CARE HOMES FOR OLDER PEOPLE
Queenswood Care Home Cliffgrove Avenue Nottingham NG9 4DP Lead Inspector
Meryl Bailey Unannounced 27 June 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Queenswood Care Home Address Cliffgrove Avenue Nottingham NG9 4DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9221037 0115 9436245 Methodist Homes for the Aged Mrs Agnes Elizabeth Grognet Care home 41 Category(ies) of OP Old age, x 41 registration, with number of places Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: NONE Date of last inspection 6 December 2004 Brief Description of the Service: Queenswood is a Methodist Care Home providing personal care and accommodation for 41 older people. The home is located in a residential area, one mile from Beeston town centre. The home has a minibus that is used for the service users to access local facilities and for other outings. The home was built for the purposes of a care home and the two-story building has level access. It is totally wheelchair accessible throughout with a passenger lift and other adaptations. All bedrooms are single and have en-suite toilet and shower facilities, with the exception of one room. There are well-maintained and accessible gardens providing seating areas outside. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by two inspectors during one day. 40 current residents were at home. Five staff were seen on duty in addition to the manager. Some residents and staff gave their views about the care provided. The communal areas of the home were inspected and a sample of bedrooms was also seen. What the service does well: What has improved since the last inspection?
The written plans of care are developing and have become clearer. Residents are involved in planning their care. A new central heating system has been installed, but the effect of this cannot be assessed during the hot weather. Food choices continue to be given and now there are bowls of fruit on all dining room tables. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 6 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. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 he needs of prospective service uses are assessed before admission is arranged. EVIDENCE: Pre admission assessment material was seen on the three files examined. For those funded by the local authority a social work assessment has been obtained and filed. All people referred to the home are visited by the manager or other senior staff prior to admission. The pre printed assessment form used provides gives space to record the person’s past history and current circumstances. It also details significant events and interests that are important to the individual. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Needs are set out in clear care plans, but assessments of risks are not always recorded, which could jeopardise personal health and safety. Health needs are met with the involvement of a range of external healthcare professionals. Medication is well organised, but not kept totally secure at all times. EVIDENCE: Three care plans were examined in detail and were found comprehensive and regularly reviewed. However, there were no formal risk assessments for two people who have fallen frequently, though there were some relevant comments in the daily notes and some instruction in the plan of care about support required to assist with mobility. One member of staff has recently obtained an assessment tool regarding the prevention of falls and it is recommended that this now be used. There are additionally plans for an information day for service users, relatives and staff to be held at the home on July 19th 2005. This is specifically regarding the Prevention of Falls and will involve direct advice from Chiropodist, Vision Care, Physiotherapist, Occupational Therapist and a Moving and Handling trainer. Records show that these professionals have been involved with individual service uses and a district nurse was in
Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 10 attendance on the day of this inspection. Medication is stored in a locked cupboard most of the time, but during lunchtime the trolley was left unattended in the entrance area for short periods, while tablets were being given in the dining room. Although the trolley was locked, some medication was left on the top. It was agreed during this inspection that the trolley would be left locked in the medication room during this time. Records of medication given appear well maintained, but discussion with staff revealed that staff administering the medication individually have not been signing the record. The initials signed are of the staff member responsible for medication for the shift. It was agreed by the manager that the person observing that medication is taken will now be the one signing the record. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Close contact is encouraged with family, friends and the local community. Meals are enjoyed and satisfy individual diets and preferences. EVIDENCE: Several service uses stated that their relatives and friends are welcomed to the home at any time and are invited to planned events. The notice board shows that a barbecue is to be held in the grounds with jazz band planned for July. There are a choice of rooms available to see visitors. Some people remain actively involved with friends and activities in the community. Services are held in the homes chapel located on the second floor twice weekly and a prayer group on Fridays. The menu for the day was displayed. The main course for lunch was Toad in the Hole or Beef Stew. Vegetables were served in tureens on each table for people to help themselves. A choice of cranberry, apple or orange juice was given and fresh fruit was on each table. People were observed enjoying the food served and some said that individual choice was catered for and that the meals provided were always good. Discreet assistance was given with eating when necessary. The dining room is spacious and the atmosphere was relaxed. There are a number of kitchenettes (tea bars) close to bedrooms, where residents can make their own drinks, breakfasts, snacks and suppers. One on the ground floor is available for visitors to make drinks. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints are taken seriously and responded to appropriately, but not all recorded fully in writing. Appropriate action has been taken to protect service uses from abuse. EVIDENCE: The complaints procedure is issued to all service users and posted on the notice board. A file is available in the reception hall for residents and visitors to record their concerns and other comments. Responses are recorded against concerns. The manager has copies of letters regarding the outcome of some complaints, but was advised to keep a central confidential record to summarise all complaints and concerns and state clearly the action to be taken. There is a copy of the Nottinghamshire’s Protection of Vulnerable Adults procedures, but the manager was not aware of recent amendments. The procedure has, though, been appropriately followed on one occasion and staff have received training in protection. It is recommended that the manager obtain the amended procedures. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The accommodation is well designed and maintained to provide a range of facilities that meet the different needs of service users. The vast majority of bedrooms are fully equipped to meet needs and all areas are kept clean and hygienic. EVIDENCE: A tour of the premises was made, and a sample of bedrooms was seen. All areas were found clean, fresh and well maintained. There are a variety of rooms that provide opportunities for quiet relaxation and recreation. All areas are maintained to a very good standard. The rear garden is safe and accessible, providing seating areas for residents and visitors. Five rooms were seen. Those occupied on a full time basis were highly personalised and comfortable. All doors are lockable and those that want one have a key. One service user was unhappy that her room does not have ensuite facilities, not even a washbasin. This was the only such room as all others have ensuite toilet, shower and washbasin. To meet minimum standards a wash basin must be provided, but it is recommended that full ensuite facilities be installed to bring this room up to the standard of the rest of the home.
Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staff are sufficient in number during the day, but needs at night should be continually monitored to ensure sufficient staff are on the premises. Appropriate recruitment procedures are followed to protect service uses. EVIDENCE: The rota shows there are at least five care staff on duty at all times during the day in addition to the manager. Agencies are used to provide staff when needed, but the manager is recruiting further staff to build up a relief pool in order to provide more consistency. At night there are two staff with a third available on call at home. Some night staff are not trained in medication or First Aid and the manager stated that a senior care worker sleeps on the premises if both night staff are untrained. Sleeping accommodation was seen available for staff and it is recommended that the need for a third member of staff to be available on call within the home is reviewed. It would take over thirty minutes for some staff to travel from home. The manager stated that McMillan nurses have been provided through the night for individuals as needed. Maintenance and activities and domestic workers are employed in addition to care staff. Staffing records show that Criminal Record Bureau checks have been carried out on all staff in addition to obtaining suitable references. Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Maintenance procedures and staff training protect health and safety within the environment. EVIDENCE: Staff spoken with reported receiving appropriate initial training and refresher courses in safe working topics. There is always a member of staff trained in First Aid available on the premises. Equipment around the home is labelled with dates of maintenance checks and records are held of appropriate safety checks. A new boiler system is in place. Accident records are well recorded, though these should link to risk assessments and care planning (see under standard 7) Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 4 14 x 15 4
COMPLAINTS AND PROTECTION 4 x x x x 2 x 4 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x x x 3 Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 17 No 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. 2. Standard OP 9 OP 9 Regulation 13 (2) 13 (2) Requirement Ensure all medication is held securely at all times. Ensure the medication record is initialled by the person administering the medication. Timescale for action 27th June 2005 27th June 2005 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 OP 7 OP 16 OP 18 Good Practice Recommendations Use the assessment tool regarding the prevention of falls and include the assessment in each careplan with clear actions to be taken to reduce the risk of falling. Keep a central confidential record to summarise all complaints and concerns and state clearly the action to be taken. It is recommended that the manager obtain Nottinghamshire’s Protection of Vulnerable Adults amended procedures available on the internet at www.nottsadultprotection.org.uk Provide ensuite facilities to the room without them - at least the minimum of a washbasin. Review needs at night and ensure sufficient staff are provided within the home. 4. 5. OP 24 OP 27 Queenswood Care Home C53 C03 S8735 Queenswood V235765 270605 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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