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Inspection on 26/09/05 for Perry Locks Nursing Home

Also see our care home review for Perry Locks Nursing Home for more information

This inspection was carried out on 26th September 2005.

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

Perry Locks provides a friendly, homely, clean and comfortable environment in which to live, where residents are well supported by the care staff to meet their health, welfare and personal care needs. Residents can personalise their own bedrooms to reflect their individual tastes to ensure that they feel comfortable in their surroundings, they are able to exercise choice over their daily lives and this promotes independence and individuality, they can have a lock and key to their bedroom door if they wish to. Residents are offered a choice of meal and special diets are catered for. One resident said "there is always plenty to choose from and there are always alternatives" Prior to the inspection thirty-one comment cards were received by the CSCI about the service provided at Perry Locks, the majority of these were very positive in nature and comments included: "We have been extremely pleased with the care and attention mother has received at Perry Locks" "Staff are genuinely caring and take time to talk with the residents" "The home is superb" "I like the activities, bingo, current affairs, crafts and have plenty of visitors" "They will bring you a cup of tea in the night" The manager responded well to the immediate requirements and had actioned some of these before the inspector completed the inspection.

What has improved since the last inspection?

The home has re-decorated the lounges on Brooklyn and Lawrence House, and many bedrooms throughout the home. Care planning on Perrywell House has improved and provides more detail for staff to ensure residents receive good continuity of care.

What the care home could do better:

Medicine management remains an issue within the home and the home must endeavour to improve practice to a safe level. Care plans throughout the site require further improvements to ensure that they are written for acute care needs and that risk assessment and continence assessments are fully completed. The manager stated "we can do everything better and continue to improve all the time"

CARE HOMES FOR OLDER PEOPLE Perry Locks Nursing Home 398 Aldridge Road Perry Barr Birmingham B44 8BG Lead Inspector Lisa Evitts Announced 26 & 27 September 2005 th th 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 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. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Perry Locks Nursing Home Address 398 Aldridge Road Perry Barr Birmingham B44 8BG 0121 356 0598 0121 331 1261 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Ltd Sarah Slym Care Home 120 Category(ies) of Physical Disability - Over 65 - Physical Disability registration, with number Dementia - Over 65 - Dementia - - Old Age of places Mental Disorder - - Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Males & females over 50 years. 2. Care Home for service user categories OP, DE(E), DE, PD(E) PD, MD and people over 50 with dementia or physical disabilities requiring continuing care. 3. The Registered Manager achieves a relevant management qualification by 2005. 4. That two named service users (names held on CSCI file) under the age of 50 may be accommodated. Date of last inspection 21st June 2005 Brief Description of the Service: Perry Locks is a modern purpose built Nursing Home and is part of the BUPA organisation. The home comprises of four separate houses, each with thirty beds. Three houses are registered for nursing care: Lawrence, Brooklyn and Calthorpe and Perrywell house for dementia care. All four units take residents requiring respite care. All houses have access to small landscaped gardens (Perrywell is safely enclosed) and there is ample parking facilities at the front of the home. In addition to the Registered Manager, there is also a Clinical Team manager and a Senior Nurse on each house/unit. The home is situated beside a canal in a residential area, four miles from Birmingham City Centre. It is on a local bus route and local shops are only a short distance away. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was undertaken by four inspectors, including the pharmacy inspector, over one and a half days, and was assisted throughout by the Registered Manager and Clinical Team Manager. There were 117 residents living at the home at the time of the inspection. Information was gathered from talking with the residents, staff and from observing the care staff performing their duties and examining care and medication records. What the service does well: Perry Locks provides a friendly, homely, clean and comfortable environment in which to live, where residents are well supported by the care staff to meet their health, welfare and personal care needs. Residents can personalise their own bedrooms to reflect their individual tastes to ensure that they feel comfortable in their surroundings, they are able to exercise choice over their daily lives and this promotes independence and individuality, they can have a lock and key to their bedroom door if they wish to. Residents are offered a choice of meal and special diets are catered for. One resident said “there is always plenty to choose from and there are always alternatives” Prior to the inspection thirty-one comment cards were received by the CSCI about the service provided at Perry Locks, the majority of these were very positive in nature and comments included: “We have been extremely pleased with the care and attention mother has received at Perry Locks” “Staff are genuinely caring and take time to talk with the residents” “The home is superb” “I like the activities, bingo, current affairs, crafts and have plenty of visitors” “They will bring you a cup of tea in the night” The manager responded well to the immediate requirements and had actioned some of these before the inspector completed the inspection. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 8 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 standard(s) 1,2,3 & 5 The home provides prospective residents and their representatives with relevant information about the home and this enables them to make a decision as to the suitability of the home. The home has comprehensive pre admission assessments in place. EVIDENCE: The home provides a service user guide to each resident in the form of the home brochure; the brochure provides excellent information in relation to the services and facilities the home provides. A Statement of Purpose was taken for review and was found to contain all the relevant information about the home. Terms and conditions of residency are issued to each resident when they move into the home. Residents and their relatives are encouraged to visit the home prior to admission and one resident said, “ both my daughters came to look around while I was waiting for a bed”. Each resident has a completed comprehensive assessment on file. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 9 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 standard(s) 7,8,9 &10 Resident’s health and personal care needs were generally well met by the care staff. Written care plans need further development to ensure that they include sufficient detail enabling good continuity of care to be provided. Medicine management remains an issue within the home and the home must endeavour to improve practice to a safe level. EVIDENCE: Samples of care plans were reviewed on each house and standards were variable between each house. The clinical team manager had undertaken an audit of all care plans, but staff had not addressed the issues identified. Each resident had a separate set of care plans, which generally recorded the personal preferences of the residents. There was limited evidence that family had been involved in care planning process. Comprehensive pre admission documentation is utilised, although not always available on the individual residents file. Not all care plans for moving & handling stated the size of sling and it is recommended that staff have training in how to measure for this. The moving and handling assessment does not give details how to move a resident from the floor. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 10 Bed rail risk assessments are in place but they do not give details of the potential hazards. Brooklyn house Two files were reviewed. One resident who remains in bed, had not had any entries made into the activity care plan since January. Doctor’s visits were clearly recorded. Consent forms had not been signed for photography. Care plans and risk assessments were inadequate or not available in respect of continence, weight loss, nutritional needs, pressure area care and mobility. A care plan regarding nutritional needs was confusing. One resident was currently sleeping in her chair and this was not evident on the care plan. Daily reports were very detailed. Key Worker diary entries were inconsistent. The pharmacy inspector reviewed medication and the majority of audits undertaken were accurate, indicating that the medicines had been administered as prescribed. Inadequate checks were evidenced for the receipt of medicine in some instances. One Controlled Drug was recorded accurately in the CD register but not recorded on the Medicine Administration Record (MAR) chart. Lawrence house One file was reviewed and a comprehensive nursing assessment had been completed with individual likes and dislikes recorded. There was evidence of G.P, optician and chiropody visits. Specific care plans and risk assessments for continence, diabetes acute needs, wound care and nasogastric feeding were absent or incomplete. Entries in daily reports were not reflected in the care plans, as they had not been evaluated since July. Key worker diary had only had two entries made, in July and September. The medication room and refrigerator were too hot at the time of the inspection to safely store medicines. Oxygen cylinders were not chained to the wall in the medication room. The quantities of medicines received had not been routinely recorded so audits could not be undertaken to demonstrate they had been administered as prescribed. One medicine was inaccurately recorded on the Medicine Administration Record (MAR) chart. It could be demonstrated that they had been administered correctly but this was not reflected on the Medicine Administration Record (MAR) chart. An unlabelled pot containing some tablets was found in the trolley. It could not be demonstrated who they belonged to. The Controlled Drug cabinet contained medicines for service users that were no longer required. One Controlled Drug was recorded as administered but none were available at the time of the inspection, nor was it recorded in the Controlled Drug register. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 11 Calthorpe house Care plans were detailed and gave information about specific likes and dislikes. Wound care plans were well documented. There was evidence of visits from external professionals and daily reports were very informative. Care plans for continence and continence assessments were not fully completed. Risk assessments had not been completed in respect of manual handling, use of bed rails, and safe bathing. Acute care needs care plans had not been written. Social assessments and activity reports were detailed. Variable doses of medications had not been recorded so it could not be demonstrated how many tablets had been administered. One medicine was available for administration but was not recorded on the Medicine Administration Record (MAR) chart, indicating inadequate checking in and poor administration procedures. The trolley was too small to hold all the medicines received and this resulted in medicines being poorly stored within. Quantities and carry over balances had not been routinely recorded so audits were difficult to perform to confirm staff are administering medicines as prescribed. Inadequate checking procedures for new medicines received into the unit were found. Perrywell house It was clear that care planning had improved significantly on this house since the last inspection. Map of life and social assessments provided detailed information about the resident’s interests and hobbies. Manual handling assessments, continence assessments, nutritional and pressure sore risk assessments were evaluated monthly. General safety risk assessments were also in place, for example a falls risk assessment with indicators of when to implement a care plan. Care plans identified short and long-term needs, and provided clear actions for staff to follow, these were evaluated monthly. Key workers had also written regular records, however one of the files reviewed found that entries regarding behaviour contradicted the care plan. Visits from the General Practitioner were recorded separately. There was evidence of visits from tissue viability nurses and wound care was well documented. It is recommended that visits from external professionals are documented separately for ease of monitoring. One file reviewed showed that challenging behaviour was evident between two of the residents and no risk assessment was in place to provide staff with guidance to minimise this risk. One file did not have a care plan for continence devised, therefore was no specific details for staff to follow. Progress reports were written daily and reflected the care plans. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 12 It was noted that residents on Perrywell did not have ready access to the hairdresser, due to concerns about behaviour. A solution to this must be found. The medicine management was poor in this unit. Inadequate checks had been made for medicines received into the home. Audits indicated that the medicines had not been administered as prescribed in all instances. Medicines had been signed as administered when they had not been. Conversely medicines were unaccounted for. Medicines remained in the trolley that had no longer been prescribed which may have lead to the service user inadvertently being administered them. One Medicine Administration Record (MAR) chart recorded a different dosage to that prescribed. Medicines were not available for administration despite being prescribed. Medicines were incorrectly stored in some instances. Eye drops found did not have a date of opening so it could not be demonstrated that these had been opened for less that 28 days as stated in their product licence to reduce the risk of microbial contamination. The refrigerator temperatures were outside the recommended limits to safely store medicines requiring refrigeration. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 15 Residents are able to exercise their choice over their daily lives, community contact and the activities, which they choose to participate in, which promotes their individuality and independence. Residents receive a wholesome and varied diet, which meets any specific dietary needs. EVIDENCE: Residents are able to go outside of the home with family and friends as they wish, one resident said “You can go out of the home if you want, but I don’t” and another resident said “I went out to my daughters for Sunday lunch” The home has an open visiting policy and several residents commented that their visitors could come at anytime. On the first day of the inspection, children from a local nursery were visiting the home to sing for the residents, and another resident spoken to said that she had “attended the concert yesterday afternoon and it was excellent” On the second day of the inspection there was a “Back to Broadway pantomime” Residents are taken to the different houses to join in activities as they choose. Another resident was observed to be painting, and stated that this was “a new hobby” Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 14 The house manager informed the inspector that an artist used to come and see the resident in a previous home, and that he was continuing to visit the resident at Perry Locks. This is commendable as shows that residents are able to continue with their interests. Each house has a notice board displaying photographs from days out, resident notices; advertising planned activities such as coffee mornings and weekly activities. Minutes from resident meetings were available, and these indicated that discussions about food, along with outcomes of past fundraising activities and planned activities for the future had been raised. One inspector joined residents for lunch. Staff were observed to be assisting residents respectfully and encouraged residents to feed themselves. Residents were wearing appropriate protective clothing, however staff on Lawrence House were not wearing protective clothing. Food was well presented, including special diets and tables were laid attractively, with condiments available. Residents had appropriate utensils in order for them to maintain as much independence as possible. Comments from residents included: “The food is very nice here, I like the Cornish pasties” “You get a choice of meal and can have another helping if hungry” “Food is very good, its always there if you want it” “Plenty to choose from, always alternatives” The last environmental health report was reviewed and this stated “Excellent standards, very good practices and procedures” The chef keeps a daily record of food provided, and also keeps an alternatives list so staff can cross-reference and identify exactly what the resident had to eat. Menus are laminated and are accessible to residents. The home is currently developing a menu for bedtime snack meals, and has plans for a bedtime “snack box”. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The complaints procedure is comprehensive and is accessible to the residents. The home has an adult protection policy, which needs some amendments, to ensure that such incidents are dealt with appropriately by staff. EVIDENCE: The home has a comprehensive complaints procedure, which is displayed. The home keeps a complaints log and this includes the methodology used for the investigation. Response letters to complainants were sent out and these were found to be very comprehensive and provide evidence that thorough investigations had taken place. The outcome of the investigation and actions taken were also recorded. A range of compliment and thank you cards are displayed on notice boards in each house/unit. The adult protection policy requires some amendments, as the policy does not reflect the Department of Health or Birmingham Multi Agency guidelines. For example, the policy currently states, “that the resident should be interviewed” other relevant information is omitted such as including social services as the lead agency and contact details of CSCI. The Clinical Team Manager has recently implemented refresher training of abuse in the form of a POVA Awareness Week. The training covered types of abuse, procedure for staff to follow should they suspect abuse and case studies to review, along with a reminder of the whistle blowing policy. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 16 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 standard(s) 19,20,21,23,24,25 & 26 Perry Locks provides a clean, homely and comfortable environment to live in, where residents are safe, relaxed and secure. EVIDENCE: From the twenty resident comment cards received, prior to the inspection, all twenty of the residents had indicated that they felt safe in the home. Adequate assisted bathing facilities were available; hoist and bath aids are regularly serviced and checked monthly by the maintenance person. Handrails and raised toilet seats were available as required and an emergency call system is in place. One toilet on Perrywell house also has an assisted bath and signs are needed to assist the residents to identify the facilities. Another toilet on Perrywell house had a missing light cover, which requires replacing. A lock is required on the sluice room door, on Perrywell House to prevent wandering residents accessing the sluice facilities. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 17 Some fire doors to the storerooms on Brooklyn house required attention as they did not close properly and some locks were faulty. There is adequate seating available for all residents living at the home, and the arrangements promoted social interaction. The home has a sensory garden. Since the last inspection, Lawrence house has had its lounge redecorated. Brooklyn house had had the corridors and lounge redecorated, along with many bedrooms, throughout the site. On the day of the inspection, decorators were observed on site, painting rails and doors. One resident on Brooklyn house said that her room “wanted decorating” and this was brought to the attention of the manager. Hot water temperature checks are recorded, and weekly random water temperature checks have been implemented since the last inspection. One resident room however had a recorded hot water temperature of 47 degrees and no comments had been recorded as to what action had been taken to reduce this temperature and remove the risk of scalding. All of the bedrooms had a call system in place to enable residents to summon help from the care staff as required. All of the bedrooms area seen were personalised with residents own possessions to ensure that their surroundings are as comfortable as possible. One identified room on Lawrence house was noted to have some items of worn furniture. Memory boxes had been fitted outside the resident bedrooms, on Perrywell house and the residents’ families had filled some of these with personal reminders. Some bedroom doors have locks, if the resident has requested this, and residents can request this if they would like a lock and key. The home was found to be clean and odour free with the exception of one room, where the manager asked for the carpet to be cleaned. Shower chairs needed a thorough clean as they had a build up of residual soap. Hygienic hand washing facilities were noted throughout the home. One resident stated, “it’s a beautiful, clean home” One resident toilet was found to have staff clothes and bag hung on the door. After discussion with the manager, this is due to only having changing facilities for female staff, therefore male staff tend to use residents toilets. Appropriate changing and storage facilities should be provided for all staff. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 & 30 Adequate staffing levels are maintained to meet the needs of residents. The robust recruitment practice and comprehensive training ensures that residents are supported and protected by competent staff. EVIDENCE: In addition to care staff, the home employs ancillary staff including kitchen, domestic, laundry and maintenance staff. The home has a site cover rota, which ensures that there is always a senior nurse on site for all emergencies, advise and support. The Manager provided copies of the rota for each house for review. Perry Locks has its own bank staff and agency staff are rarely used. Perrywell house also has a twilight shift and there is now an extra carer on Brooklyn house for the 8-2 shift. Comments from residents included: “All are so kind and eager to help you, nothing is too much trouble” “Staff come very quickly” “Staff are helpful, sometimes they are very busy” “All the staff I have been in contact with are very good” “They come quickly and know my needs” “All the staff are friendly” “Sometimes they don’t come quick enough but they come when they can” Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 19 Each member of staff had a staff file. Two new employee files were looked at in depth and these contained all the information required by the regulations, with the exception of one file missing a photograph of the carer. Protection of vulnerable adults first checks had been completed and enhanced criminal records bureau checks had been received. Staff have received training specific to their role including a comprehensive induction, moving & handling, health & safety, food hygiene, abuse/pova, fire safety, skincare, Parkinson’s disease, ear syringing, phlebotomy, dementia care and bereavement and loss. Trained staff on Lawrence house have attended the Queen Elizabeth Hospital for training regarding trachyostomy care. Training is planned for the remainder of the year including wound care, challenging behaviour, further dementia care and ongoing mandatory training. Individual staff training matrixes are in place and copies of training certificates are kept. Only sixteen staff have NVQ level 2 or above. Some staff are working through the care skills, which is a prelude to NVQ. Six further carers are starting NVQ level 2 one carer has just completed level 2 on Lawrence house. Ancillary staff have completed training for lifting of loads. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36,37 & 38 The Registered Manager ensures that a good standard of service is provided at the home. Staff are trained and supervised in the majority of health and safety issues to ensure that the resident’s safety and welfare is maintained as required. EVIDENCE: The Registered Manager has much experience in caring for older people and is currently working towards her Registered Managers Award. There is evidence that resident meetings take place, and minutes from the homes health & safety meeting were provided by the manager. The manager aims to hold monthly senior sister meetings. There was evidence that supervision sessions were taking place but these were not always regular and one file had gaps of five months. Staff supervision notes were reviewed, and these reflected practical skills observed. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 21 Records were found to have limited information about any topics of discussion. There was limited information about training and development needs, with the exception of one file. One member of staff spoken to said that they had discussed issues such as resident needs and how to improve the service. One of the house managers appeared to have limited understanding of the kind of topics, which could be discussed at supervision, and thought was only to discuss what she had observed. This was discussed with the manager and clinical team manager at the time of the inspection. Health and safety checks have been undertaken on all equipment used within the home including lighting, gas safety certificate, fire alarm systems, nurse call systems and electrical wiring. Whilst all the information was available there was a lot of old paperwork in with the new and the information on maintenance files was not easy to access. It is recommended that files are divided into old reports and the most recent reports are kept separate. Senior management undertake visits to Perry Locks and a report of this is sent to CSCI as per regulation 26, in order to ensure a high standard of service is provided at the home. Accident records were recorded in line with the data protection act. Records included description of any treatments administered and any other remedial action taken. The Clinical Team Manager sees all accident reports and follows up any repetitive accidents. During the inspection COSHH products had been left unattended and unlocked in a bathroom area, posing a potential risk to residents. Quality assurance and residents finances were not reviewed at this inspection. Some bedroom doors were noted to be open during the inspection, the doors do not have magnetic closures and risk assessments were not written in respect of this. Fire training had taken place but there had been no recent fire drills. This was left as an immediate requirement on the first day of the inspection, and was acted upon prior to completion of inspection, with a fire drill taking place on Brooklyn house. A copy of this was provided for the inspector. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 2 x 3 2 2 2 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x x 2 3 2 Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? 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 OP8 Regulation 12 (3) 13 (4) ( c) (5) 15 (1) (2) (a) (b) (c) (d) Requirement The registered person shall ensure that: Consent forms for photography and use of bed rails are signed by the resident or their representative. There is demonstratable evidence of resident/family involvement in the review of care plans across all units. (Previous timescale of 31/03/05 not met) Care plans are further developed to ensure that all care needs are met, and that changes in care needs are reflected. Care plans require regular evaluation. Continence needs across all units require developments to ensure that assessments are fully completed and details of size and type of pad required are documented. Care plans for acute care needs such as chest infections need to be implemented. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 24 Timescale for action 27/01/06 Key worker diaries require consistent entries to reflect resident needs. Risk assessments need to be completed in respect of manual handling, use of bed rails and challenging behaviour. Moving and handling assessments need to include instructions on how to move a resident from the floor. Bed rail consent forms should identify the potential hazards when using bed rails. Residents on Perrywell house should also have access to a hairdresser. The registered person must ensure that all the nursing staff adhere to the procedures for the safe handling of medicines at all times and appropriate action taken when the staff breach these procedures. The quantities of all medicines received or balances carried over must be accurately recorded on the Medicine Administration Record (MAR) chart. Adequate checks must be made for all medicines received into the home and the Medicine Administration Record (MAR) chart must accurately reflect what has been prescribed and administered in all instances. All prescriptions must be seen prior to dispensing and the dispensed medicines checked against the original prescription in all instances. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 25 2. OP9 13 (2) (4) (C) 17(1)(a) schedule 3(3)(i) 14/12/05 All medicines must be stored as stated in their product licence. The medication rooms’ temperature must fall below 25ºC at all times. The refrigerator temperatures must lie between 2ºC and 8ºC at all times. The receipt, administration and disposal of Controlled Drugs must be recorded in the Controlled Drug register in addition to the Medicine Administration Record (MAR) chart All oxygen cylinders must be secured to a wall when not in use. Staff drug audits must be undertaken before and after a drug round to confirm nursing staff competence in medicine management and appropriate action taken when discrepancies are found. All service users must have regular compliance checks undertaken to confirm they can self-administer their own medicines safely. A contract must be set up with an appropriate waste disposal company to remove all unwanted medicines from the premises Minor amendments are required 13/01/06 to the adult protection policy to ensure it reflects the multi agency guidelines and includes contact details for the CSCI. Appropriate signs are required to 31/01/06 identify the bathroom facilities on Perrywell house. Store room locks are to be 27/09/05 Version 1.40 Page 26 3. OP9 13 (2) 14/12/05 4. OP18 13 (6) 5. 6. OP21 OP24 23 (1) (a) 12 (1) (a) Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc (4) (a) reviewed and repaired or replaced on Brooklyn House as they will not close and are labelled as fire doors. Sluice room on Perrywell house must be fitted with a lock to prevent residents entering the room. (The manager received this in the form of an immediate requirement) Furniture to one identified room on Lawrence house requires review as was found to be worn. One bedroom was found to have a water temperature of 47 degrees, a record of actions taken must be documented. Shower chairs and bath chairs require a thorough clean, to remove build up of soap residue. The registered manager must ensure that formal staff supervision is documented at least six times per year and ensure that senior staff are aware of what issues can be discussed within supervision. All COSHH products must be secure and not left unattended on domestic trolley. (The manager received this in the form of an immediate requirement) Bedroom doors which are left open at residents request, must have a written risk assessment on file, as the doors are not on magnetic closures. 7. 8. OP24 OP25 16 (2) ( c) 13 (4) (a) (b) (c) 13 (3) 18 (2) 13/01/06 23/12/05 9. 10. OP26 OP36 16/12/05 27/01/06 11. OP38 13 (4) (a) (b) (c) 27/09/05 12. OP38 13 (4) (a) (b) (c) 23 (4) (a) 06/01/05 13. 14. Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 27 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 OP7 OP9 Good Practice Recommendations It is recommended that staff receive instruction on how to measure residents for slings, to use with the hoist. It is advised that an additional Controlled Drug cabinet is purchased to store all Controlled Drugs that are no longer required. The home is to use a new system for the administration of medicines and it is advised that adequate storage arrangements are made to accommodate. It is recommended that alternative arrangements for male staff changing are sought and that personal belongings and clothing are not stored in residents toilets, due to the risk of cross infection. Arrangements must be made to ensure that 50 of care staff are trained to NVQ Level 2. It is recommended that only recent maintenance certificates/reports are kept in the maintenance folder and old documents are stored away separately. 3. OP26 4. 5. OP28 OP38 Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 Page 28 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor , Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Perry Locks Nursing Home E54 S24879 PerryLocks V244275 260905 AI stage 4 .doc Version 1.40 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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