Inspection on 04/02/08 for Perry Locks Nursing Home

This inspection was carried out on 4th February 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Perry Locks Nursing Home 26/02/10

Perry Locks Nursing Home 20/05/09

Perry Locks Nursing Home 25/11/08

Perry Locks Nursing Home 26/09/06

Perry Locks Nursing Home 02/02/06

Perry Locks Nursing Home 26/09/05

Perry Locks Nursing Home 07/12/04

Perry Locks Nursing Home 15/07/04

Perry Locks Nursing Home 21/01/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Perry Locks Nursing Home 398 Aldridge Road Perry Barr Birmingham West Midlands B44 8BG Lead Inspector Karen Thompson Unannounced Inspection 4 February 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Perry Locks Nursing Home Address 398 Aldridge Road Perry Barr Birmingham West Midlands B44 8BG 0121 356 0598 0121 331 1261 slyms@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sarah Elizabeth Slym Care Home 120 Category(ies) of Dementia (120), Dementia - over 65 years of registration, with number age (120), Mental disorder, excluding learning of places disability or dementia (120), Old age, not falling within any other category (120), Physical disability (120), Physical disability over 65 years of age (120) Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Males & females over 50 years 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. That two named service users (names held on CSCI file) under the age of 50 may be accommodated in the home. 26th September 2006 Date of last inspection 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 Perry Well house for dementia care. All four houses take residents requiring respite care. In addition to the Registered Manager, there is also a Clinical Team Manager and a Senior Nurse for each house. All houses have access to landscaped gardens (Perry Well is safely enclosed). Each house has a lounge/dining room and a quiet room available to residents. There are ample off road parking facilities at the front of the home. All bedrooms are for single occupancy. There are no en-suite facilities but a wash hand basin unit is included in each bedroom. The home is situated beside a canal in a residential area, four miles from Birmingham City Centre. It is sited close to a local bus route and local shops are only a short distance away. Fees vary and are dependent on the needs of the service users. Items not covered by the fees include toiletries, visitor’s meals, continence products, private treatments such as physiotherapy and chiropody, escort by a member of staff outside the home, hairdressings and newspapers. The current scales of charges for the home range from £491 to £1299 per week. The home retains the nursing element of the fee, which is paid by the Primary Care Trust. For up to date fee information the public are advised to contact the home. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was carried out by three inspectors and one lay assessor over a one day period. The focus of inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirement, minimum standards of practice and focuses on aspects of service provision that need further development. The inspection commenced at 8:00am and the home/provider did not know that we were coming. The manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection by the management team of the home which was sent to us, on the day of the inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home, conversation with managerial and care staff plus visitors and some residents. Some residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Eight residents who live in the home were ‘case tracked’ this involves establishing individuals experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experience of people who use the service. Questionnaires were forwarded to a randomly selected number of residents, relatives and health professionals prior to the inspection. Comments from the questionnaires and those residents and relatives spoken to during the inspection have been incorporated into the report along with comments from staff working at the home. The inspectors would like to thank the residents, relatives, management and staff for their hospitality throughout this inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. What the service does well: Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 6 Relatives stated they could visit at a time that suited them; therefore residents were able to maintain contact with their family and friends at a time that suits them. Staff recruitment procedures were robust with appropriate checks undertaken to ensure residents were protected by the employment of new staff. Money, which is held on behalf of residents by the home, was accounted for and there were good systems in place to ensure residents’ finances were protected. The organisation has a good induction programme for staff to ensure new staff have the skills and knowledge to meet the needs of residents. The home has four activities co-ordinators working with in the home to provide purposeful and stimulating activities for residents. What has improved since the last inspection? What they could do better: The home has amended its safeguarding policy and procedure to incorporate the local guidance. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 7 The staffing levels and deployment of staff needs to be reviewed on Brooklyn and Perry Well house to ensure residents’ needs are met appropriately at all times. Storage of equipment in bathrooms whilst residents are using them must be reviewed, so as not to impact on residents bathing experience. The quality of meals provided and the dining experience for residents must be reviewed and action taken to ensure residents receive food they like in an environment that is conducive to eating. The Statement of Purpose and Service Users Guide must be reviewed and developed further so that residents and their representatives are fully informed of what the service can offer and provide. Individual wheelchairs must be obtained for residents who need them, so that their mobility is not restricted. The training matrix must be updated and include the details of all training that staff have undertaken, so that any areas of shortfall are easily identified. Where any shortfalls are identified an action plan must be drawn up and implemented, to ensure staff have the knowledge and skills to care for residents. Areas of training identified within the inspection findings that require urgent attention include the Mental Capacity Act, manual handling and adult protection. These are needed to promote and protect the well being of residents. Fire records need to be more detailed to demonstrate who has attended fire drills. There must be greater awareness by staff of their role in promoting privacy and dignity for residents in the home so that their rights are promoted and protected. The systems for maintaining cleanliness on Perry Well house must be reviewed and action taken to ensure residents live in a clean, hygienic and homely environment. Systems must be in place to eliminate the odours and carpets replaced where necessary, so that residents live in a pleasant homely environment. Systems must be in place to ensure prompt action where shortfalls are identified through the quality assurance process, so that residents do not have to wait 12 months in order to benefit from improvements. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1.3. Quality in this outcome area is good Prospective residents are not given sufficient information to enable them to make an informed decision. The Pre-admission assessment was consistently comprehensive and available for staff to refer to, this assists staff to provide appropriate care to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service Users Guide (Welcome Handbook) were examined. The Statement of Purpose continues to refer the reader to several BUPA policies and procedures before they are fully informed about the service that can be provided. These policies and procedures are not included in the Statement of Purpose. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 11 A copy of the Service Users Guide was given to the inspectors at the time of the visit. The management team advised that relatives of residents with dementia are given a copy of this handbook. The documents did not give any information about the range of fees, the Care Manager and provider’s qualifications and experience or description of the accommodation available. It is recommended that these documents be reviewed. These documents do not therefore supply potential residents and their representatives with sufficient information to make an informed judgement and need to be developed further and in alternative formats if needed. All residents’ case tracked had a detailed assessment of their needs prior to moving into the home. Records showed that whenever possible the residents or their representatives are involved in the assessment of needs. The provider has introduced a QUEST system, which enables both staff and residents to take part in the assessment process. Throughout the document there are prompts for staff to complete risk assessments and care plans once an area of need has been identified. The Care Manager will visit potential residents prior to admission at their home or in hospital to make sure that the home can meet their needs. A relative confirmed that their parent had been invited to visit the home prior to deciding to live there. One resident commented, “I am very happy here they are all very good”. No intermediate care is provided at the home. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11 Quality in this outcome area is adequate Residents care needs were not consistently met in an effective manner despite a comprehensive care planning system being in place. Medication management was robust to ensure residents receive the medication prescribed and ensure their safety. Resident’ privacy and dignity is not being upheld in all situations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care records of eight of the people living at the home across the site were looked at in detail and other records were sampled. The implementation of “QUEST” care documentation had been very positive according to the management team and staff. Care plans are based on the “QUEST” documentation that is completed before residents’ move into the home. The Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 13 care records also had risk assessments in respect of areas such as pressure sore risk, nutritional risk, falls and the use of bed rails. Care planning and implementation of care was observed across the four houses during the visit. Care plans for residents on Calthorpe and Lawrence house were found to be in the main comprehensive and detailed, identifying residents needs, preferences, likes and dislikes. Care plans on these units were found in the main to be delivering the care stated and being used as a tool to monitor the effectiveness of the care delivered. These were being updated at least monthly and there was evidence of residents and their representatives being involved in the care planning process. However the bedroom of a resident on Lawrence house who was identified as being partially sighted was visited in the early evening, the lighting in the room was found to be poor. The house manager stated that they had asked in the past for stronger wattage bulbs to improve bedroom lighting but these had not been supplied. Lighting was discussed with the Care Manager and it is recommended that the home contact the RNIB for good practice guidance in relation to meeting the needs of residents with sight impairment. Care plans for Brooklyn and Perry Well house appeared generally good but there were some concerning omissions in monitoring and delivering the appropriate care. One resident on Brooklyn house had lost 10kgs in body weight over 12 months, there were no current records to demonstrate staff were monitoring the situation in relation to diet. The only records available related to dietary intake were dated October 2007. Food and fluid charts had been completed but these had not been completed for several weeks. There was no evidence that staff at the home had contacted a G.P or dietician about this weight loss, however the family had contacted the G.P. A residents care plan on Perry Well house identified a food diary should be kept for 3 weeks”. Staff were only able to produce records for four days. Therefore it could not be demonstrated that instruction were being followed or that the residents was receiving an adequate diet. Staff were not in some instances adopting a proactive approach to meeting residents needs, problems once identified should be acted upon and monitored to ensure residents health needs are met. All residents are registered with a local GP practice within the area. There was evidence to show that other community professionals visit the home upon request. The Primary Care Trust tissue viability nurse carried out a tissue viability audit in August 2007. Following this a number of new chairs were purchased. Medication management across all four houses was found to be good with only minor shortfalls. The house managers were found to be pro-active in addressing any medication that was not delivered or errors on the medication administration record (MAR) charts. Prescribed creams are not always signed for on the MAR charts. Daily temperature recordings were kept in relation to Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 14 the drug fridges, so ensuring the medication was stored at the correct temperature. The storage and recording of controlled medication was satisfactory and a record of medication that was destroyed was retained in the home, as required to assist auditing. Medication systems in the home promote and protect the well being of residents. The home needs to seek guidance on the suitability of administration of medication via the PEG (Medically assisted) route. Post inspection the Commission was informed that this had taken place. During the inspection concerns were raised with the management team as to the availability of wheelchairs for residents. Discussion with the management team confirmed that accessing individual wheelchairs was a problem. One resident on Lawrence house commented, “The only thing I’d change would be to be able to get out more often”. This resident no longer had a wheelchair. On further investigation it appears that on Lawrence unit there are only 12 wheelchairs of which 6 are assigned to individuals and 6 are available for whoever requires them. The numbers available across all four houses was not assessed. Restrictions on residents’ liberty of movement is a form of restraint and the issue of wheelchair availability needs to be addressed, so all residents who need a wheelchair are supplied with an individual chair that meets their needs. During the inspection it was also observed that residents on both the Lawrence and Brooklyn houses were being transported in bucket/curtain chairs and Kirton chairs. Staff were observed to be moving residents backwards on both these houses without talking to residents. One resident on Lawrence unit was observed to have their feet being dragged along the floor with only socks for protection, thus exposing this resident’s heels to damage. Residents on Brooklyn house were observed to be sitting in the Kirton chairs with their feet left dangling in mid air increasing the potential for pressure damage. This practice will need to be reviewed and appropriate action taken to ensure residents well being and staff safety. Care in relation to respect and dignity was mixed across all four houses. Whilst some good practice was observed especially on the Lawrence and Calthorpe houses it was not consistent through out the whole of the home. Residents on the Calthorpe and Lawrence houses were observed to be appropriately dressed. There were noticeably fewer residents on Brooklyn house wearing stockings or socks. An inspector carried out a short observation framework inspection (SOFI)) on Perry Well house, which is a specialist tool used by inspectors developed for the Commission by Bradford University. The observation demonstrated that there was very little staff interaction with quiet residents, but plenty of interaction with those of a more challenging nature. This observation took place during lunchtime. Residents on Perry Well house were observed to have dried food on their faces and were walking around the unit with aprons on. A visiting health care professional to Perry Well house was observed to give an inoculation to a resident seated at the dining table with other residents present. The health Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 15 professional giving the inoculation and/or the staff working on Perry Well house did not speak to the resident. The resident looked bewildered and Perry well staff did not challenge the health professional over this incident. This is concerning as the resident’s rights and wishes were not being promoted or protected by staff at the home. End of life care planning was taking place but the content varied across all four houses. One resident, who had an end of life care plan, was found to have poor assessment and monitoring of the effectiveness of pain control. The Care Manager forwarded a statement from a member of staff post-inspection listing the care that had been provided in relation to pain control. What remains concerning is the fact that between Oct 07 and Jan 08 the residents records did not demonstrate the effective monitoring of pain or the effectiveness of the analgesia used. The residents end of life care plan identified that the resident was to be kept pain free and comfortable, but the home is unable to demonstrate that this occurred or the rationale for the decisions they took in managing this resident’s pain. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Quality in this outcome area is adequate. Visitors could visit at times that suited them enabling residents to maintain contact with them. The choice of food was not always suitable to meet residents’ preferences. There were not sufficient numbers of staff on all units to ensure residents’ mealtime experiences met their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arrangements for visiting were flexible enabling relatives to visit at a time that suited them and residents to maintain contact with them. Care plans identified residents’ choice and preferences A “map of life” which gives details of the residents interests and previous life experiences was found in residents care records. The Care manager informed the inspectors that the number of hours devoted to activities had been increased to meet residents’ needs. An activities co-ordinator was observed on a number of the houses Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 17 during the inspection visit. The home employs 4 activities co-ordinators who all work part time in this role. Preferred times for rising and going to bed were identified. One resident on Lawrence house informed the inspector that despite their preferences being identified they did not always get up or go to bed when they wanted. A relative visiting on Calthorpe house informed the inspectors that their relatives’ pattern of going to bed and rising was the same as they had previously maintained at home. Residents’ bedrooms were personalized with their own possessions so providing a more homely environment. The “QUEST” documentation looks at mental capacity issues however these assessments were not detailed enough to ascertain the residents ability to consent to treatment. Staff said they had heard of the Mental Capacity Act but did not understand their role or responsibility under the Act. Training is needed in this area so staff are aware of their responsibility and to ensure residents risk and rights are protected and promoted. The lounge and dining areas are combined in one room on each house. Each house has a kitchenette area off this room. The menu for the day was observed to be posted in each house. The mealtime experience across the houses was varied. The lay assessor took part in a meal with residents on Brooklyn house and observed that the food was served hot and quickly but was tastleless and not appetising. The lay assessor also observed that soft food was served in individual compartments and that residents who required help with meals were given it with care. For residents on Perry Well house lunch was observed to be served two hours after breakfast. The mealtime experience on Perry Well house was chaotic. Staff were observed helping those residents who needed feeding first, meaning other residents seated at the table waited with no one to supervise them. Not one resident on Perry well house was offered a choice of food, which was not the case in the other houses within the home. The main lunchtime meal on Perry well house was cold and the pudding hard and chewy. Comments in relation to food for the whole of the home were not on the whole positive, ranging from “rubbish”, “tasteless”, “its okay I don’t eat much” to “I refuse to eat the sandwiches, long term bread and all meals are tasteless and need spicing up”. The provider has however initiated a nite bite system to ensure that each house has snacks available to residents at night, which is a positive move to enhance nutritional intake of vulnerable residents. However the provider needs to review the main meal provision to ensure residents are provided with food they enjoy to ensure their health needs are met as the comments above are concerning. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 18 Concerns in relation to safety and dignity of residents at mealtimes were discussed with the Care Manager as a visiting relative was observed feeding a number of residents on Brooklyn house. Staff also informed the inspector that they had been asked to look out for volunteers who would come into the home and help with activities. This indicates that on both Brooklyn and Perry Well house there are not sufficient staff to meet residents dietary needs. There are significant safety implications relating to the lack of sufficient staff and the use of untrained members of the public feeding residents. The home will need to review the levels and deployment of staff at peak times and take appropriate action to address the shortfalls. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 Quality in this outcome area is adequate Systems for picking up and recognizing complaints are satisfactory. Not all residents are safe quarded appropriately and this can effect their health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint log contained 15 formal complaints since the previous inspection. The type of issues raised varied and were across all four houses within the home. The home has a comprehensive system in place for dealing with residents concerns and complaints. The Service User guide available in residents’ bedrooms contained a copy of the complaints procedure. This procedure does not contain the contact details of the local CSCI office, however there is a complaints procedure in each house in the reception area that details the local CSCI office. These will have to be amended to acknowledge a recent change to the local CSCI address. The home has a system in place to record the investigation and the outcomes. The Care Manager also has to ensure that the provider is aware of any concerns raised by a monthly audit that they have to submit to head office. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 20 Relatives who completed our questionnaire indicated that they were aware of how to make a complaint if they needed to. Residents who completed our questionnaires either stated they knew how to make a complaint or they would get their relative to do this on their behalf. The homes policy and procedure in relation to safeguarding residents has been amended since the previous inspection to ensure that it is reflects the multiagency guidelines for Birmingham. The Commission at the time of inspection was aware of two adult protection investigations. However, following the inspection the Commission was contacted by Social Care and Health and made aware of a further eight Adult protection investigations that were being undertaken by them for the period of February and April 2008. The majority of these Adult protection investigations were in relation to resident living on Perry Well house. Social Care and Health have been in discussion with the organizations representatives post CSCI inspection about these concerns. The organization has bought in its own representatives who are external to the immediate homes management team to support the home and try to resolve any issues identified. The organization representatives have offered to submit an action plan to Social Care and Health to demonstrate they are working to resolving an concerns. Discussion with one member of staff in relation to safeguarding issues was concerning as they stated, “I would have to whistle blow”. Indicating they were aware of what whistle blowing entailed they were not aware of the adult protection procedure. The training matrix did not indicate that any training had occurred for staff in the area of safeguarding adults. It was stated that the matrix was not comprehensive and no formal adult protection training was in place at present, but staff knowledge was tested informally by the training coordinator. The training co-coordinator stated that three members of staff were going on formal adult protection training and they would become trainers for staff at the home. During feedback to the homes management team, the inspectors were informed that one resident had sustained an injury of unknown origin; this had not been reported at the time to Social Care and Health under adult protection procedures. This is concerning as incidents like these should be reported to the lead agency, so they can make decisions as to the appropriate course of action to ensure residents are protected and their well being promoted. The Care Manager was asked following the inspection to report this to the residents’ social worker team. We also contacted the same social worker team for this resident. The Acting Care Manager contacted the inspector following the inspection and stated there had been some confusion and they could now demonstrate that the bruising to the face had been caused by a fall and they would be forwarding this information to Social Care and Health as the lead agency. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 21 Perry Well house specialises in providing care for residents with dementia. During inspection it was noted that a number of residents on Perry Well house were exhibiting challenging behaviour. Residents were being aggressive to each other and members of staff. Staff did intervene and were seen to be calm in their approach, so as not to exacerbate the situation. Staff on this unit stated they had been given dementia and challenging behaviour training but felt unsupported. Staff said, “they give use the training and we understand, but try to put it into practice when it’s as bad. There is no support”. “They train us in challenging behaviour it’s a good job because that’s all we seem to be doing”. The inspectors are concerned that incidents as witnessed on the day of inspection were seen as the norm and prevention of these challenging outburst need to be the key to providing good care to residents . There needs to be pro-active strategies in place to prevent these aggressive outburst occuring. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.21.22.23.24.25.26 Quality in this outcome area is adequate Although it is a modern purpose built home there were shortfalls in a number of areas which should be addressed during the refurbishment programme if not sooner. The majority of the home was clean and pleasant but this was not the case for Perry Well house. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All four houses were visited during the inspection. The four houses are linked to the main block by a covered access. The main block contains the kitchen laundry and administration area. All four houses are built to the same design. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 23 Bedrooms are all off an “H” shaped set of corridors and are singly occupied with wash hand basins only. The common area (sitting and dining areas) and the office are at one end. There is a fully equipped kitchen attached to the dining area. There is a small sitting room with comfortable chairs and sofas for private use by visitors, relatives and staff. The lounge had large television fixed to a wall, a music systems with radio and CD facilities, and a supply of Videos, DVD’s and CD’s., so there was a choice of entertainment facilities available. Bathrooms and toilets are positioned conveniently around the corridors and have special equipment in them for use with all levels of mobility. The inspectors were informed on one unit that this equipment is not removed when residents use the bathroom. Furthermore care plans also specified that equipment was to be stored in the bathrooms. The storage of equipment in bathrooms impacts on the bathing experience for residents and also places residents at risk due to the cluttered environment. Staff did not use one assisted bath on Lawrence unit as residents had a tendency to slip off the bath seat. The inspector was informed that various techniques had been tried to prevent this but to no avail. Also they experienced difficulty with showering residents as the flat floor shower did not drain the water away quickly enough and the water would back track into the corridor. These aspects impact on the privacy, dignity and safety of residents and staff and these shortfalls need to be addressed to enhance the bathing experience of residents. Bedrooms are personalised and residents are able to bring in their own possessions and items of furniture if desired, so providing a more homely atmosphere. Whilst some bedrooms were decorated to personal taste, one relative commented about Perry Well house “ there’s little point doing it because others ….go into rooms and mess things up and take stuff for a walk and it never comes back”. There was evidence from daily records seen on the Perry Well house that residents had been found in other residents’ bedrooms. Bedrooms visited were clean and tidy, but furniture in all of the houses was beginning to look tired and worn and will need replacement in the near future. Residents’ bedroom doors do not have locks fitted as standard. The Service Users Guide identifies that these will be fitted if requested by a resident and following a risk assessment. Good practice would dictate that a lock is fitted and the risk assessment would evolve around the issuing of a key to residents. If locks were fitted to resident’s doors it would enhance security arrangements especially if residents were away from the home for any reason. The home has recently purchased 52 profiling beds, so arrangements for the comfort and re-positioning of residents in bed has been enhanced. Management and staff informed the inspectors that all four houses were identified for refurbishment. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 24 The home was found to be clean with the exception of Perry Well house where the kitchen was found to be in need of a clean. Perry Well unit was found to be omitting malodours; this problem could be partly caused by the pervading smell of stale urine in the toilets, despite just being cleaned. One relative informed the inspectors that when they clean the carpet, the smell is so bad they do not visit on those days. They stated, “It smells like vomit, it’s disgusting, at least I can leave, my mother has to stay and put up with it”. This was discussed with the house manager on the unit who confirmed that the carpet did smell and the description of “vomit” was probably an accurate one. They went on to say that on days that the carpet was cleaned they put signs up apologising for the smell. This was also discussed with the homes management team who acknowledged that there was a smell specific to this house. The corridors on Perry Well house had interesting memorabilia attached to the walls thus giving residents with dementia helpful clues in relation to orientation around the home. The home has a purpose built laundry and systems in place to deal with soiled laundry. The laundry was found to be clean and well organized. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 Quality in this outcome area is adequate The number of staff available and the training provided does not guarantee resident’s needs are being met. Staff recruitment is robust ensuring residents are protected by the employment of new staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The training matrix shown to the inspector was problematic as it was not comprehensive. Therefore, it was difficult to ascertain who had received training and when. In discussion with the deputy manager they were aware of this and would be making improvements. The management team informed the inspector that they would be updating the matrix and from this would be able to identify short falls in staff training. The management team informed the inspectors that staffing levels have increased on the Perry Well house by one carer for a morning and night shift. Similarly activity co-ordinators and housekeeping hours had increased recently. A copy of a four week rota for all houses was obtained, but finding s form the inspection indicates that there are not sufficient staff on duty at all times to meet residents needs. Staff informed the inspectors that they had been asked to look for volunteers for Perry Well house and the use of visitor Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 26 on Brooklyn house suggests staffing levels need to be reviewed especially around peak activity times of the day. Staff on Perry Well house had received one days training in dementia care along with training in challenging behaviour. A one day training course in dementia is not sufficient to equip staff with the skill and knowledge to meet the needs of residents living on this unit. The organisation post inspection informed the Commission that a distance learning course is available to staff in an “Introduction to Dementia” but due to difficulties with the training matrix we were not able to assess at the time of the inspection. The home has a satisfactory recruitment procedure undertaking a range of checks on staff before they commence employment, so ensuring residents are safeguarded. In the past twelve months according to the management team the home has recruited 50 new starters out of a workforce of 159. This means approximately a 30 change of staff. The management team should reflect on the impact of staff turnover to ensure the best possible way to retain staff and intergrate new members. Systems for checking nurse’s registration with the Nurses and Midwives Council were in place ensuring all nurses are registered to practice. Statistics supplied by the management team for carers with NVQ2 or above was 50 . The inspectors were unable to confirm this due to difficulties retrieving training information from the training matrix There was an induction training programme available and this meets the Social Skills Council standards. Carers have an induction programme consisting of them being supernumerary when they first start and working through a training booklet during a 12-week period Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32. 33.35.36.38. Quality in this outcome area is adequate The management systems in the home sometimes work and sometimes don’t and this means the residents could be put at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager possesses a wealth of experience and skills and is in the process of obtaining a Masters Business Administration. A deputy clinical team manager supports the Care Manager. Each house has a senior trained member of staff and there are a number of senior carers. Perry Well house staff were not feeling supported by the management team and informed the Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 28 inspectors of this as detailed in the complaints and protection section of the report. However the Care Manager did inform the inspectors that staff from this house had approached her three days prior to the inspection visit and that a plan to improve the house was in place and would be implemented, but this was not available at the time of inspection as it was being finalized. The issues relating to Perry Well house on the day of the inspection gave us cause for concern. Staff on this house felt demoralized. Also on checking the Regulation 37 notifications received by the Commission it appears that a number of incidents that affect the well being of residents had not been reported to us. This means that concerns cannot be monitored by the Commission in between inspection visits and calls into question the transparency and openness of the management team. Following the inspection the Commission was informed that the Care Manager would be temporarily leaving the home and the deputy manager who is a registered nurse would be taking care of the running of the home. The provider tries to reward good practice and they have a system of the personal best award where visitors complete and highlight good practice. When three comments are received staff receive a £25 voucher. This is a positive move on the behalf of the provider to encourage and promote good practice, which ultimately benefits residents. The provider has introduced an Early Warning tool as part of the quality and compliance checks. The Commission is forwarded copies of the providers visit reports on a monthly basis. The Providers head office sends out questionnaires to relatives as part of the quality system and from this an action plan is drawn up. Whilst concerns in relation to cleanliness have led to an increase in housekeeping hours and concerns about level of activities have led to an increase in activity co-ordinator hours and concerns about food have led to review of the menu, it has taken twelve months from identification of concerns to implementation of practical solutions and there are still concerns about odour, cleanliness and the food. It is concerning that identified needs can take twelve months to be rectified. This was discussed with the Care Manager at the time of the inspection and they stated that to obtain the budget to implement these changes the home had to prove with evidence that it was necessary, however the time span is still excessive. Residents’ finances were discussed with one of the homes administrators. Residents’ money is held in a bank account, which has sub accounts for each individual residents money. The administrator stated that no cash is held on site, but if residents wanted cash this could be obtained for them. The administrator stated that the provider audits the accounts and the home is never aware when these audits will take place. A sample of records in relation to servicing and checking of equipment were inspected to determine health and safety systems in the home and they were Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 29 found to be up to date e.g. Gas safety certificate, legionella certificate, fire extinguishers, hoists inspection, emergency lighting testing. The maintenance operative carries out a number of checks in relation to fire safety. Fire alarms are tested weekly but there were no records demonstrating which zones are activated. There were some issues found around the fire recording records and the home reassured the Commission these would be put right. There was no evidence that the emergency nurse call bell had been serviced but there was evidence to demonstrate that the home had frequently called out contractors to fix issues with the system. Some issues were found around fire record keeping and the home have advised us they will be putting this right. Residents were observed on both Calthorpe and Brooklynn house to be lifted under their arms, which puts residents at risk of injury. The home has its own manual-handling trainers, but it was difficult to ascertain from the training records how many staff had received up to date manual handling training. Also a resident was observed twice on Brooklyn house being moved in a wheelchair without footplates. There was no written record to demonstrate that the resident had requested to be transported in the wheelchair without footplates. Staff had however recorded that footplates and lap belts were to be used when transporting this resident in the wheelchair. This puts residents at risk and is concerning as staff are not following instructions written in care plans. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 x X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 2 3 2 3 1 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 1 X 3 X X 2 Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1) Sch 4 (13) Requirement Residents who are identified, as being nutritionally at risk must have a comprehensive set off records to ensure that the appropriate treatments and interventions are implemented to meet residents needs. Systems must be in place for appropriate pain control and documentation available to demonstrate that residents receive appropriate pain relief to ensure their needs are met. Residents identified as having limited mobility and who do not have a wheelchair must be referred for a wheelchair assessment so they are not restricted in their movement. Appropriate systems must be in place to demonstrate the suitability of medication administered via a PEG feeding tube to ensure residents safety and well being. The home must ensure that staff are trained and knowledgeable about the safeguarding procedures to ensure all DS0000024879.V350672.R01.S.doc Timescale for action 30/04/08 2 OP11 12(1) 30/04/08 3 OP8 13(1)(b) 30/06/08 4 OP9 13(2) 30/04/08 5 OP18 13(6) 30/04/08 Perry Locks Nursing Home Version 5.2 Page 32 residents are protected. 6 OP18 13(6) 37 All incidents in relation to adult protection must be reported to the appropriate agencies in a timely manner and the home must have an retrievable audit trail to demonstrate this has occurred to protect and promote well being of residents. Staff must receive training in manual handling to ensure the safe and well being is promoted and protected. Residents must be transported in wheelchairs with footplates unless a risk assessment indicates otherwise. This will ensure residents limbs are not damaged during transportation in a wheelchair All staff must attend a fire drill twice a year and records kept to demonstrate that this has occurred to ensure they are aware of the action to take in the event of a fire. Fire alarm testing records must demonstrate what zone has been activated in setting off the alarm, so all zone are systematically tested over a period of time. These will ensure the safety and well being of both staff and residents living in the home. The emergency call bell system must have an annual service so that any issues can be identified and rectified swiftly, so the system is available to all residents to summon assistance when required. 30/04/08 7 OP38 13(5) 30/06/08 8 OP38 12(1) 30/03/08 9 OP38 23 (4) 30/06/08 10 OP38 23 (2)(b) 30/04/08 Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The registered person must ensure the statement of purpose and Service User Guide includes all relevant information in a format accessible to residents, so that they can make an informed choice. 2 OP10 The home must consider the arrangements for ensuring the privacy and dignity of all residents in relation to appropriateness of dress, movement around the home and interactions. Movement of residents in bucket/curtain and kirton chairs must be reviewed and action taken to ensure resident and staff safety plus the dignity and well being of residents being transported. It is recommended that the home obtain a copy of the Dept of Health guidance “Mental Capacity Act 2005 core training set” published July 2007 and staff are provided with training, so that staff are aware of their responsibility and residents rights are protected. The home must review the mealtime experience for residents in the home, to ensure that the quality meets the preference of residents and is served at the appropriate temperature and time. The Complaints procedure must contain contact details of the local CSCI office, so that they are aware of the contact details is they wish to complain. It is recommended that the home contact RNIB for guidance on the appropriate lighting conditions for residents with sight impairments. The refurbishment programme must review the bathing facilities and ensure that these are suitable to meet residents needs The storage of equipment must be reviewed in bathrooms so that residents bathing experience is enhanced and safe. The refurbishment plan should include private accommodation being fitted with locks suitable to resident capabilities and accessible to staff in an emergency, so DS0000024879.V350672.R01.S.doc Version 5.2 Page 34 3 OP10 4 OP14 5 OP15 6 7 8 9 10 OP16 OP20 OP21 OP22 OP24 Perry Locks Nursing Home 11 12 13 OP25 OP29 OP31 14 OP30 15 16 OP32 OP33 that privacy and security arrangements are enhanced. Systems must be put in place to ensure the home is free from offensive odours so that it is a pleasant environment for people to live. The provider should review the high staff turnover and implement systems to improve the retention of staff, so that continuity of care is improved. The Care Manager ensures staff are briefed and supervised in respect of safe guarding procedures whilst awaiting for formal training in order that residents are protected adequately. Training matrix must be a comprehensive record of the training that has taken place and what is required. Shortfalls in training must have an action plan in place to ensure staff have the skills and competence to met residents needs The management team must review the systems of support for staff to ensure the workforce can perform appropriately Issues identified in the quality assurance system must be swiftly addressed and monitored on a regular basis to ensure and developments have a positive outcome for residents. Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Perry Locks Nursing Home DS0000024879.V350672.R01.S.doc Version 5.2 Page 36 - 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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