Inspection on 26/03/08 for Quinton House Nursing Home

This inspection was carried out on 26th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Quinton House Nursing Home 18/03/09

Quinton House Nursing Home 15/02/07

Quinton House Nursing Home 01/12/05

Quinton House Nursing Home 12/07/05

Quinton House Nursing Home 02/03/05

Quinton House Nursing Home 18/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY Lead Inspector Suzette Farrelly and Sandra Wade Key Unannounced Inspection 26th March 2008 08:30 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 Quinton House Nursing Home DS0000004407.V361557.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. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quinton House Nursing Home Address Lower Quinton Stratford On Avon Warwickshire CV37 8RY 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) 01789 720247 01789 720245 angelabirioo@quinton.house.wanadoo.co.uk Quinton House Limited Ms Kathleen Januszka Care Home 37 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (37) of places Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Ms Kathleen Januszka to undertake management training equivalent to NVQ level 4 by April 2005. Residents with dementia will not be accommodated in the annex. Date of last inspection 15th February 2007 Brief Description of the Service: Quinton House is situated in the village of Lower Quinton a short drive away from Stratford on Avon. The current provider Quinton House Ltd has owned the home since 1995. The home is registered to provide nursing care to 37 elderly residents, with three of these places registered for care of those with dementia. Accommodation is provided in two areas of the home. The main House, which accommodates up to 29 residents and a smaller annex, which is adjacent to the main building and accommodates up to 8 residents. The main house has accommodation on three floors with access via a passenger lift or stairs. Accommodation is provided on the ground floor of the annex. The majority of the accommodation for residents in the main house is provided in shared bedrooms. Gardens to the front and side of the main building are well maintained with access possible for all of the homes residents including those who may require a wheelchair. The owner of the home advised at the time of this inspection that the fees for residents ranged between £450 and £665 per week, these are subject to change and enquires should be made as to the weekly fee prior to admission. Residents pay additional charges for the services of the hairdresser, Dentist, Optician and Chiropodist. Further charges are also made for other items or services provided by the home, £10 per month is charged for toiletries. These include the transport and staff escort time to attend out patient visits if an ambulance is not booked, name tapes and fixings for clothing, sundry items and newspapers, which includes the weekly delivery charge. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This inspection was unannounced and took place from 8.30am – 4.20pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. This was provided to inspectors during the inspection. Information contained within this document has been reviewed and considered and is included within this report where appropriate. Five people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide/Statement of Purpose, staff duty rotas, kitchen records, accident records, health and safety records and medication records. Service users were observed during lunchtime to ascertain choices and view meals made available. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: Quinton House has a homely friendly atmosphere. It is generally well maintained and looks comfortable. The furniture, lighting and fittings are of a good standard and in keeping with the age and look of the home. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 6 Relatives are made to feel welcome and no complaints have been received about the home. The quality monitoring survey carried out by the home showed that positive responses were received from relatives and professionals and residents in regards to the care and services provided. Relatives said: ‘I am really happy with this home and feel confident that the care is given even when I am not here’ ‘ My relative has settled very well and the staff know how to manage their care’ ‘We are always made welcome and the care is good’ All residents spoken with said that they were happy in the home and were positive about the staff who care for them. One said “”I am quite happy here” and “I like being here, staff are very good to me”. The home had a good stock of both fresh, frozen and dried foods to allow for a choice of meals and snacks to be provided. The number of care staff with a National Vocational Qualification II in Care exceeds the standard of 50 which is to be commended. The training required to achieve this qualification helps staff to provide more effective care to the residents. The assessment carried out prior to admission gives sufficient information to enable the home to meet the needs of the person when they arrive. The care planning is good and this enables the staff to give consistent and appropriate care. A visiting professional said ‘ that all residents admitted to Quinton House improve in their health and the care is good.’ What has improved since the last inspection? Work has commenced on a new conservatory, which will give extra space to the existing dining room for residents and visitors. New carpets have been fitted to some areas of the home and some bedrooms have been decorated to improve the environment for residents. The driveway to the home has been tarmaced and security lights installed to improve the access to the home for visitors and prospective residents. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 7 What they could do better: Urgent action is required to repair/replace the call bell system in the home to ensure all residents can alert staff for assistance when required. Suitable risk assessments for each resident need to be devised in the interim to ensure they can be cared for safely. Hot water and radiators need to be maintained at safe levels to ensure there are not burn/scald risks to residents. Action is also required to ensure the water flows sufficiently from taps in resident’s rooms. The home needs to demonstrate there are sufficient numbers of nurses working at all times to ensure that the health and welfare needs of service users are met. Action is needed to ensure the safe storage of medication. Doors to areas where medication and chemicals are stored need to be kept secure. Residents’ wishes and choices in regard to care and services they receive need to be more clearly demonstrated so it is clear this is happening. This includes making decisions about what toiletries they use and what meals they wish to have. The home need to take advice of the fire service in regards to the fire escape door on the top floor to ensure this meets with fire precautions and residents are not placed at risk. Advice should also be sought on securing other doors, which allow entrance to the home to ensure residents feel safe. The policies and procedures for abuse need to be accessible to staff and staff need to be clear on their responsibilities should abuse be reported to them. This is to ensure staff are aware of the procedures they need to follow to safeguard residents. A review of current laundry equipment is needed to ensure this is sufficient to effectively service the needs of the home. Record keeping within the home needs to improve. This includes: • The Service User Guide which needs a Statement of Terms and Conditions and summary inspection report included so that people who access the service have all the information they need to make a decision about staying at the home. Records regarding resident’s money, which should show what the money was used for and receipts kept for items or services purchased. This ensures that the residents’ money is spent on items for them and that they are aware of what they are spending. • Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 8 • • Assessment records, which should detail the individuals’ abilities and areas where care is required to ensure that, needs can be suitably met. Menus, which need to show all meals, drinks, and snacks that are made available to residents so that residents are clear on what choices are available. Duty rotas, which need to demonstrate there, are sufficient staff to meet the needs of residents consistently. Training records which need to clearly demonstrate that staff are completing induction training based on the Skills for Care Common Induction Standards so it is clear they have built up appropriate competencies to care for residents safely. Reports of quality monitoring surveys, which need to include all information such as questions and responses, made to give a full overview of outcomes. This will allow people to see clearly what the results were and the actions taken in response by the home. • • • 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. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 3 were assessed. Quality in this outcome area is adequate. Residents do not have all of the information they need to make an informed choice on whether to stay at the home. Assessments prior to admission are carried out; the quality of the information does not always show the extent of the needs of each individual and this may result in the admission of some whose needs cannot be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Service User Guide is in place, which gives some information about the care and services provided, but this did not contain a summary of the inspection report or a Statement of Terms and Conditions for the home. This information should be available so that prospective residents have all the information they need to make an informed choice on whether to stay at the home. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 11 Four residents were ‘case tracked’ which involves looking at their records and meeting with the person and their relatives if available to discuss their experience of being admitted and the care they receive. All four files contained information from the home and social services, which was comprehensive and showed clearly the care that would be required on admission. The staff had ensured that they had suitable information to care for a resident with a new procedure and the records showed that staff were aware of the care required and had involved other professionals. The assessment format used by the home is limited, when used alongside the social service care plan and assessment this gives sufficient information. It is advised that more information is recorded onto these forms when admitting private paying residents to ensure that there is sufficient information. A relative told us ‘My relative has settled very well here. We looked at a number of homes and this was the best’ Another relative said that ‘We were made welcome and everything was explained to us. We feel we have made a good choice’ A person who lives at the home told us ‘I choose to come here and it is OK not like home, but I am happy enough’ Overall all residents admitted in the last six months have a pre-admission assessment, the quality of the information is varied and in one case seen the information was not sufficient to be confident that all needs would be met. From observation and discussion, all needs are met and the residents and relatives are happy with the care received. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 were assessed. Quality in this outcome area is adequate. The care received by all residents is good and staff are knowledgeable. The storage of medication is not safe and this could result in loss of medication. Issues of privacy and dignity are poor and residents are not encouraged to make choices about their daily lives, this may reduce the positive experience of good care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessments, risk assessments and care plans for four people were read. It was found that assessments are carried out on admission. All care planned is reviewed monthly and any changes are updated on to the written plan of care. Review of care is also carried out if there is a change in the individual’s health. The written care plans told us that staff consider the daily needs of each person, there is a lack of planned action to minimise risk such as breaks in the skin (pressure sores) and nutrition. It advised that this is completed to ensure that all care required is given. There were no residents with poor nutrition or sore skin at the time of this visit. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 13 The nurses were able to discuss the care of the residents and care staff were aware of their social care needs. A visiting professional told us that ‘In my experience residents improve in their physical health when they come here. I feel confident that the care given is good and have never received any concerns or complaints from either residents or their relatives.’ Residents have access to a GP and other professionals as required. Records of visits and the outcomes are recorded in each individual’s file. There are clear records of any outpatient appointments and of transport booked to ensure that they can attend. For more complex needs such as diabetes, care plans were detailed and actions stated were carried out. Staff were seen using moving and handling equipment properly and explained their action to each resident in a quiet and sensitive manner. Residents and relatives are addressed by their preferred name and both residents and relatives spoken with stated that the staff are polite and respectful at all times. The screening in shared rooms did not always appear adequate and as they are removable it is difficult to know if they are always used. Residents have not complained that there is a lack of privacy. Residents are supplied with toiletries from the home as and when they need them. It was seen that all residents had the same shower cream, bubble bath and other items to maintain cleanliness. There was no evidence that the residents are given a choice of what they would like to use, it is good practice to ensure that each person is allowed to choice their own products and maintain their individuality. Medication administration and management was checked. It was found that the lock to the room where medication is stored was insecure and the door could be opened without a key, this needs to be addressed to ensure safety. The medication fridge was clean and had the appropriate medications stored in it. Eye drops and creams and lotions were dated when these had been opened, this is good practice. The temperature is recorded daily it is suggested thay record the maximum and minimum temperatures, the deputy manager adjusted this immediately. Controlled Drug cupboard is a metal cupboard, it was seen that the lock has been replaced and is no longer safe the service imust replace this with a storage cupboard that meets with national regulations. The controlled drugs Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 14 are properly managed. A destruction kit is used to dispose of any unused controlled drugs as required by law. Destroyed medication is recorded in the Controlled Drug book and also in a receipt book for the company who remove these from the premises, a copy of the receipt is kept by the home. The resord keeping applies to all medicines destroyed. Medication Administration Records (MARs) were seen for those people ‘case tracked’ these were maintained properly and good records of received medication were available. If there are any mistakes in the medicines received from the pharmacist the nurse telephones the pharmacist and they respond promptly. It is suggested that records are kept. The deputy stated that the pharmacy support is very good. Twice a year the pharmacisit will come and do a fuill assessment. The clinic room is clean and tidy. The room temperature is recorded and it was evident there were days when the temperature had risen above 25OC. The service must assess this and take action to ensure that medicines are stored at 25OC and below to prevent deterioration. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 15 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 and 15 were assessed. Quality in this outcome area is adequate. Residents have access to some social activities and enjoy the food available although it is not clear a choice of meals is always being provided or that some residents find mealtimes a positive experience. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are some social activities provided but it was not clear that a range of different activities including outside visits are provided. The activity schedule on the wall in the home showed the following activities:- motivation to music, hairdresser, passing the balloon, bean bag toss, jigsaws, arts and crafts, Easter cards, video afternoon, karaoke and darts. Care plans contain a section on social activities for each resident and list interests, hobbies and things they like to do now so that staff can support them in these. One person’s file indicated they liked outings in the countryside, gentle music, drawing and colouring, patting dogs and cats and chatting about the old days. It was not clear from social activity information on display that these preferences had been fully considered to form part of the social activities provided. It was also not clear that outside visits are regularly Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 16 planned and take place. the day of the visit. No activities were seen to take place in the home on A resident who was asked about social activities said “there is a bit” and there was “enough for them”. They stated that they went on trips occasionally and were able to use the garden. Residents were observed to read newspapers and staff were seen conversing with residents between their work. The provider advised that an Activities Co-ordinator had been appointed and would be spending four hours a week on helping to organise social activities for the residents. The Annual Quality Assurance Assessment (AQAA) provided by the home acknowledges that the provision of outside activities is something they want to improve. Religious services can be provided at the home but at the time of inspection there were no set arrangements for these to take place. Staff said that arrangements are however made according to the requests of residents. Two visitors stated that the home is always welcoming and that there is a good atmosphere. They are always offered a drink and food while visiting and the staff are polite and share information as needed. One relative said “I am very happy with this home, the staff are kind and caring and respect each person”. Two relatives spoken with stated that the life in the home is good and residents are encouraged to make decisions and that they are consulted about the care and needs of their loved ones. It was evident that residents are able to make some choice about their care and services but it was not clear from records in place that this aspect of their care is being fully supported. A gender policy was viewed and this stated that no male carers were employed and was dated 2006. It was evident that the home now employ male carers and one resident said they liked having the male carers around to talk to. It was not clear that residents have been asked if they mind being cared for by a person of opposite gender. The menus showed the meals served during each day but only one choice was listed. The cook explained that residents are offered a choice each day and this is done in the morning. The choices could not be evidenced from menus in place and staff were unable to provide any records of records to show meals provided to confirm this. The home is required to keep records of meals provided to residents to demonstrate a wholesome and nutritious diet is being provided consistently. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 17 On the day of inspection the meal was chicken in sauce with vegetables, potatoes and fruit crumble and custard. Other main meals indicated on the menu included steak and kidney pie, fish and chips, baked ham and onion sauce and pork stroganoff. The evening supper menu included pilchards on toast, corned beef hash, sausage pasta bake and tuna and sweet corn quiche. Salad was listed as an alternative. The cook prepares all the food in the kitchen. In the evening a carer is designated to cover the teatime meal and prepares and cooks the hot alternatives. A resident spoken to said they were “quite satisfied with the food”. Two relatives spoken to stated that the food is good. One stated, “The food is excellent and there is always enough, people are offered drinks and snacks regularly and the staff are attentive to these needs”. Another stated, “‘Mum thinks the food is really good’. The dining room is bright and cheerful and looks out onto the gardens, the tables were laid nicely and residents were assisted to eat if required. Two incidents were seen where two separate staff did not assist a resident in a sensitive and caring manner. During the morning a member of staff was seen to hold a resident’s arm while assisting this person to eat, the person moved their head away suggesting that they did not want the food, but the staff member continued to put the food into this person mouth. At lunchtime another carer was seen assisting a resident to eat while standing by their side as opposed to sitting next to them. The carer did not pay attention to the resident and continued to put spoonfuls of food into their mouth. Eventually the resident told them they could not get more food into their mouth. This is poor practice, residents must be assisted with care and dignity to eat their food and staff must be aware that their actions can cause harm and also reduce the pleasure of eating. Other staff seen assisting residents did this in a sensitive and caring manner. Not all residents eat in the dining room; some people ate in the lounge areas with over-chair tables. The kitchen was well organised, clean and tidy. The kitchen was awarded the ‘Gold Award’ from the food hygiene department in June 2007. Records are kept of cleaning schedules and temperatures of the fridges and freezers. There are certificates telling us that staff have completed the Food Hygiene Training are on display in the servery. Quinton House Nursing Home DS0000004407.V361557.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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. Systems are in place for the protection of residents but it is not clear all staff are fully familiar with them to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints system is in place and any complaints received are logged onto a form. Forms are kept in a folder in the main office where staff can access them. The complaints procedure was on display on the notice board but it was found other notices, which had been pinned on the top of it, had covered this. It also had not been updated with our current address, which has changed twice since the procedure was printed. The home had not received any complaints since the last inspection and we also have not received any complaints regarding this home. The provider said that a copy of the complaints procedure is given to residents when they come to stay at the home. Residents spoken to had no complaints about the care and services they receive. One stated “I like being here” and “I don’t like to complain”. On speaking to staff it was not evident that they are fully familiar with the procedures for managing allegations of abuse. The policy relating to abuse Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 19 was not in the main folder with other policies but was found in the office diary. Staff felt that this was due to the policy being in the process of being reviewed. Staff said that they had done training on abuse last year. The Annual Quality Assurance Assessment (AQAA) forwarded to us from the provider states that it is intended that staff be retrained on abuse so that they are aware abuse is not always physical. Training will also need to include what is expected of staff if this is reported to them. All residents are charged £10 per month fro toiletries. There were no receipts in residents’ individual financial records to show what they had received and the cost; therefore we cannot be sure that all residents are using the £10 per month. It is required that better records are maintained and residents are charged fort eh toiletries they use. Quinton House Nursing Home DS0000004407.V361557.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): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. Residents live in a pleasant environment but some actions are required to ensure the environment is safe and suitable for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Quinton House is a large domestic building that has had some modifications to meet the needs of elderly residents. There is an annexe to the main house, which has been built to provide accommodation for up to 8 residents’ on the ground floor and the first floor provides accommodation for staff working in the home. Access to the first floor of the annexe is separate to that of the home, to ensure that visitors to staff living on the premises do not have to enter the resident’s home. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 21 Staff confirmed that all residents in the Annexe were mobile and did not require wheelchairs so they could access the main building easily. It was also confirmed that the residents with rooms in the Annex usually spent most of the time in the main building. We were told that six of the bedrooms in the Annex had en-suite facilities and there was also a communal shower room with toilet available. Rooms seen were clean and tidy. A radiator in one of the rooms was hot to touch and had not been guarded to prevent any burn risk to the resident. The water was also found to be hot which could present a scald risk. In other rooms viewed the water was at a safe level. It was found when viewing the Annexe that the cupboard next to the shower room contained chemicals but had not been locked. Chemicals such as bleach should be kept in a secure area to prevent any risks these could present to residents. A tour of the main building was undertaken and the home was found to be clean and tidy with no unpleasant smells. Bedrooms were light airy and spacious. There are a large number of shared rooms, each have removable screens, which provide some privacy. Each bedroom has en-suite toilet and hand washbasin. The water to the top floor flows slowly and takes some time to get warm. Water on the 1st floor is hot and on a number of resident wash-hand basins there was a “Hot Water” warning. No risk assessments in regards to scalding were seen and there was no clear evidence of actions taken by the provider to deal with this. Window restrictors have been fitted to help ensure that residents cannot fall from the windows. The bathrooms and shared toilet facilities were clean and free from clutter or personal items. Individual washing items were seen in the en-suites. It was noted that there were no locks on the communal toilets on the ground floor to promote privacy and choice. The provider was made aware of this. The call bell system was not working and it was established had been out of service for 5 weeks. We were told that the part required is being ordered but as the system is old it is difficult to get. There were no risk assessments or actions recorded on how the needs of residents was to be met. One of the residents found to be in bed in the Annex seemed anxious about not being able to alert staff due to the call bells not working. Three residents told us that the call bell system was not working and that they could not call for assistance during the night. Since the visit the provider has sent a basic risk assessment with action on how this is to be managed. We have not received confirmation of the date the system will be fixed or updated. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 22 When discussing the call bell system with staff, one carer was unaware that this was not working. This is of concern, as staff may not ensure a consistent approach is taken to managing risks to residents in the absence of a call bell. The home has a separate laundry room, which contains two washing machines but only one drier to service all laundry for the home. Suitable process were in place for the collection, washing, ironing and returning of laundry but it was not evident the drying facilities were sufficient for a home of this size. Staff confirmed that wet washing did build up while waiting for the drier to finish its cycle. Gloves were available in the laundry but disposable aprons were not and it was not evident that staff always wear them. On discussing this matter with staff they advised they do have supplies of disposable aprons and they do wear them but they had experienced problems with the aprons splitting and had to change them constantly. This matter will need to be reviewed. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 23 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 and 30 were assessed. Quality in this outcome area is adequate. Residents feel they receive good care and services from suitably trained staff but nursing staff levels are not always maintained to promote effective care of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home aim to provide two nurses from 8am to 5pm and one nurse from 5pm to 8am and six carers from 8am to 2pm, five from 2pm to 5pm and six again from 5pm to 9pm. There are dedicated staff to provide cooking, laundry and cleaning services to the home. The manager works four days a week and should work in a supernumerary capacity but it is not clear from viewing the duty rota this is always happening. This is because on some days the manager is on duty with only one other nurse. A deputy manager who works as part of the shift when on duty supports her. The home provides sufficient numbers in respect of care staff but the skill mix and ratio of nurses to care staff has the potential to affect the standards of care and safety of residents. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 24 Duty rotas show that the number of nurses the home aim to have on duty is not always met in that on some days the nurses are working in the capacity of a care assistant. The hours that the night duty staff work are not defined on the duty rota so that it is clear what hours they work. The duty rota shows that some staff are working a 5pm – 8pm shift followed by a night shift. This is poor practice as the double shifts could cause tiredness and impact on the effectiveness of staff. There should be sufficient breaks between working day and night shifts in line with the Working Time Directive. Residents spoken to were positive in their comments about the staff, one said “staff are very good to me”. Comments that the home had received from relatives were also positive about the staff. One stated, “the care which relatives receive from staff is wonderful, they are always ready to help with anything you ask and they are marvellous at their job”. A professional who has responded to a questionnaire provided by the home had stated, “residents and staff always seem to have a good rapport”. New staff do undertake induction training when starting at the home but it was not clear from records in place that training has been provided in line with the Skills for Care Council Common Induction Standards. This training involves staff completing a number of care modules over a period of weeks so that staff can develop their competences to care for residents safely. One training record seen for a new member of staff did make reference to the “common” induction standards suggesting systems are in the process of being implemented for this training. Training records showed that statutory training is being provided on an ongoing basis and includes health and safety, fire, moving and handling, food hygiene and first aid. Some staff had not completed the moving and handling and fire training but staff advised further training would be organised to ensure these staff completed this. The Annual Quality Assurance Assessment (AQAA) document provided by the home indicates that they plan to improve staff development and in-house training. The AQAA also states that out of 18 care staff 15 have completed a National Vocational Qualification (NVQ) II in care, which helps staff to provide more effective care to the residents. This exceeds the care staff for 50 of staff to achieve this and is to be commended. Staff had not attended equality and diversity training to help them understand how they may be able to support residents better in the service they receive. Two staff files were reviewed to confirm that appropriate and safe recruitment procedures are in place. It was found that appropriate checks had been Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 25 obtained such as Criminal Record Bureau checks and written references before the staff commenced work at the home. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 26 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 31,33,35,36 and 38 were assessed. Quality in this outcome area is adequate. Residents feel that the home is being run in their best interests but there are some actions required to secure the health and safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection the manager was not on duty, the inspection was therefore carried out with the assistance of the deputy manager and provider who was present in the home. Both had a good knowledge of the residents in the home. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 27 The manager/matron has completed a National Vocational Qualification (NVQ) level 4 in management and during the previous inspection the certificate was seen to confirm this. Overall residents and relatives spoken to were happy with the service and care being provided. Since the last inspection the home have implemented a quality monitoring survey. This had been forwarded to residents, relatives and professionals who visit the home to assess their views on the care and service provided. The home had received positive responses in relation to these surveys. It was evident that residents had been assisted by staff to complete some of their surveys, which does not allow for an independent view. The outcome report of the surveys did not list all questions, responses and comments from all parties and it was therefore difficult to get an overview of all responses, comments and actions the home needed to take in response to these. It was advised that outcome information of surveys is presented in a way that lists the questions, answers and comments made. Comments would need to be anonymous so that the report can be made available to residents and other interested parties. The home have two monthly staff meetings so that issues relating to the management of the home can be discussed. Relative and resident meetings are held but are less frequent. The financial management systems within the home need to be addressed. A £10.00 charge is made monthly for toiletries and each resident receives an invoice detailing toiletries provided. The toiletries are supplied by the service. There were no receipts to show what toiletries were being supplied to which person; therefore it could not be shown if each person is spending this amount of money each month. Records of toiletries supplied and their cost must be recorded and the amount deduced from the £10 deposited and these records must be available to view by residents, relatives and regulators. Chiropody and hairdressing invoices had been obtained for services provided but these were not signed or stamped. As they also did not show any address it was difficult to evidence who had provided the service. This needs to be made clear so there is an effective audit trail in confirming services residents have received. Records of money deposited by residents and money actually available was checked and found to be correct. It was not clear from records in place that all staff had received supervision six times per year as required. This will need to be addressed to ensure staff Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 28 training and development needs can be identified and competencies can be assessed to ensure residents receive safe and appropriate care. A review of health and safety checks was undertaken. A water check for Legionelleas had been completed in December 2007. Checks of hot water in residents’ rooms were not being undertaken monthly to ensure they were operating at safe levels so as not to scald residents. Water in the annex was found to be hot in one of the bedrooms viewed and there were also taps in the main building that were running above the recommended guidelines. The provider advised that thermostatic mixing valves were in place to help regulate the temperatures and agreed to implement more regular checking of hot water. Electrical portable appliances had been checked in August 07 and the Annual Quality Assurance Assessment (AQAA) provided by the home showed that appropriate checks had been made of electrical circuits, the lift and gas appliances. Dates for checks of the hoists indicated they were overdue. A fire risk assessment was not available in the home to evidence that this was in place. The provider said that this had been completed and said this could be forwarded to us if needed. It was evident that emergency lighting had been checked and there were records of fire drills and checks on fire extinguishers. The call bell system for the home was not operating and staff advised had been out of order for around 4 weeks. No risk assessment had been devised to ensure the safe management of residents and we had not been informed of this. Staff gave conflicting messages about how residents were being managed and one member of staff did not know the call bells did not work. This demonstrates the need for clear guidelines and risk assessments about how to manage residents while the system is not working. Since the visit the service has issued a basic risk assessment and action to be taken to meet the needs of residents when they are in their rooms. It was noted during the inspection that many of the doors into the home were open presenting a risk that people could enter the home and resident areas without staff noticing. This places residents and their personal possessions at risk. It was also found that doors which should have had restricted access could be opened ie rooms where medicines and chemicals are stored. The provider said that a member of staff had now been identified to be responsible for health and safety matters and was currently working through policies and procedures and safety checks to make sure these were all in order. Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 2 2 X X X X X 2 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 30 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. No. 1. Standard OP9 Regulation 18 Requirement A suitable cupboard that meets the national regulations must be purchased to store controlled drugs. This is to ensure that they are properly stored and cannot be accessed without a key. The lock to the room that houses the medication and dressings must be made secure to ensure safety to residents and the staff in the home. Each person must be allowed to choose the items they want to use to maintain cleanliness and individuality. All communal toilet and bathroom facilities must contain locks to enable residents to lock these if they wish to maintain their privacy and dignity. The call bell system must be fixed or replaced to ensure that residents are able to inform staff when they need assistance or DS0000004407.V361557.R01.S.doc Timescale for action 31/05/08 2. OP9 18 09/05/08 3. OP10 12(4)(a) 31/05/08 4. OP10 12(4) 31/05/08 5. OP19 13(4) 09/05/08 Quinton House Nursing Home Version 5.2 Page 31 care. 6. OP25 13(4) Hot water and radiators in the home need to be checked and made safe to prevent any burn/scald risks to residents. Risk assessments should be devised as appropriate. There must be suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of service users. A review of the skill mix of staff on duty at any one time is to be undertaken to ensure that there are sufficient nurses on duty at all times to safely meet the needs of residents. Not met from 30/04/07 8. OP35 17, Sch. 4(9) Appropriate records must be 31/05/08 maintained in regard to resident’s money. Records must show what the money was used for and receipts kept for items or services purchased on behalf of the resident such as toiletries and newspapers. Costs for these items must be clearly stated. (Issue outstanding from 31/05/07) This ensures that the residents’ money is spent on items for them and that they are aware of what they are spending. 9. OP38 23(4) The home must take advice of the fire service in regards to the fire escape door on the top floor to ensure this meets with fire precautions and residents are not placed at risk. 09/05/08 31/05/08 7. OP27 18 30/05/08 Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 32 10. OP38 13(4) Action needs to be taken to ensure the hoists are serviced and deemed safe to use. 09/05/08 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 OP3 Good Practice Recommendations Full assessment of needs with detail of the individuals’ abilities and areas where care is required should be completed by the home to ensure that needs can be suitably met. Proactive care should be developed for areas where a risk has been identified to ensure that all staff provide consistent care. The temperature in the medication room should not exceed 25OC. It is advised that an assessment is carried out and actions taken to ensure that this room is at 25OC or below. A review of activities should be undertaken to ensure the preferred social activities and interests of residents are considered and supported where possible within the homes activities programme. The home needs demonstrate that it is conducted in a manner that maximises resident choices. This includes evidence of choices of meals, toiletries and activities of associated with daily living. Menus need to be reviewed to ensure they show all meals, drinks and snacks that are made available to residents. Records of meals provided to residents need to be maintained to demonstrate a wholesome and nutritious diet is being provided consistently. These also need to show any specialist diets being provided to show residents nutritional needs are being met. The policies and procedures for abuse need to be readily accessible to staff and staff need to be clear on their DS0000004407.V361557.R01.S.doc Version 5.2 Page 33 2. OP7 3. OP9 4. OP12 5. OP14 6. OP15 7. OP18 Quinton House Nursing Home responsibilities should abuse be reported to them. This is to ensure staff are aware of the procedures they need to follow to safeguard residents. 8. OP19 The registered provider should review the number of shared bedrooms in the home. A review of the screens currently in use in double rooms should be considered to include options which would allow for more privacy. The flow of water in some of the bedrooms needs to be addressed so ensure taps work effectively for residents to use. Sufficient laundry equipment needs to be available to service the needs of the home and to maintain effective infection control procedures. Duty rotas need to demonstrate there are sufficient staff to meet the needs of residents consistently. It is advised that a review of shifts is undertaken to ensure staff are not completing a day shift followed by a night shift would could impact on their effectiveness. 12. OP30 Training records need to clearly demonstrate that staff are completing induction training based on the Skills for Care Common Induction Standards. This is to ensure staff build up appropriate competencies to care for residents safely. Reports of quality monitoring surveys need to include all information such as questions and responses made to give a full overview of outcomes. Comments should be included where appropriate (which should be annonymised). The report should be published and made available to service users and interested parties. Arrangements need to be made to ensure staff receive supervision at least six times a year. This is to ensure training and development needs are identified and actioned. The number of doors which are not locked and allow for free access into the building should be reviewed to ensure residents are not placed at risk from unwanted visitors. Chemicals in the home must be kept securely to prevent any risk of harm to residents. DS0000004407.V361557.R01.S.doc Version 5.2 Page 34 9. OP25 10. 11. OP26 OP27 13. OP33 14. OP36 15. OP38 16. OP38 Quinton House Nursing Home Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Quinton House Nursing Home DS0000004407.V361557.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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