CARE HOMES FOR OLDER PEOPLE
Queens Court Nursing Home 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS Lead Inspector
Francesca Halliday Key Unannounced Inspection 5th December 2006 – 9th January 2007 09:00 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 Queens Court Nursing Home DS0000015397.V321586.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. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Queens Court Nursing Home Address 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS 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) 0208 559 0620 0208 559 0315 queenscourt@hotmail.com Ranc Care Homes Limited Mrs Rosemary Mathias Care Home 89 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (21), Physical disability of places over 65 years of age (27), Terminally ill over 65 years of age (1) Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 21 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 27 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 41 persons) One person, over the age of 65 years, who requires palliative care The total number of service users accommodated in the home must not exceed 89 persons 26th June 2006 Date of last inspection Brief Description of the Service: Queens Court is a purpose built two-storey care home for up to 89 residents. The home has a garden to the rear and a patio area to the front. It is near to the local shops and underground railway system. It has a bus stop nearby, and is within easy reach of the M25 and M11. The home provides personal care to people over 65 on the ground floor. The nursing units on the first floor are predominately for people over the age of 65, but people with physical disabilities above the age of 40 can also be accommodated. The home had a range of information for prospective residents and their representatives. At the time of inspection in December 2006 the range of fees was £407 - £1300. Additional charges are made for private chiropody, toiletries, newspapers, hairdressing, dial-a-ride and some activities. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection visits took place on 5th and 18th December 2006. Francesca Halliday and Lysette Butler carried out the inspection on 5th December and Francesca Halliday carried out the inspection on 18th December. The pharmacist inspector, Derek Brown, carried out an additional inspection visit on 9th January 2007, following concerns about the standard of medicines management in the home. An immediate requirement notice was issued at the time of the pharmacist’s inspection visit. The inspection process included discussions with 16 residents, 10 relatives and 12 members of staff including the manager and the director of nursing. Parts of the premises and a sample of records were inspected. 11 survey forms were received from residents and 5 from relatives. A number of their comments have been included in the report. At the time of this site visit the inspectors were required to include a detailed inspection of the quality of the contracts and information offered by the home as part of a national themed inspection. Information gained form this part of the inspection will be included as part of a national report due out in late 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well:
One resident said, “The home is nice. We have a laugh and joke here (with the staff)”. Another said “the staff are always nice”. The pre-admission assessments were of a good standard. The home was clean and odour free at both unannounced visits. One resident said “I have only praise for the domestic staff”. Residents and relatives spoken to during the site visit reported that they were notified in a timely fashion when there were proposed changes to the issued contracts. Residents generally found the staff helpful and kind but said that a few were not helpful. The home had an emphasis on training but there was not always documentary evidence of training that staff said had been given. Procedures for ordering and receipt of medicines are robust. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 (6 is not applicable). Quality in this outcome area is adequate. Residents and their representatives do not always consider that they are given sufficient information to enable them to make an informed decision about admission to the home. The home has a good pre-admission assessment system in place, to ensure that the home can meet the needs of prospective residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the themed inspection (mentioned in the summary) particular consideration was given to the standard of introductory documentation, such as the statement of purpose, service user’s guide, contract and terms & conditions, which residents and their representatives received before entering the home. Six residents were spoken with and three residents were case tracked to consider this aspect of the services provided. All the above documents were reviewed.
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 9 A number of residents and relatives considered that they had not received sufficient information either before or on admission to the home. The contract was worded ambiguously and did not provide protection for either the residents or the home. 6 residents spoken with were given prior notice of changes to fees and there were letters on their files as reference. The statement of purpose and service user guide both contained all the elements required by the national minimum standards. The manager stated that a copy of the service user guide was in every resident’s room. Some residents knew that it was there others had never seen it. Two residents said that they were only given a small leaflet prior to admission and no other information since. A number of residents said that they were given very little written information about the home before they were admitted. One relative said that they had received no written information prior to making a decision about the home. The manager stated that she would send all residents and their representatives a new copy of the current statement of purpose and service user guide following this inspection. The manager confirmed that a pre-admission assessment was carried out prior to all admissions. The assessments sampled were of a good standard. They were present on all care files seen during the site visit, and contained sufficient information to inform staff of the needs of the new residents. Relatives spoken with said that they had been involved in the assessment process, and social services assessments were on file where appropriate. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9, 10 Quality in this outcome area is adequate. Care plans are of a fairly good standard but are not sufficiently resident focused. There are serious shortcomings in the standards of medicines management, but immediate action is being taken. Residents’ privacy and dignity are not always upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been some improvement in the standard of care documentation since the last inspection. However, the majority of care plans seen needed to be more resident centred. A number of residents spoken with considered that they had not been consulted about the drawing up and evaluation of their care plans. Some issues of importance raised by residents in relation to their care had not been documented in a care plan. For example there was no care plan concerning a resident’s depression (they were very tearful when spoken with and had been prescribed an antidepressant) and no evidence that their
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 11 psychological health was being monitored. A number of residents gave examples of instances when care was not delivered in the way that they wished. Daily records were recorded every day and the information contained was of a fair standard. Appropriate risk assessments had been carried out for residents, some assessments had been regularly reviewed and updated, whist others seen had not been reviewed for up to four months. The care documentation contained a section for recording details of residents’ wishes in relation to terminal care, to death and to funeral arrangements; however, they were only completed on one of the files sampled. Some information contained within the care files was contradictory. One file clearly stated that the staff were unable to weigh the individual concerned, however there was also a comment saying that there ‘was no evidence of any weight loss’ without explanation of what evidence was being used to make this assessment. A number of documents within the care files were not signed or dated making it difficult on occasions to establish how current the information was. The health care needs of the residents appeared to be catered for. All residents were registered with a local GP, the majority with the retained GP for the home, who visited the home on a regular basis to see residents in rotation and when called for specific problems. Residents had access to chiropody services and dental and optical services. There was evidence that residents had good access to local specialists, such as dieticians, speech and language therapists and clinical nurse specialists. There was evidence of GP input and referral to a dietician following a resident’s weight loss. A few of the issues raised at the last inspection in relation to medicines had been addressed. However, a large number of medication issues were highlighted during the site visit on 5th December 2006, therefore the inspectors requested a specific pharmacy inspection to be carried out by the Commission for Social Care Inspection pharmacy inspector. The findings of the pharmacist’s inspection on 9th January 2007 are included below. Written policies and procedures in relation to the safe handling of medicines were available for inspection. These were reasonably comprehensive but needed to be updated to include changes in the arrangements for the disposal of medicines. Procedures for the ordering and receipt of medicines were fairly robust, staff had sight of the original signed prescription before it was dispensed and a copy was retained in order to be able to validate the prescriber’s instructions. None of current residents was self-medicating. There was a policy for a risk assessment and risk management procedure in place for self-medication. The home mainly used pre-printed forms as the profile of medicines prescribed and these were also used as the record of receipt and administration. Records of the receipt and disposal of medicines were satisfactory. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 12 Many deficiencies were seen in the records of the prescribing and administration of medicines. Examples included, but are not limited to: • The administration of external creams and ointments was only recorded as a tick and so no indication of who administered the medication. • Medication not being administered in accordance with the printed instructions both on the record form and the labelled container. • Medication omitted since it was “out of stock” for a number of days. • Changes to instructions for medication administration without justifiable reason recorded in the care notes. • Medication remaining printed on the form but where it was no longer prescribed and so could result in medication error. • Medication prescribed for use in the eye without any indication of which eye was to be treated. • A number of gaps in the administration records and not clear indication of why medication was omitted. • Medication recorded as being refused without any report or discussion with the prescribing GP. • Medication administration records were completed in advance of the administration of medication. An immediate requirement notice was served in respect of a resident whose medication was not being administered as prescribed and which was of particular concern. Feedback was received from the registered manager on 10/01/07 outlining the investigation and action taken in response to the immediate requirement notice. Care plan documentation did not carry meaningful results of GP or other professional visits and there was little indication of blood glucose measurements for all those residents with diabetes. Storage facilities provided on the each floor for medicines were satisfactory and secure. Keys to the medication rooms are held by senior staff and also held by cleaning staff. Not all medicines in the room are stored in locked cupboards and so to permit unauthorised staff access to such areas is an unacceptable security risk. The storage room temperatures were monitored and recorded and were satisfactory, although it was strongly recommended that the temperature was more satisfactorily controlled on the ground floor since records indicated that the temperature was consistently at the recommended maximum of 25C. There were dedicated refrigerators used for the storage of medicines on each floor. The temperatures were monitored and recorded regularly. However, the temperature of the refrigerator on the ground floor has been recorded outside the recommended range of 2-8 C on a number of occasions over the previous six weeks and this has not been reported to the manager or investigated. Staff questioned were not aware of what the correct temperature of the fridge should be. Medication that was clearly labelled “do not refrigerate” was found stored in the fridge on the first floor. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 13 Stock levels of medicines were at a reasonable level. There was some evidence that medication, including dressings, prescribed for individual residents had been retained and some had dispensing labels removed. A container of medication carrying a hand-written label with the information “[resident name, Ear drops, 31/12/06, one drop” was found in one of the trolleys on the ground floor. There was no indication of the name of the medication on the container, nor a record on the medication record form for the named resident that it was being administered. Separate facilities were provided for the storage of medicines controlled under the Misuse of Drugs Act 1971. The cupboards in use complied with the Misuse of Drugs (Safe Custody) Regulations. Dedicated and suitable registers were used for the recording of controlled drugs. Administration records were satisfactory and witnessed, but the register carried entries that medication had been disposed of but the recorded stock balances were not zeroed when medication was returned and so was confusing. Training on the safe use of medicines had been provided for some senior care staff authorised to administer medicines, but not all. Training files for three staff members who were authorised to administer medicines were examined. There were no certificates of attendance held for these staff members and there was no documentary evidence of assessments of competence to administer medicines held on file. Given the inaccuracy of the medication records, and the medication error referred to in the immediate requirement notice, it is questionable whether the level of training already provided is adequate. It is essential the staff, including registered nurses, are trained and are assessed as competent to undertake medication related tasks to safeguard the health and welfare of residents. Residents spoken with said that their privacy and dignity was respected. However, daily record charts, including fluid, turns and continence charts were kept on show at the nurses’ stations, which constituted a lack of privacy and dignity for the residents concerned. This was discussed with the manager at the inspection visit on 5th December 2006 but the record charts were still on display at the visit on 18th December. During the site visits inspectors also observed other issues surrounding privacy and dignity, which were relayed to the manager and director during the feedback from the visit. This included a resident being hoisted in the middle of the lounge without any attempt to maintain their dignity whilst this was taking place. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is adequate. The standard and variety of activities is improving and links to the community are being developed. Resident choice is not always upheld in this home and the standard of food is seen as variable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents generally considered that the standard of activities had improved since the last inspection. A few residents, however, were unhappy as they felt that the increase in activities had been at the expense of some of their physiotherapy sessions. There was evidence of a greater range of activities and social events in the home. However, some residents commented that there were no activities at weekends. The activities included exercise sessions, bingo, cookery, quizzes, film sessions, puzzles and crosswords. The home had improved links with the local community and to local schools. A PAT dog visited the home regularly and arrangements were made for residents to attend local churches on some Wednesdays and Sundays. Once a month communion was held in the home and once a fortnight a Roman Catholic
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 15 service was held. Some residents were going to a pantomime and various Christmas functions had been organised. The recording of activities and social interaction needed to be improved, as according to the records a number of residents had only been involved in two activities or one to one sessions during 2006. Some residents said that they felt very isolated in their room. A discussion was held with staff about the need to ensure that residents who did not wish to join in formal activities were still offered stimulation and regular one to one time with staff. It was of concern that two staff expressed anxiety about the reaction of other staff to their sitting down and chatting to residents. On more than one occasion staff were observed to be sitting in the lounges and not engaging with the residents there. Relatives said that they felt welcomed when they visited the home. Residents said that they were generally able to get up and go to bed at a time that suited them. Some residents were satisfied with the food and considered that the standard had improved since the last inspection. However, others described the food as of a “very poor standard”, “inferior quality”, and “uninteresting and generally well below the standard that would be expected from a home of this kind”. One resident said that the hot food was sometimes served to them “lukewarm”. A resident surveyed said “please employ someone who can cook, as the fee for staying at Queens Court should include mealtimes to look forward to”. The kitchen floor had been replaced since the last inspection. A new larger fridge had been purchased, to enable more fresh produce to be stored, and a fly screen had been fitted to the outside door since the last inspection. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18 Quality in this outcome area is adequate. Residents and relatives are not confident that their complaints and concerns will be appropriately addressed. Staff are generally aware of the actions to take if abuse is suspected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the themed inspection (mentioned in the summary) particular consideration was given to the standard of complaints information the home offered. The home had a complaints policy that has been reviewed recently to reflect the current role of the CSCI with regards to complaints. All residents and relatives spoken with said that they either had a copy, or had seen a copy of the home’s complaints procedures. One relative spoke at length about the manager’s helpfulness during recent problems they had experienced in the home with their relative and the care offered. However the majority of residents and visitors spoken with said that it was “not worth complaining as nothing is ever done to rectify the problems”. One resident said “if the complaint has to go to management my experience is that nothing usually comes of it”. There was clear evidence that staff were not documenting verbal complaints. This resulted in the manager not being aware of a number of issues and problems that residents were concerned about. The manager said that a new
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 17 system was being introduced to improve communication particularly around complaints and concerns. The home had procedures for the protection of vulnerable adults (POVA), and the majority of staff had received POVA training. Staff spoken with generally had an understanding about the types of abuse that could occur and the actions to take if abuse was suspected. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 Quality in this outcome area is good. The home was generally in good decorative order, and action was being taken to address areas in need of attention. The home is clean and odour free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three of the lounges had been decorated since the last inspection and quotes were being requested for redecorating the reception area and the stairs. Some of the curtains had been renewed and others were being cleaned. Some of the armchairs in the home needed to be cleaned. The floorboards on the upper floor were very noisy and the noise was very noticeable in some parts of the ground floor. One resident said that the creaking of the floorboards above their room was “very bad” and caused them considerable disturbance at night (the resident was being moved to another room). The director of nursing said
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 19 that this had been investigated but that it was a major structural problem and would be too expensive to put right. The two kitchenettes on the nursing floor were in an extremely poor and unhygienic condition. The manager said that new units were due to be installed in the near future. One relative considered that the layout of the in a part of one of ground floor dining rooms was a potential health and safety hazard. The layout was viewed, there was sufficient room when chairs were used but insufficient room for staff access and resident movement when a number of wheelchairs were in place round the tables. The manager said that the layout would be changed following the inspection. Residents and relatives considered that the home was generally clean and fresh. The home was clean and free from unpleasant odours at the time of both the unannounced inspection visits. One resident said “I have only praise for the domestic staff”. During the site visit the home was generally very warm, staff and relatives were commenting on the heat. However the weather outside was unseasonably warm for the time of year and relatives stated that the previous week the home has been very cold, therefore the maintenance man had recently turned the heating up. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 Quality in this outcome area is adequate. The adequacy of the current staffing numbers needs to be further reviewed. The home generally has sound recruitment procedures. Documentary evidence of training was not fully available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken with and surveyed considered that the majority of staff were kind and helpful, but that they were often “pushed for time” and that a few care staff “were not as helpful as they could be”. A number of residents said that the care at night was not as good as in the day, and that night staff frequently did not respond to call bells. One resident considered that it was “the shortage of staff that causes some complaints”. A number of residents said that staff frequently said that they would return to assist them but did not return. During the site visit the inspectors observed residents having to wait a long time for carers to help them with activities such as going to the toilet. Relatives spoken to also stated that there was often a prolonged wait for residents to get assistance from care staff, which they perceived as being due to a lack of staff numbers on duty. Staff were not wearing name badges, but the director of nursing said that this was because new badges were on order.
Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 21 Residents reported, and the manager confirmed, that some of the agency nurses and care assistants who had been used to cover shifts recently had not been competent. This was being taken up with the agencies concerned. The home did not meet the standard for 50 of care assistants to have completed the National Vocational Qualification (NVQ) at level 2 or above. Two care staff spoken with said that they were keen to undertake NVQ level 3 but that the funding was not available. The manager said that new induction training was being introduced, which complied with the standards in Skills for Care, and said that the induction would be carried out over a three month period. The recruitment process was generally sound. There was evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks and checks with the Nursing and Midwifery Council. An interview record had been instituted since the last inspection. Staff said that they were being provided with training updates to enable them to meet residents’ specialist needs such as palliative care, tracheostomy care, the giving of subcutaneous fluids and PEG feeding. However, there was not always documentary evidence of the care related and clinical training. One resident considered that “many (staff) could do with more training”. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 Quality in this outcome area is adequate. The manager is well qualified for her role. Residents wish to speak to the manager and deputy on a more regular basis. Communication within the home needs to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was an experienced registered nurse, who had been managing Queens Court for a number of years. She had completed a diploma in management. The clinical nurse manager was also in the process of studying for the same diploma. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 23 Eighteen residents were spoken with during this site visit, of which sixteen stated that they only saw the manager “very rarely” or “seldom”. One resident said, “One of the most noticeable things is that the manager and deputy are hardly ever visible”. However one resident said that they did see the deputy manager fairly regularly. The manager strenuously denied that she did not see residents regularly,as her practice was to go round the home each morning. However, she was not aware of many of the issues, concerns and complaints raised by residents during the inspection many of which had been ongoing for some time. One relative said “Staff morale is low. Staff aren’t valued. Communication is a problem in the home”. The relative considered that this impacted on staff attitudes and the way that care was delivered in the home. Residents and relatives gave examples of problems with communication. The manager said that a new system was being introduced to improve communication in the home. The director of nursing carried out regular visits and audits of the care and services in the home. The commission had received a report summarising these visits. Five residents’ personal money accounts were reviewed during the site visit, and the balances were all seen to be correct. The administrator and registered manager were the only people who had access to the safe and residents’ monies. The administrator had a good knowledge of POVA policies and procedures, with special reference to financial abuse. All bills other than hairdressing bills were separated out and kept with individual accounts. During the visit the inspector was shown the chiropodists and the hairdressers insurance indemnity certificates, however the hairdressers certificate was out of date. Following the inspection the manager confirmed that new individual invoicing systems had been introduced for hairdressing bills and that the current public liability insurance for the hairdresser had been obtained. No obvious hazards were noted in the environment. There was evidence that staff were recording bruises and accidents appropriately. The maintenance man on duty at the time the site visit said that any equipment he needed to carry out his job safely was supplied by the home, however if larger items of equipment were needed there was sometimes a delay in obtaining these due to the procurement policies of the proprietors. The majority of staff had received fire safety training, however, a number of staff had not received an updates in this training for two to three years. A number of staff had not received moving and handling, food hygiene, infection control and health and safety training. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 X X 2 Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. The requirements were discussed with the registered manager at the time of inspection. No. 1. Standard OP1 Regulation 4, 5 Requirement The registered person must ensure that residents and their representatives are given copies of the statement of purpose and service user’s guide. The registered person must ensure that the contracts contain sufficient detail so that the terms and conditions are clear and unambiguous. The registered person must ensure that: 1. Care plans are resident centred and are developed and updated in consultation with the resident and relatives if appropriate. This is a repeat requirement. Timescale of 14/08/06 not met. 2. Care plans cover all identified needs. Timescale for action 01/03/07 2. OP2 5(1), 5A 01/04/07 3. OP7 15(1)(2) 01/04/07 Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 26 4. OP8 14(2) The registered person must ensure that: 1. Risk assessments are regularly reviewed and updated when residents’ condition changes. Requirement in a previous report - timescale of 14/08/06 not met. 2. Residents’ psychological health is monitored when appropriate. 3. All assessments are signed and dated. The registered person must ensure that the notified medication error is investigated and appropriate action taken. Notified at the time of inspection. 01/04/07 5. OP9 12(1) 13(2) 10/01/07 6. OP9 13(2) 13(6) 18(1) 01/02/07 The registered person must ensure that: 1. Clinical room temperatures are controlled and action is taken if the temperatures exceed 25c. 2. Medication refrigerator temperatures are controlled and action is taken if the temperatures are outside the recommended range of 2 – 8 c. 3. Medication must only be given as prescribed. 4. Medication administration (and non-administration) records must be accurate and complete. 5. Medication administration records must not be completed in advance. 6. Residents receive their prescribed medicines, and that interruptions to supplies are kept to a minimum. 7. Staff record the administration of insulin,
DS0000015397.V321586.R01.S.doc Version 5.2 Page 27 Queens Court Nursing Home blood glucose levels in a consistent manner. 8. A record is made on the Medicine Administration Record when a new supply of medication is started, to enable an audit trail to be made. 9. Medication that is no longer prescribed must not be retained as “stock”. 10.Medication must only be administered from correctly labelled containers. 11.Access to medication storage areas must be restricted to authorised persons only. This is a repeat requirement. Previous timescale of 14/08/06 not met. The registered person must ensure that all staff authorised to administer medicines have been trained and assessed as competent to do so. 7. OP10 12(4)(a) The registered person must ensure that staff uphold residents’ privacy and dignity at all times. This is a repeat requirement. Timescale of 26/07/06 not met. 01/02/07 8. OP12 16(2)(m) (n) The registered person must 01/04/07 ensure that: 1. Staff receive training in the provision of activities and social stimulation. 2. There are sufficient staff hours identified for activities for the number of residents in the home and for residents to have activities every day. 3. Staff document the activities and social stimulation provided. This is a repeat requirement. Timescale of 14/05/06 and 01/09/06 not met.
DS0000015397.V321586.R01.S.doc Version 5.2 Page 28 Queens Court Nursing Home 9. OP14 12(2) The registered person must ensure that staff promote choices and independence in the home and try as far as possible to provide care in the manner that residents prefer. This is a repeat requirement. Timescale of 26/07/06 not met. The registered person must ensure that the standard of food is regularly monitored until improvements are made to the satisfaction of residents. This is a repeat requirement. Timescales of 24/01/06 and 14/08/06 not met. 01/02/07 10. OP15 16(2)(i) 01/03/07 11. OP16 22 01/02/07 The registered person must ensure that: 1. An open culture is promoted in the home, whereby complaints are addressed positively as part of the quality assurance process. 2. Verbal concerns and complaints are documented along with the action taken to address the issues raised. This is a repeat requirement. Timescales of 01/06/05, 30/04/06 and 26/07/06 not met. The registered person must ensure that numbers of staff on duty are appropriate for the level of dependencies in the home. This is a repeat requirement. Timescale of 01/09/06 not met. 01/03/07 12. OP27 18(1)(a) 13. OP30 18(1)(c) The registered person must 01/03/07 provide documentary evidence of all clinical and care related training. This is a repeat requirement. Timescale of 01/09/06 not met.
DS0000015397.V321586.R01.S.doc Version 5.2 Page 29 Queens Court Nursing Home 14. OP32 12(1)(a) The registered person must ensure that systems of communication are improved within the home. The registered person must ensure that staff do not transport residents in wheelchairs without foot rests. The registered person must ensure that all staff receive updates or training in moving and handling, fire safety, health and safety, food hygiene and infection control. This is a repeat requirement. Timescale of 01/12/06 not met. 01/02/07 15. OP38 13(4) 01/02/07 16 OP38 13(3), 13(4), 13(5), 16(2)(j), 23(4) 01/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations The registered person should ensure that a minimum of 50 of care staff achieve NVQ level two in care. Queens Court Nursing Home DS0000015397.V321586.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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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