. The inspectors met with a number of residents and visitors and spent time observing interactions between staff and residents. Wherever possible residents were asked about their views and experiences of living in the home and some of their comments are quoted in this report. Discussions were held with the manager and six members of staff. The inspectors made a tour of the premises and looked at a number of bedrooms. Records and documents were viewed. What the service does well: Staff showed respect for residents in the way they spoke to them. They understood their needs for privacy and helped residents to maintain their dignity, for example, by making sure they were dressed appropriately. Residents and their relatives were very complimentary about the staff. Their comments included, “staff are grand, good workers,” and “I can’t praise them enough.” Residents were happy with the routines in the home and said they could make their own choices about when to get up and what to do during the day. Staff made choices for residents who were not able but there was not always enough information written down about residents’ likes and dislikes to help staff to make those choices. Residents and relatives appreciated the open visiting policy. A resident told the inspector, “they are very good about visitors, you can have them whenever you want.” A relative said that one of the reasons the home was ideal “mainly because she can have visitors when the visitors want to come.” Visitors could have meals with the residents if they wished. Most of the residents who were asked said they liked the meals. Their comments included, “we have a good dinner every day,” and “the food’s good you get a choice at dinner and tea.” Mealtimes were relaxed and social events but on Holly House high dependencies and minimum staff meant that some residents had to wait to be assisted. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 7 There was a clear complaints procedure. Records showed that formal complaints were investigated and acted upon but minor complaints were not always resolved. The way that new staff were recruited provided safeguards for residents. The new manager made sure that staff had background checks before they started work at the home. The way that residents’ money was looked after was safe. The administrator kept thorough records and made sure that there were receipts for any money residents spent. What has improved since the last inspection? What they could do better: The manager should send out information about the home before residents are admitted. This may help residents to make a decision about whether the facilities at Old Gates would be suitable for them. Prospective residents should also be assessed by senior staff from the home. This would make sure that the resident’s needs are understood and can be met. It would also help staff to make a decision about whether the resident would fit in to the home. Written care plans did not always give staff enough directions about what care the resident needed. The plans were not always kept up to date which meant that staff might not know if the resident’s care needs had changed. Residents or their relatives were not generally involved in talks about their care. There were concerns that the residents’ medication was not managed safely. A few bedrooms had been decorated but there were still a number of areas that needed redecoration and new furnishings. Several bedrooms on Holly House had old marked and torn vinyl on the floor. This must be replaced. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 8 There must be an improvement in the cleanliness of bedrooms, especially on Rowan House, to make sure that residents are comfortable and safe. Some areas of the home were very busy and the staffing levels should be planned to take into consideration to how much care the residents need. Staff did not have enough training. The staff working with residents with dementia did not all have training to understand the special needs of these residents. Health and safety training was not up to date which may affect the safety of all residents and staff. There were not enough staff who held the National Vocational Qualification (NVQ). There were some shortfalls that could affect the health and safety of residents, staff and visitors. For example one of the fire doors on Rowan House was not in good working order and the service for the electrical installation was overdue. 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. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents were not given enough written information about the home to help them to make an informed choice. Inadequate pre-admission assessments may result in a lack of understanding of residents’ needs. EVIDENCE: Residents did not receive a service user’s guide or statement of terms and conditions of residency until they had moved into the home for a trial period. The service user’s guide contained out of date information. The files of new residents contained assessments carried out by health and social care professionals. One resident on Cherry House had not been assessed by Old Gates staff before being offered a place. This meant that the resident’s needs had not been assessed in relation to the environment, staffing structures and the residents already living at Old Gates. Other pre-admission assessments did not include essential information about the resident. Residents did not receive written confirmation that their assessed needs could be met at the home. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although residents were treated with respect and their rights to privacy were upheld, staff did not have sufficient written guidance to understand and meet residents’ personal, social and health care needs. Some medication practices were not safe and placed residents at risk. EVIDENCE: The content and quality of care plans varied between the three houses. Plans on Rowan House generally outlined residents’ personal and social care needs and how they were to be met. However, plans did not provide adequate directions for staff on how to provide individual care for residents with dementia. Plans were reviewed every month and updated when necessary. There was no evidence that residents or relatives had been involved in planning and reviewing care. Although there had been some improvements to plans on Holly House there were still some shortfalls. For example, the assessment for one resident clearly identified communication needs but there was no plan of care. Plans were reviewed every month but were not accurate. For example, review notes for one resident for the last two months stated they continued to be aggressive Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 12 but there was no mention of this in the daily notes. On Holly House care plans were usually updated when residents’ needs changed but the additions were not always dated. A relative had signed agreement to the plans for one resident but other residents/relatives had not been involved. Following a previous requirement plans were written to include information and advice given by other health care professionals. There were major shortfalls in the plans on Cherry House. One recently admitted resident who had a number of serious physical health care needs did not have a plan of care. A member of staff spoken with was not aware of all the resident’s needs. Another resident who had been admitted in August 2005 did not have a care plan. A third resident had an incomplete set of care plans that were out of date and did not address current care needs. Residents on Rowan and Holly House had risk assessments to monitor and address health care risks. The moving and handling assessments were not always completed and two residents on Rowan House were seen to be assisted using inappropriate handling techniques. There were no risk assessments for the three residents case tracked on Cherry House. The use of bed rails for a resident on Holly House had not been reviewed even though her notes indicated that she may be at greater risk by climbing out of bed. Care plans to address psychological health care needs were not always adequate and the plan for one resident on Holly House indicated a lack of understanding of staff in caring for residents with dementia. Ongoing physical health care needs were generally monitored although there was sometimes lack of directions for staff. Lack of clear directions for a resident on Rowan House resulted in their blood sugar not being monitored closely enough even though it was unstable. A resident on Cherry House was being cared for through a terminal illness but there were no care plans in place. At the time of the inspection on Rowan House a resident became unwell and not all staff were clear about how he should be cared for. His notes showed that this was becoming a regular occurrence but there was no care plan in place. Despite this his relative said that staff were looking after him very well and got the doctor whenever necessary. Relatives had mixed views about the standards of care. One relative wrote that they had noticed that standards had dropped and a relative at the time of the inspection said the same. A relative stated that they did not think new staff understood his relative’s needs the same as old staff had. Other relatives spoken with were happy with the standard of care and their comments included; “very well looked after, always nicely dressed,” “he’s not been so well and they’ve been great,” and one said that when they go home they feel confident that their relative will be looked after. All the residents’ comments about their health and personal care were positive. One said, “if you’re poorly they see to you,” and another said “it’s better than hospital, they look after me well.” Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 13 There were shortfalls in the management of medicines in all three houses. There were no risk assessments to support residents on Cherry House who wished to self-medicate. There were no checks to monitor compliance. Medication was stored inappropriately in residents’ bedrooms. One resident had a tube of cream that she was no longer prescribed. The records of medicines received were incomplete on all houses. There were gaps on Medication Administration Record (MAR) charts, with no explanation as to why medicines had not been given. There was no MAR chart for a resident who gave their own insulin; therefore staff had no record of what was being administered. There were few records of creams being administered. On the day of the inspection one visitor was observed having to ask staff to put his father’s cream on. He said that it was rarely done. Several residents were prescribed when required and variable dose medicines. There were no written criteria to direct staff when medication should be given, which could result in over or under medicating. Handwritten instructions on MAR charts did not always match instructions on the medicine containers and they were not always double signed or dated. There were no records of controlled drugs that had been stored on Holly House for at least 2 months. Records of medication leaving the home were up to date and there were records of homely remedies. A pot of medicines was found in a resident’s room on Holly House. These were found to be from the previous night and included a tablet that was handled as a controlled drug. The night nurse had signed that the medicines had been administered and her entry in the controlled drug register had been signed and witnessed. A registered nurse on another house was observed signing several MAR charts at the same time. Staff from the houses had carried out some audits of medicines but these were found to be inaccurate in several cases. Storage areas were secure, clean and tidy. Storage temperatures were not always monitored. There were no excess stocks of medicines. Staff said they received training on care values during their induction. Those spoken with were able to give examples of how they maintained residents’ privacy and dignity by providing personal care in private, making sure that residents were dressed appropriately and “not taking their independence away.” At the time of the inspection visit staff were observed speaking to residents respectfully. Residents said they were able to “be private.” Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents who were able were encouraged to make their own choices and decisions but insufficient written information may result in wrong decisions and choices being made on behalf of less able residents. Social and recreational activities did not meet all residents’ expectations. Residents received a varied diet of their choice. EVIDENCE: There had been improvements in the level of activities in the home and a number of residents made mention of this. One said the activity person had “done more to make it a bit livelier.” Another said, “there is a new person, she does very well, there is more going on.” On the days of the inspection activities seen were walks in the garden, decorating for the world cup and a sing a long and dance. Other residents and relatives said there was still not enough stimulation. One said, “It’s alright but I would like to be doing something more.” Two of the regional manager’s reports on the home highlighted that residents thought there was a lack of activities but there was no obvious plan to address this. Residents on Rowan House had very good social care plans outlining their strengths and needs but there was no evidence that these were carried out. Staff said they didn’t usually have the time to assist with activities and one said, “the activity person is very good but there is only one of her for three houses and 90 residents.” Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 15 Residents said they were happy with the routines in the home. One resident said they were able to get up and go to bed when they wanted. Another said that they always got a cup of tea first thing, no matter what time they woke up. A third said they could choose where to sit and what to do. Throughout the visit staff were seen to consult residents about various things. Some residents were unable to communicate their needs. One member of staff said they would ask relatives about residents’ preferences but this was not always recorded so that the information was available to all staff. Another member of staff said they sometimes had to make decisions for residents based on their condition. For example, residents who were diabetic needed to be up by a certain time in the morning. Staff said there were a significant number of residents on Holly House who wanted to go to bed very early but there were not always enough staff to assist them. Residents and relatives were satisfied with the open visiting arrangements. One resident said “they are very good about visitors, you can have them whenever you want.” A relative told the inspector, “the place is ideal, mainly because she can have visitors when the visitors want to come.” Visitors were made welcome and offered drinks, several stayed for meals. There were not many opportunities for residents to go out unless it was with their families. One relative said, “staff used to take him out but they don’t now.” They said they were not given any reason why this had stopped. Residents’ views about the meals were mainly positive. Comments included, “dinners are good,” “good breakfast,” “the food’s perfect” and “the food’s good, you get a choice at dinner and tea.” One person said they had too much corned beef hash. Another said that although there was a choice of meals they were all very similar but they could always request a chop or chicken leg. The record of meals served showed that residents regularly requested and were given meals that were not on the menu. Records of meals showed a balanced and varied diet. Fresh fruit was available on the houses. The cook said that the menus had only just been reviewed and new dishes added. She said there was some consultation but two residents said they could not remember the last time they had been asked or filled in a questionnaire about food. Mealtimes were relaxed and social occasions. Some residents on Holly House had to wait to be helped with their meals. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure ensured that formal complaints were investigated and acted upon. The lack of staff training in protection of vulnerable adults could result in abuse being undetected and unreported. EVIDENCE: The complaints procedure was on display in the home. Residents did not receive a copy in their information pack and two relatives said they were not aware of the procedure. Two residents who returned comment cards said they knew who to speak to if they had a complaint and one resident said they would speak to matron if they had concerns about their care. There had been four complaints since the last inspection and records showed that the manager had investigated and responded appropriately to all. However, some residents and relatives said they had spoken to staff on more than one occasion about small issues, (some have been included in this report) but nothing had changed. Not all staff had received training in the protection of vulnerable adults. All staff were aware of their responsibility to report witnessed or suspected abuse within the company. However, not all senior staff were aware of the need to report to the adult protection team in line with the local authority procedure. The company procedure for protection of vulnerable adults was not complete and available at the time of the inspection and staff were not completely clear about its contents. The manager stated that the company head office would undertake any referral to the POVA list. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 17 Following a requirement at the last inspection the written interventions for dealing with residents’ aggressive behaviour were clearer and staff said they no longer employed restraint or breakaway techniques with any residents. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The poor standard of décor and furnishings in some areas and deterioration in cleanliness in some areas detracted from residents’ comfort. EVIDENCE: Some of the redecoration and refurbishment identified during the last inspection had been carried out, but there were a number of areas that still needed attention. These were discussed with the maintenance person who stated that there was a planned refurbishment of Cherry House this year and money had been allocated for new floor coverings in Cherry and Holly House. A group of residents on Cherry House said they had made a complaint to the regional manager about noisy pipes but nothing had been done. There was a loud banging at one point during the inspection but residents and staff said it was sometimes much louder. One resident said she was unable to hear her TV above it. This was reported to the maintenance person at the inspection. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 19 Several residents made mention of the gardens which were very well maintained. One resident said, “there’s nothing to touch this garden, it’s beautiful.” Residents were satisfied with their bedrooms, many of which were highly personalised. One said, “I was really pleased when they showed me this room.” Another commented, “I’m short of nothing.” The company still did not provide bedside lights as a matter of routine and residents who wanted one had to purchase their own. The communal areas of the home were clean and tidy but some of the cleanliness issues highlighted during the last inspection had not been addressed. Several bedrooms had furnishings that were stained with faeces. These were mainly on Rowan House but a few were also noted on Cherry and Holly. A number of wheelchairs and bedside tables were encrusted with food debris. Some bedrooms did not have a waste bin. A relative said he had complained to staff about this on three occasions but nothing had been done. The extractor fan in one of the toilets in Cherry House was completely clogged and ineffective. Residents on Cherry House said that they often found toilets dirty or blocked. They said they had reported this but nothing had been done. One of the relatives who completed a comment card referred to Rowan House frequently being malodorous. The laundry was adequately equipped and there were sufficient hours allocated to laundry staff. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment practices provided safeguards for residents. Staffing levels in some areas of the home may not always be sufficient to meet the needs of residents. Shortfalls in staff training may result in residents’ needs not being understood. EVIDENCE: Duty rosters showed which staff were on duty and at what times. Staff, residents and relatives said that at times they did not think there were enough staff on duty on Holly House. Comments from residents included “staff are pushed,” and “very busy.” One relative said that “a couple of times they slip up but that’s because they are so busy.” Staff said they did not have time to do activities with residents. One member of staff described Holly House as being like a “small hospital.” In the afternoon and evening the staffing levels were reduced to 2 nurses and 2 care staff to care for up to 28 residents. At the time of the inspection staff said that most residents needed the help of two staff for all personal care and eight residents needed help to eat their meals. One member of staff said, “it causes stress if you are with someone and someone else buzzes, they can get impatient.” The manager stated that the BUPA quality team had been involved in looking at staffing levels and dependencies of residents but there was no feedback at the time of the visit. Residents and relatives were very positive in their comments about staff throughout the home. One resident said, “staff are grand, good workers.” Others said, “I find the nurses very, very good,” and “the regular girls are Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 21 absolutely great.” Relatives comments included, “can’t say enough about them,” and “I can’t praise them highly enough.” Four staff files were inspected. One member of staff had left the home last year and returned after a month. There was no evidence of re-employment on her file and she was not asked to complete a new Criminal Record Bureau (CRB) disclosure. Three staff employed by the new manager had received CRB disclosures before starting work at the home. They had most of the required information and documents on file but references were not always taken up from the last employer and there was no evidence that gaps in employment were explored. The use of agency staff had decreased over the past few months. A new member of staff said their initial induction included orientation to the home, policies and emergency procedures. New staff were supernumerary for the first shifts when they shadowed more experienced staff. The induction programme did not meet the latest standards set by the National Training Organisation. There were other opportunities for training and staff discussed recent courses in communication and infection control. However, not all staff working with residents with dementia had received appropriate training. Records were not clear enough to be able to confirm what training each member of staff had undertaken. The manager said that training in safe working practice topics was not up to date. Only 28 of care staff were trained to NVQ level 2 or above. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An experienced manager had been appointed. Residents had opportunities to make their views known but had little influence on service but their safety maybe put at risk because of some shortfalls in health and safety practices. EVIDENCE: A new manager had been appointed since the last inspection. The manager is a registered nurse and has experience of managing nursing homes. She is undertaking a series of short management courses arranged by BUPA and is also enrolled on the NVQ 4 in management. A new part time post of Clinical Services Manager had been created since the last inspection. One of the aims of the post is to support the manager in improving care services but the role had not been fully developed at the time of the inspection. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 23 The home held the Blackburn with Darwen quality assurance award. BUPA carried out a resident and relative survey about Old Gates twice a year and the results of the last survey were published in March 2006. One of the comments made by residents was the use of agency staff and the manager had addressed this soon after her appointment. However, there was no action plan to tackle other areas that residents had identified as needing improvement. The BUPA quality team had carried out a recent review of Holly House and made several recommendations. There was no action plan to address these. Internal audits had been carried out on care plans and medication. The care plan audits had not identified the lack of plans on Cherry House. The medication audit was inaccurate in more than one case. The manager held weekly meetings for the managers of each department and staff meetings were held on the units every two months. Minutes of these meetings were available. A number of requirements and recommendations made at previous inspections were not met and have been carried forward. The administrator was the appointee for two residents. Transactions carried out on behalf of residents were recorded. Receipts were provided for monies handed over for safekeeping. Any personal allowances managed on behalf of residents were banked in the resident account. A monthly statement provided information about current balance and interest accrued. One member of staff talked about formal supervision and how the process had helped them to identify further training needs. Not all other staff were receiving supervision from their line manager. With one exception the heads of department did not have one to one supervision with the manager. The fire risk assessment was available as recommended during the fire officer’s last visit. Most staff had completed fire safety training. Servicing and testing of the fire system, equipment and alarms was up to date. The lock had been removed from a fire door on Rowan House; consequently there was a hole in the door that could compromise fire safety. Servicing of the electrical installation was overdue. Maintenance and testing of other installations, equipment and appliances was up to date. Some of the environmental risk assessments were out of date. There were no potentially hazardous items found to be stored in residents’ rooms. Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 25 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 26 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 OP1 Regulation 6(a) Requirement The registered person must keep the service user’s guide under review and update it when appropriate. Residents must not be offered admission unless their needs have been fully assessed and can be met at the home. (Timescale of 31/12/05 not met) The registered person must provide written confirmation to a resident that their assessed needs can be met in the home. All residents must have a plan of care. Care plans must set out details of the resident’s personal, social and health care needs (physical and psychological) and how these are to be met. (Timescale of 31/08/05 not met) Care plans must be kept up to date in accordance with changes in the resident’s care needs. (Timescale of 30/06/05 not met) The registered person must provide opportunities for residents or their representatives to be involved in drawing up and reviewing care plans. (Timescale of 30/06/05 not met) DS0000022478.V287484.R01.S.doc Timescale for action 30/06/06 2. OP3 14(1) 30/06/06 3. OP3 14(1)(d) 30/06/06 4. 5. OP7 OP7 15(1) 15(1) 30/06/06 30/09/06 6. OP7 15(2) 30/09/06 7. OP7 15(1)(2) 30/09/06 Old Gates Nursing & Residential Home Version 5.1 Page 27 8. OP8 13(4) 9. OP8 13(4) 10. OP8 13(4)(5) 11. OP9 13(2) 12. OP9 13(2) 13. OP9 13(2) 14. 15. OP9 OP9 13(2) 13(2) 16. OP9 13(2) The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This would include the risk of falls, nutritional risk, risk of pressure sore development and manual handling risks. (Timescale of 31/08/05 not met) Bed rails and other forms of restraint must not be used unless the resident’s assessment clearly indicates that this is the most appropriate way of controlling the risk. The moving and handling arrangements for residents on Rowan House must be reviewed to ensure that residents are assisted to move safely. The manager must ensure that self-medication is promoted where appropriate. Risk assessments must be completed (and reviewed) and the resident provided with secure storage facilities within their private room. (Timescale of 31/07/05 not met) Medicines must be administered as prescribed. This would include creams as well as tablets and medicines. Accurate records must be kept of: Medicines prescribed to each resident. Medicines received into the home.Medicines administered to residents. Out of date medicines, including eye drops, must be discarded. Records, storage and administration of controlled drugs must be accurate and appropriate. Handwritten instructions on MAR DS0000022478.V287484.R01.S.doc 31/07/06 30/06/06 30/06/06 12/06/06 09/06/06 09/06/06 09/06/06 09/06/06 09/06/06 Page 28 Old Gates Nursing & Residential Home Version 5.1 17. OP12 16(2)(nm) 18 OP18 13(6) 19. OP19 23(2)(d) 20. OP19 23(2)(b) 21. OP26 16(2)(k) 22. OP29 19(4) Schedule 2 18 23. OP30 24. OP31 8 charts must accurately reflect those on medicine containers. Suitable arrangements must be made to enable residents to engage in local, social and community activities. (Timescale of 31/12/05 not met) The registered person must ensure that the manager and all staff have training in adult protection. They must be aware of their responsibilities in handling any allegations in line with the local authority procedure (Timescale of 31/08/05 not met) The registered person must ensure a reasonable standard of decoration in all areas of the home. (Timescale of 30/04/06 not met) The registered person must investigate and eliminate the cause of the noisy pipes on Cherry House. The registered person must ensure that all parts of the home are kept clean and free from offensive odours. (Timescale of 31/07/05 not met) The registered person must ensure that all documents and information required to be held about staff are obtained and retained. All staff must have up to date training in the safe working practice topics. The depth of training must be suitable and relevant to their job role. The manager must submit an application for registration with the Commission for Social Care Inspection. All care staff working at the home must be appropriately DS0000022478.V287484.R01.S.doc 31/08/06 31/10/06 31/12/06 31/07/06 30/06/06 30/06/06 31/10/06 30/06/06 25. OP36 18(2) 31/08/06 Version 5.1 Page 29 Old Gates Nursing & Residential Home 26. 27. OP38 OP38 13(4) 13(4) supervised. Servicing of the electrical installation must be carried out. All fire doors must be in good working order. 30/06/06 12/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP9 Good Practice Recommendations Pre-admission assessments should be signed and dated. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. A second member of staff should witness all hand written annotations on Medication Administration Record charts. Care plans should contain details of residents’ likes, dislikes and preferences about their daily life and routines. There should be a procedure to ensure that minor, verbal complaints are dealt with. The manager and staff should have access to the company policy on protection of vulnerable adults. Furnishings in individual rooms should include bedside lighting. Staffing levels throughout the home should be reviewed in accordance with residents’ needs and dependency levels. At least 50 of care staff should be trained to NVQ level 2. The training records should be brought up to date. The induction training for care staff should meet the standards of the national training organisation. Staff working with residents with dementia should have relevant training. The systems for monitoring and improving the quality of care in the home should be further developed. Environmental risk assessments should be brought up to date. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. OP14 OP16 OP18 OP24 OP27 OP28 OP30 OP30 OP30 OP33 OP38 Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Gates Nursing & Residential Home DS0000022478.V287484.R01.S.doc Version 5.1 Page 31 - 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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