CARE HOMES FOR OLDER PEOPLE
Prospect House Nursing Home Blundells Lane Rainhill Merseyside L35 6NB Lead Inspector
Mr Michael Perry Unannounced Inspection 18th April 2007 10:00 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 Prospect House Nursing Home DS0000005467.V330637.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. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Prospect House Nursing Home Address Blundells Lane Rainhill Merseyside L35 6NB 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) 0151 4931370 Ms Maureen Bromley Mr Neil Malkhandi Ms Maureen Bromley Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The Service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. The service is registered to provide personal care to 24 older people with Dementia 20th November 2006 Date of last inspection Brief Description of the Service: Prospect House is a care home for 24 older people with dementia, and the registered manager is Mrs. Maureen Bromley. The home is a large converted dwelling house, which has been extended. Prospect House is set in its own grounds a short car journey from local amenities and bus routes. The home provides single accommodation and is staffed throughout the day and night. All residents are registered with a local G.P. and the service includes personal care, home cooked meals and a laundry service. The grounds include a car park, paved areas and extensive gardens with views of the countryside. The fees in the home are £395 per week. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection follows on from the inspection in January of this year [2007] and is the third inspection of the home over the last year. Originally there were issues raised on the inspection in May 2006 when the home was assessed as having some major work to do in terms of meeting outcomes for people with dementia and was assessed at that time as ‘poor’. This inspection took place over a period of 10 hours over 2 days. The inspector met with the majority of residents and spoke with visitors including a health care professional, who were visiting at the time. The inspector also spoke with members of care and ancillary staff on a one to one basis and the registered manager [also the Registered provider]. A pre inspection questionnaire aimed at eliciting information before the site visit was not completed and returned by the management. This meant that resident/relative comment forms normally issued prior to the inspection were not sent. The inspector did leave these as part of the inspection over the 2 days site visit however. None were returned before the report was completed. A tour of the premises was carried out and this covered all areas of the home including the resident’s rooms [most rooms were seen but not all]. Records were examined and these included three of the resident’s care plans, staff files, and staff training records and health and safety records. The main area of concern had been the organisation of the environment of the home with respect to providing a service for people with dementia and the general maintenance and upkeep of the home. An improvement plan was asked for at the time of the last inspection in January 2007 [and on the previous inspection to that] and was received on 23.2.07. The plan outlined some improvements that will be made but all have not yet been actioned. From the inspection there have been some further improvements noted but these still need further organisation and commitment from the management team. Overall there is much work still to do in this area and the managers of the home need to be a lot more responsive and focused in their plans. There were similar comments on the last two inspection reports. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 6 What the service does well:
There is a written guide to the home which tells prospective residents and thier supporters about the home and its staff and facilities. Relatives spoken to stated that the information given at the point of admission the home including the issuing of contracts was sufficient and that the management were helpful in providing information. All residents have a preadmission assessment completed prior to moving into the home. Care files contain copies of social work assessments and health assessments if needed. Further assessments are carried out in house once admitted. They are carried out by senior staff members usually the manager or deputy. This helps ensure that the home are aware and can meet any care needs the resident has. The care plans seen were generally satisfactory in that the basic care can be followed and monitored. There is evidence of relatives being involved in the care planning and those spoken to were pleased with the way staff communicated and supportd them. One spoke about how their relative had received a spell in hospital and they had been advised tha general deterioration had ment that any independant mobility was highly unlikly. The staff in the home, however, had worked on this and the resident was now mobile. It was clear from the care records that residents have regular access to GP services as well as district nurse and community psychiatry if needed. One of the residents reviewed was having regular visits from district nurses who were reviewing a dressing. The medication process was reviewed. There are no residents self medicating due to their mental state. It was clear that residents are reviewed by GPs on a fairly regular basis regarding medication. All residents seen were presented satisfactory in terms of dress and personal hygiene and staff were observed to be attending to residents promply. Care staff were observed to be interacting and suporting residents and some of the intervetions displayed skill and patience. Relatives felt that staff were suportive and helpful to residents. There is reference in care plans to residents diet and nutrition. There are written menus and residents are asked for choice of meals. Limited setting of tables is encouraged just prior to serving meals. A menu is displayed. The home have a complaints procedure and this is in the information guides available in the home. Staff interviewed were aware of the complaints procedure and relatives feel that the managers were appoachable and any issues would be addressed.
Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 7 For 20 residents in the home at the time of the visit there were 5 care staff [including the manager]. These levels are generally maintained as evidenced by the duty rota and interviews. Relatives interviewed generally felt that staff were very caring and supporting of the residents needs. One relative commented ‘care staff are very approachable and always keep us informed’. What has improved since the last inspection? What they could do better:
There remains little evidence in terms of staff enabling residents through modifying the environment [see enviormental outcomes] to suggest that there is a full understanding of care needs for this specific group. Some work has been completed over the last two visits but progress is slow in this area. Not all care needs are being addressed on the care plan however. For example one resident was assessed as having a need to ‘wander’. The resident was observed to be very restless and in need of guidence and support to wander about the home safely. There was no mention of this in the care plan so that staff were left to manage on an ad hoc basis with no real objective to the care.
Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 8 Generally reference to residents social care needs around activity and social interaction and family involvment were not in evidence on the care plans and this could be improved. Following requirements from the previous inspections the staff list dates for evaluations of the care plan on a monthly basis but there is still no written records of an evaluation which should be a record of any progress made set against the objectives of the care plan. The mediation records were generally satisfactory although one record did not have the date or signature of the staff member for the receiving of a particular medicine so it was difficult to audit this medicine. The medication policies refer to ‘nursing’ and are somwhat confusing for staff. The medication policy needs reviewing so that it is a clear reference tool. This was discussed on previos inspections. Of concern is the fact that there are no training records for staff who are administering medicines. There is no list of staff administering medications in the medication records. The manager confirmed this and has accessed some acredited training recently and will be sending staff as needed. This must be attended to as a priority and full records made. Because of the high number of residents that congregate in the dining area the inspector observed a high level of agitation from some residents and varying degrees of expressed emotion from some residents towards others. The residents who need to wander had no practical access to other areas as the garden area is closed off [despite the good weather] and was not made available and the doors leading from the corridor area where closed providing a visual barrier that the residents do not appear to cross. The discussions that the inspector has had previously regarding the opening up of the environment and removing barriers for the residents group by providing orientation aids and safe areas have still only partly been met. The management has not addressed access to the garden, which was a requirement of the last report, and this area remains unsafe for residents. The manager’s records for training are incomplete so there was little evidence for staff training in medication administration of health and safety for example. The need to develop better training records and schedules remains a management task. Only one member of staff currently has NVQ qualification. Although more staff are commencing training, progress here is slow in order to meet national minimum standards of at least 50 staff trained. This is particularly pertinent for senior staff who run shifts and give out medicines as some of these lack any qualifications for this role. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 9 The current package does not meet induction standards set by ‘skills for care’. One new member of staff spoken to had received very little induction apart from a first day checklist. There were no other records. This is important so that staff are properly prepared for their role ion the home. Recuitment records were seen and remain poor despite requirements being made on the last inspection. Staff records seen were incomplete and did not contain CRB [criminal records] checks, POVA [protection of vulnerable adults] or full written references. This was also outlined on the last inspection and it is a concern that the management continue to put vulnerable adults at risk with poor recruitment procedure. The management team need to address the issues arising from this report. Following the last two inspections similar management issues have been raised and, although progress has been made in some areas, there are areas of the management of the home that are not being addressed in order to meet National Minimum Standards. The basic management systems are poorly devised and need tightening up so that the manager has up to date monitoring processes. Records are generally poor. This was evidenced with the lack of quality assurance monitoring and also a lack of adequate health and safety records so that key areas such as fire; first aid, electrical and gas safety are not maintained adequately. There are requirements listed in the report under all of these headings. 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. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 10 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 Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 11 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): Standard 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides good information for prospective residents and their relatives so that an effective chioce can be made to move into the home. There are some amendments needed to clarify the homes identity. Appropriate assessments are carried out by the home, which include social service and / or health assessments so that the home is better able to ensure care needs will be met. Staff still need to continue to develop their understanding of the needs of people with dementia. EVIDENCE: Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 12 There is a written guide to the home [service users guide] together with a philosophy of care and customer charter that aim to tell prospective residents and thier supporters about the home and its staff and facilities. Relatives spoken to stated that the information given at the point of admission the home including the issuing of contracts was sufficient and that the management were helpful in providing information. The home provides personal care and not nursing care. The sign outside the home has now been removed and a new one has been fitted as this previosly advertised ‘nursing’. The stationary and policies /procedures still need reviewing however as they contain references to ‘nursing’ [for example the medication policies]. The manager advisd the inspector that she is still working through these policies. All residents have a preadmission assessment completed prior to moving into the home. Care files contain copies of social work assessments and health assessments if needed. Further assessments are carried out in house once admitted and include activities assessment, nutrition, falls, moving and handling and pressure sore risk. Three assessments were seen for residents prior to addmission and one of these was not signed or dated. They are carried out by senior staff members usually the manager or deputy Staff interviewed varied in there understanding of the needs of people with dementia. There has been some training in dementia care and staff reported attending training days and there are more of these booked. There remains little evidence in terms of staff enabling residents through modifying the environment [see enviormental outcomes] to suggest that there is a full understanding of care needs for this specific group. Some work has been completed over the last two visits but progress is slow in this area. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 13 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): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home manages the health care needs of residents satisfactorily. care needs are included on care plans and are monitored although improvements can be made in the quality of the evaluation process. There are some requirments around the training of staff administering medicines so that a sound knowledge base can be evidenced and residents can benefit from best practice. Staff attend to personal care needs and these are met. They are tempered with the environmental improvements needed to maintain dignity. EVIDENCE: Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 14 All residents have a care plan. 3 care plans were reviewed and were generally appropriate in that they covered the basic needs needs of the residents and the progress of care could be followed. The staff in charge informed the inspector that care plans are signed by relatives and relatives commented that they are kept up to date with the care and, following on from previous inspection comments, relatives have been contacted and care files bear evidence of signatures indicating that the care has been discussed. Relatives were pleased with standards of care. One spoke about how there relative had received a spell in hospital and they had been advised that general deterioration had indicated that any independant mobility was highly unlikely. The staff in the home, however, had worked on this and the resident was now mobile. Not all care needs are being addressed on the care plan however. For example one resident was assessed as having a need to ‘wander’. The resident was observed to be very restless and in need of guidance and support to wander about the home safely. There was no mention of this in the care plan so that staff were left to manage on an ad hoc basis with no real objective to the care. It was observed that while staff intevened well in general there was no real consistency of approach. Some care needs were very generalised. For example ‘unable to maintain a safe environment’ for one resident but no reference as to what this need was in any more detail and there were no planned care interventions. Other care needs were well referenced. For example one resident with swollen legs and feet was being reviewed by the district nurse and the care plan detailed this so that progress could be followed. Generally reference to residents social care needs around activity and social interaction and family involvment were not in evidence on the care plans and this could be improved. Following requirements from the previous inspections the staff list dates for evaluations of the care plan on a monthly basis but there is still no written records of an evaluation which should be a record of any progress made set against the objectives of the care plan. As previosly it was agreed that these would be recorded in the daily records and the date referenced on the care plan or evaluation sheet. Daily records and diaries are used to back up the care plans and these are a usefull recording of personal care given by the care staff. Records are easily accessible and were tidy and easy to find. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 15 It was clear from the care records that residents have regular access to GP services as well as district nurse and community psychiatry if needed. One of the residents reviewed was having regular visits from district nurses who were reviewing a dressing. The visiting nurse interviewed was pleased with the way the home reffered residents. The medication process was reviewed. There are no residents self medicating due to their mental state. It was clear that residents are reviewed by GPs on a fairly regular basis regarding medication. Medication records seen were generally clear in their recording although one medication record [MAR] seen had no date or signature for the receiving of a particular medicine so an audit coud not be made. The medication policies refer to ‘nursing’ and are somwhat confusing for staff. It states for example that ‘all drugs should be under the control of a first level nurse’. The medication policy needs reviewing so that it is a clear reference tool. This was discussed on previous inspections. The supplying pharacist does not complete any auditing of the medicines and this would be a good practice recommendation. Of concern is the fact that there are no training records for staff who are administering medicines. There is no list of staff administering medications in the medication records. Staff spoken to advised that currently the deputy manager and four other staff administer medicines. The normal routine is for these staff to be assesed by the manager or deputy as to competence. Some have received additional acredited training for purposes of sound knowledge base but others have not. The manager confirmed this and has accessed some acredited training recently and will be sending staff as needed. This must be attended to as a priority and full records made. Most of the residents in the home require quite high levels of personal care. All residents seen were presented satisfactory in terms of dress and personal hygiene and staff were observed to be attending to residents promply in the dining room area where most residents seem to congregate. Staff were able to discuss the importance of trying to get residents to choose their own daily clothing. There have been locks fitted to toilet and bathroom doors and some environmental cues such as toilet signs although this remains inconsistent and needs to be further developed [see environment] to promote both privacy and dignity for residents. Again comments here are the same as on the last visit. Prospect House Nursing Home DS0000005467.V330637.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): All key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to be involved in activities but these need to be developed further with reference to good practice in dementia care and the removing of barriers so that residents make use of the facilities in the home. A choice of good quality home cooked food is provided to the residents. EVIDENCE: The comments in this section of the report are a repeated of those on the last two inspections. Residents are engaging with their environment and staff were observed to be supporting and socialising in the dining room area and trying to provide some activity for residents. Because of the high number of residents that congregate in this area in this area, however, the inspector observed a high level of agitation from some residents and varying degrees of expressed emotion from some residents towards others.
Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 17 Staff were observed to be coping with this by continually trying to get residents to ‘sit down’ and it was difficult for them to concentrate on any group activity. The residents who need to wander had no practical access to other areas as the garden area is closed off [despite the good weather] and was not made available and the doors leading from the corridor area where closed providing a visual barrier that the residents do not appear to cross. Staff were observed to be interacting appropriately and some were very skilled and supportive. The discussions that the inspector has had previously regarding the opening up of the environment and removing barriers for the residents group by providing orientation aids and safe areas have still only partly been met. Some of the home offers a therapeutic environment in terms of socialisation; for example the corridor area is useful for exercise and the small TV lounge is relaxing and well appointed with appropriate furnishings. The Rose room at the front of the home offers some privacy for visitors. These rooms are rarely used however and most residents seem to congregate in the dining room so that this area is particularly important with respect to daily socialisation and must be further developed. There has been some improvement by providing some visual aids and the work completed on the Easter bonnets was still evident and gave a more homely feel to this area. There were some thank you letters from relatives who had clearly enjoyed the Easter party. The management has not addressed access to the garden, which was a requirement of the last report, and this area remains unsafe for residents. In particular the low level of the fence to the road and subsequent drop on the far side is hazardous and should be addressed before residents access the garden again. Relatives and staff spoken with stated that residents are taken out with staff escort but this is infrequent and happens ‘occasionally’. As with the last inspection the discussion with the managers of the home was negative in enabling safe access to green areas and is not seen as a priority in terms of quality of life for residents and this needs further thought [see environment]. This is particular the case with Prospect House as the garden could be made accessible quite easily. There is reference in care plans to residents diet and nutrition. There are written menus and residents are asked for choice of meals. Limited setting of tables is encouraged just prior to serving meals. A menu is displayed. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 18 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): Both key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed. EVIDENCE: The home have a complaints procedure and this is in the information guides available in the home. Staff interviewed were aware of the complaints procedure and relatives feel that the managers were appoachable and any issues would be addressed. A recent complaint was discussed and the managers investigation and reply to the complainant was seen. The manager had completed a good investigation and the reply to the complainant was very comprehensive with an openess of attitude displayed. There has been some inhouse training around awarness of abuse and poor practice and how this relates to local policy in reporting abuse. Following recommendations from the last inspection the manager has also arranged for staff to attend external training with social service training providers. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 19 Staff spoken to were able to understand the process of reporting abuse or mistreatment. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although improvements have been made to the environment of the home the management/provider need t speed up the process of upgrading so that residents live in comfortable surroundings. EVIDENCE: There has been some improvement to the fabric of the building. For example new windows fitted to 3 bedrooms, and a door in the dining room has been replaced. There has been some improvement by providing some visual aids in the dining area and the work completed on the Easter bonnets was still evident and gave a more homely feel to this area. There were some thank you letters from relatives who had clearly enjoyed the Easter party.
Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 21 A tour of the building including the bedrooms [most of them] revealed that the basic maintenance problems that were evident on the last inspection have been eliminated and the home is being maintained satisfactorily. The maintenance person advised the inspector of the rota of checks conducted and this was reviewed. The home was clean and there is now a full time cleaner available. The laundry room was well organised. Some of the previous requirements still need to be actioned however including: • The garden needs to be made safe and accessible for residents so that this can be an extension of the dining room and residents can experience more space. Fencing needs to be provided and trip hazards reduced as much as possible. The fence at the bottom of the garden is low and has a drop of 6 – 8 foot on the other side [drop top the road]. This is a particular hazard and must be addressed before residents can acess this area safley. This was again discussed with the managers. The internal decor needs to be made bright and homely but less stark. This can be achieved with signs for day areas and toilets bathrooms. There is some current signage but this is inconsistent. For example one toilet had a sign on it but the bathroom / toilet nearby had the sign missing. Management commented that ‘residents remove these’ but they simply need fixing permanently to the door. Various points of interest for residents need to be devised such as safe ornaments and rummage boxes and cupboards that residents can safely access. The smell of urine remainds a major concern and continues to be commented on by visitors and relatives. The smell was less on this inspection [ presumably from better cleaning schedules] but remains. The proposed programme of renewing the flooring throughout the home should improve this further. Carpets are clealy impregnated with the smell of urine and the plans for replacment carpets throughout the home must be actioned as discussed [manager gave a date on the last inspection of March 2007 for the carpets to be replaced but this has still not been actioned. Anew date of renewal commencing May was qouted by the manager]. Some of the carpets on this inspection remain badly stained. Many bedroooms still need personalising. There has been some attempt at this by the ‘memory box’ project and this should continue. Some rooms are very poorly furnished and very stark in appearance. Relatives support is needed to create a more homely environment. Residents names / photos etc can be put on the outside of doors.
DS0000005467.V330637.R01.S.doc Version 5.2 Page 22 • • • • • Prospect House Nursing Home 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): All key standards. The quality in this outcome area is poor. Care staff numbers are appropriate to meet service user’s personal care needs but staff lack basic qualifications and training remains patchy so staff may lack basic skills to care for residents. Recruitment checks are not made appropriately prior to employing staff so that residents are being put at risk. EVIDENCE: For 20 residents in the home at the time of the visit there were 5 care staff [including the manager]. These levels are generally maintained as evidenced by the duty rota and interviews. Following requirements on the previous inspection the ancillary staff cover has improved including the provision of a full time cleaner and laundry staff. Relatives interviewed generally felt that staff were very caring and supporting of the residents needs. One relative commented ‘care staff are very approachable and always keep us informed’. Staff spoke about some recent training initiatives in the home including attendance at abuse awareness training and dementia care training. At the time of the inspection there was a training session held for staff on fire safety.
Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 23 The manager’s records for training are still patchy however so there was little evidence for staff training in medication administration or health and safety for example. The need to develop better training records and schedules remains a management task. Only one member of staff currently has NVQ qualification and although more staff are commencing training progress here is slow in order to meet national minimum standards of at least 50 staff trained. This is particularly pertinent for senior staff who run shifts and give out medicines as some of these lack any qualifications for this role. The induction package for the staff was seen and discussed. The current package does not meet induction standards set by ‘skills for care’. One new member of staff spoken to had received very little induction apart from a first day checklist. There were no other records. The current induction is very task orientated – for example how to take a temperature – rather than covering care principals such as equality and diversity, principals of care or dementia awareness for example. Recuitment records were seen and remain poor despite requirements being made on the last inspection. Staff records seen were incomplete and did not contain CRB [criminal records] checks, POVA [protection of vulnerable adults] or full written references. Other details such as start dates were missing. The inspector referred the manager to schedules in the Care Home Regulations, which detail requirements. This was also outlined on the last inspection and it is a concern that the management continue to put vulnerable adults at risk with poor recruitment procedure. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 24 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): All key standards The quality of this outcome area is poor based on available evidence including the site visit. The managment team ensure there is basic personal care but there needs to be more structure around Quality Assurance processess which should aim to gradually improve standards and the quality of life for residents and maintain saftey. EVIDENCE: The homes proprioter, Mrs Maureen Bromley, is the registered manager. She has many years experience in the home and also has a general nursing
Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 25 qualification [RN]. The deputy manager also plays an important role in the running of the home. Mr Malkandi, also provider, assists in an administration role. Staff interiewed felt supported by the manager and felt that they could approach her and the deputy for help and assistance. The management team need to address the issues arising from this report. Following the last two inspections similar management issues have been raised and, although progress has been made in some areas, there are areas of the management of the home that are not being addressed in order to meet National Minimum Standards. Following the previous inspections the management have produced improvement plans the address issues but much of these plans are still outstanding. The managers must be responsive and timely in their efforts to meet requirements made in inspection reports. The quality assurance processess in the home aimed at developing the service are poorly formulated. This was discussed with the manager. • The manager showed the inspector internal audits for the general environment. These were blank copies. Those filled in were not signed or dated. The maintenance person had no awareness of these. There are no external Quality Assurance systems in place. There are policies and procedures from the ‘Blue Cross’ but there is no input from these anymore in terms of audits. The manager stated that the Blue Cross paperwork is used for internal audits but there was no records [current] of this. An annual residents survey is conducted. The manager states that ‘events’ are held to get views from relatives. When questioned about this they turned out to be social events in the home e.g. recent Easter party. There are no notes or service plans developed from these forums. There is no development plan apart from the last improvement plans for the Commissions. • • • Health and Safety management in the home was discussed with the managers and the maintenance person. The routine checks on fire safety and basic safety monitoring of the environment are now carried out routinely. There needs to be some recording of monthly inspections of the fire extinguishers [recommended previously]. The emergency lighting was last tested in 2004 although the certificate recommends testing every 12 months. The maintenance person was advised about 6 monthly checks of at least 1 hour Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 26 duration to check battery systems. There was no fire risk assessment available for the home. No member of the management team has completed any recent Health and Safety training. No other staff training in this. One of the Providers has completed a course in 1989 and has had update in 1990 but had no certificates or evidence for this. The maintenance person has recently completed ‘safer food and hygiene’ and first aid course. A First aid box was available. Key staff are trained but not enough to cover all shifts. First aid policy was seen dated 2002 No reference to reporting to relatives. Manager was advised about this. A recent accident to a resident was reviewed. The record of events was patchy with nothing recorded in the care notes on the day of the accident. There was no record of relatives being told. Some basic safety certificates were out of date. These include the gas safety certificate, which was last tested in 2004 [should be yearly] and the electrical safety certificate for the home, which was a year out of date. The Health and Safety Policy for the home was out of date. It was an old policy which was not signed or dated but referred to the old management structure of the home when it was a nursing home some years ago [refers to the ‘Matron’ and SEN [nurses] in the management structure]. Over all the management of the health and safety in the home needs reviewing. Currently there is no reliable system to ensure good monitoring. The management of resident’s monies was discussed. The home includes smaller items such as toiletries and small outings in the fees of the home. More substantial purchases such as clothing is billed to families through the homes finance officer. Staff do not handle residents money and the practice is for relatives to manage all monies. This was confirmed with relatives who were interviewed. There is currently no written policy / procedure that outlines this management system and the manager was advised to draw one up. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 X X 1 Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 28 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 Regulation 15(2)(b) Requirement The manager must ensure that all care plans are reviewed appropriately in that a record is made of the evaluation as discussed set against current individual objectives. [Outstanding from previous inspections]. All care needs must be addressed on the care plan. This includes reference to any challenging behaviours such as ‘wandering’ and also any social care needs must be addressed. There must be evidence that all staff that are administering medicines have received accredited training, to ensure safe administration practices. The Registered Manager must assess and review the care environment in the home ensuring that the inspectors comments and observations are taken into account and produce an improvement plan with time scales to improve the
DS0000005467.V330637.R01.S.doc Timescale for action 01/06/07 2 OP7 15(1) 01/06/07 3 OP9 13(2) 01/06/07 4. OP19 23 01/06/07 Prospect House Nursing Home Version 5.2 Page 29 environment in the home with respect to dementia care. 5 OP26 13(3) The manager must ensure that the home is maintained free of offensive odours the proposed renewal of flooring must be actioned which should eliminate the current problem. [Outstanding from the last two inspections]. 01/06/07 6. OP33 24 The manager must establish a quality monitoring system and annual development plan in accordance with the standard. The quality assurance system in the home should ensure that residents / relatives views are integral. An external QA system is recommended. The health and safety management of the home must be reviewed with reference to the comments in this report. Specific attention must be paid to: • • Updating the Health and Safety policy for the home. Senior staff member undergoing health and safety training / update [take advice from the HSE on this] Updating all safety certificates including gas and electrical. 01/08/07 7. OP38 13 01/06/07 • 8 9. OP38 RQN 23(4)a CSA Sec 26 The registered person[s] must complete an up-to-date fire risk assessment. The registered Person must review all documentation and
DS0000005467.V330637.R01.S.doc 01/06/07 01/08/07
Page 30 Prospect House Nursing Home Version 5.2 omit the ‘nursing’ description, which is false under the homes current registration. 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. 3. Refer to Standard OP4 OP7 OP9 Good Practice Recommendations Extend training in dementia care to all staff. Arrange care files so that the care plan is easier to locate and more prominent [as discussed] Ensure that a list of staff administering medicines together with their initials for recording purposes is maintained in the MAR. The medication policy should be revised with reference to the comments in the report. It is recommended that the supplying pharmacist complete a regular audit of stock and medicines in the home. 4 5. 6. 7 OP12 OP18 OP28 OP38 Activities and the general therapeutic environment should continue to be develo0ped with reference to good practice in dementia care and comments in this report. All staff should attend external training in local adult protection procedures [check with social services]. The home should have 50 care staff trained to NVQ level to meet this standard. It is recommended that fire extinguishers are routinely checked [visually] on a monthly basis and that this is recorded. Emergency lighting need a 6 monthly check of 1 hour duration to check the battery competence. Prospect House Nursing Home DS0000005467.V330637.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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