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Inspection on 12/06/08 for Rectory House Nursing Home

Also see our care home review for Rectory House Nursing Home for more information

This inspection was carried out on 12th June 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Although the people living in the home describe the staff team as kind and caring and say that they have some activities and a choice of fresh, home cooked meals, the general feedback being received from service users and their families is that standards have deteriorated in the home.

What has improved since the last inspection?

There have been improvements to the ground floor of the building by the addition of a sensory room and a sensory garden. A family room has been built and the home has a "high dependency" unit that is well equipped and these rooms have access to the garden area. However the physical environment in the rest of the home needs improvement and equipment needs to be in place to adequately support people.

What the care home could do better:

The home must keep the changing needs of the people living there under review in order to ensure that the home can meet their individual and diverse needs. Care plans must be reviewed and updated to reflect the actual nursing and care needs of people, especially relating to personal care choices and risk assessments, both personal and environmental must be updated to ensure people are kept safe Assessments must be carried out in order to ensure that people`s nutritional needs are met and records must be kept of food and fluid intake in order to be able to monitor people safely.Medication must not be left unattended and records must be kept up to date to show that people receive their medication correctly. In order to protect the people living in the home from risk of harm, infection control systems must be put in place and regularly monitored. The home must be kept in a clean and safe manner and should have the necessary equipment such as baths, showers, hoists and wheelchairs in good working order. Pressure relieving mattresses should be set at the correct rate to ensure they meet the needs of individual service users. In order to ensure that the people in the home are protected from risk of harm or abuse, all of the staff team must attend safeguarding training and be aware of the procedures to follow. There should be staff in sufficient numbers with the required skills and qualifications to safely meet the needs of the people living in the home. All staff members should attend training in moving and handling and should ensure that the people in their care are moved safely. This is an outstanding Requirement at the last visit. Training including all mandatory training and training in the specific needs of the people living in the home must be provided to ensure that people have the care they need in the way they wish it to be provided. All staff including ancillary staff should also have regular supervision to monitor their practice and offer support. Advice should sought from the fire department on how people can safely have their bedroom doors open if they wish to do so. This is an outstanding Requirement from the last visit. In order that there is overall safe monitoring and guidance for the home and that it is run in the best interests of service users, a Registered Manager must be in place.

CARE HOMES FOR OLDER PEOPLE Rectory House Nursing Home West Street Sompting West Sussex BN15 0DA Lead Inspector Annie Taggart Unannounced Inspection 12th June 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 Rectory House Nursing Home DS0000052037.V365469.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. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rectory House Nursing Home Address West Street Sompting West Sussex BN15 0DA 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) 01903 750026 01903 751921 rectory@caringhomes.org Rectory House (Sompting) Ltd Manager post vacant Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category - OP The maximum number of service users who can be accommodated is: 48 16th August 2007 Date of last inspection Brief Description of the Service: Rectory House is a care establishment registered to provide nursing care for forty-eight service users. Rectory House is a detached property arranged on three floors and situated in Sompting village within easy travelling distance of Lancing and Worthing town centres with their shops and other amenities. The accommodation includes two lounge/dining room areas, one on the ground and another on the first floor. Building work has been completed to increase the number of bedrooms and communal space. There are thirty-eight single and five double rooms. There is a large garden to the front, side and rear of the house. Car parking is available at the front. The fees are currently £680 to £750 per week. The new rooms are intended for people with a higher level of dependency and will therefore command a higher fee Rectory House Nursing Home DS0000052037.V365469.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 no star. This means the people who use this service experience poor quality outcomes. In order to prepare for the visit, surveys were sent to service users and professionals involved with the home and an Annual Quality Assurance Assessment (AQAA) had been sent to the manager for completion. This was returned within the given timescales and contained detailed information about the home. Three service user surveys were returned and comments from these have been used in this report. Annie Taggart and Ann Peace carried out the unannounced visit at 08:30am on Thursday 12th June 2008 and the visit lasted for nine hours. During the visit we spent time with the people living in the home, in communal areas and in their private bedrooms and we spoke to the trained nurses and support staff on duty. We also spent time observing staff practice. We were able to speak with three family members and a local G.P. who were in the home during the visit. Six care plans and all supporting documentation such as daily records were tracked and we also looked at the personal care records for service users, which are kept in their bedrooms. We looked at four staff records and the system for the recording and administration of medication. We looked at menus and food records, saw the main meal of the day being prepared and served and we asked people how they are given a choice in the meals that are provided. Records for the running of the business including the quality assurance process, health and safety, fire records and incident and accident recording were seen and we also saw the home’s registration certificate, which was current and correct. The manager, who is not registered with the Commision as the registered manager, was present and received detailed feedback at the end of the visit. Due to concerns found during this visit, and in line with the Commission’s procedures, a Safeguarding alert was made to the West Sussex Safeguarding Adults team. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must keep the changing needs of the people living there under review in order to ensure that the home can meet their individual and diverse needs. Care plans must be reviewed and updated to reflect the actual nursing and care needs of people, especially relating to personal care choices and risk assessments, both personal and environmental must be updated to ensure people are kept safe Assessments must be carried out in order to ensure that people’s nutritional needs are met and records must be kept of food and fluid intake in order to be able to monitor people safely. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 7 Medication must not be left unattended and records must be kept up to date to show that people receive their medication correctly. In order to protect the people living in the home from risk of harm, infection control systems must be put in place and regularly monitored. The home must be kept in a clean and safe manner and should have the necessary equipment such as baths, showers, hoists and wheelchairs in good working order. Pressure relieving mattresses should be set at the correct rate to ensure they meet the needs of individual service users. In order to ensure that the people in the home are protected from risk of harm or abuse, all of the staff team must attend safeguarding training and be aware of the procedures to follow. There should be staff in sufficient numbers with the required skills and qualifications to safely meet the needs of the people living in the home. All staff members should attend training in moving and handling and should ensure that the people in their care are moved safely. This is an outstanding Requirement at the last visit. Training including all mandatory training and training in the specific needs of the people living in the home must be provided to ensure that people have the care they need in the way they wish it to be provided. All staff including ancillary staff should also have regular supervision to monitor their practice and offer support. Advice should sought from the fire department on how people can safely have their bedroom doors open if they wish to do so. This is an outstanding Requirement from the last visit. In order that there is overall safe monitoring and guidance for the home and that it is run in the best interests of service users, a Registered Manager must be in place. 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. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 8 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 Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 4 and 6 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. Although the home provides good information about the services on offer and prospective service users have their needs and wishes recorded, they are not receiving the care they are assessed as needing in the way they wish. EVIDENCE: There is a Statement of Purpose and Service User Guide in place that gives information about the services on offer and detailed assessments are carried out before people are admitted to the home, with families and other professionals involved in the process. However when we checked the assessments against the care actually being provided we found that people were not receiving the care they were assessed as requiring and that their needs were not being met. An example of this was a person who has developed dementia and despite this person needing specialist care and having falls that caused them injury, the home had not re-assessed their needs and put together a plan to support them or provided training in dementia care for staff. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 10 Although some people told us that they or their families had visited the home before moving in, other people said that they had come straight from hospital or had been brought to the home by their families, who had made the choice on their behalf. Rectory House does not provide intermediate care. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. People do not receive basic care in the way that the would like or have been assessed as needing and medication procedures are not being followed by all nurses administering medication. EVIDENCE: For each person living in the home there is a plan of care in place that has been compiled from the assessment process. The care plans had been reviewed and updated but did not reflect the care that people were actually receiving. We tracked the care plans for six service users and these contained personal care plans, risk assessments and health plans. However, reviews of care plans often said “no change” instead of detailing the current needs of service users. Daily records also often said, for example, “all care given” or “usual care given” instead of reflecting the changing physical and emotional needs of people. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 12 Tracking the care plans highlighted concerns in such areas as personal care needs, where it was stated that people should be bathed at least once a week but in practice there have been no working baths in the home for some time and personal care records that are kept in people’s rooms show that people were given body washes each day. The daily staff allocation sheets showed that four people were to be given a shower on the day of the visit but there were no records that this had happened and the shower room was dry and unused and full of equipment. Many people’s ensuite bathrooms were also full of equipment such as wheelchairs, commodes and continence aids. People in the new ground floor rooms told us that they did sometimes have a shower but one service user told us, “the staff said that I could have a shower but I don’t like showers and prefer a bath”. For some people there were gaps in the personal care records, sometimes for a number of days, so it was not possible to confirm if people had received daily care. Two people who were being cared for in bed had received no oral hygiene for a number of days, for one of these people, who was “nil by mouth”, no oral care was recorded for ten days, because the charts said the person had refused. Another person being cared for in bed had very dirty nails. A family member spoke to us and said that they were very dissatisfied with the care being provided in the home and gave us a six inch square of old towel she had been given by the staff to wash her mother with. We also saw this in another room and when we spoke to the person in the laundry she said that old towels were ripped up and used as flannels. Some bedding was also very worn and ripped and we brought this to the attention of the manager. A number of people’s care plans highlighted that they had difficulties with eating but they had no nutritional assessments in place. The manager said that she was currently looking into a better system of recording. We saw that at lunchtime, people still had morning hot drinks in feeding beakers, out of reach or had gone cold and there were also beakers and jugs of water or juice, out of reach or people were unable to lift them or feed themselves without assistance. We asked the manager for records of food and fluid intake for people, especially as the weather was hot, but there were none in place. Most of the people living in the home are being cared for on pressure relieving mattresses and have an assessment of what the bed should be set at in their rooms. When checking these we found that several were set at a different rate than that recorded and were set too high for the weight of the person. We Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 13 spoke to the manager about this and she said that she would bring this to the attention of the care staff and set up a monitoring system. During the day we saw people waiting a long time to get up or to receive care and call bells were constantly ringing for people needing attention. Four of the people we spent time with had their bells left out of their of reach. Call bells were often ringing for up to ten minutes to be answered and on one occasion after a bell having been ringing for eighteen minutes, a registered nurse went into the room and turned the bell off without attending to the service user. We also saw this on another occasion when another registered nurse also turned a bell off, telling a service user she would get someone to attend to them instead of finding out what the person needed. We saw staff moving people in wheelchairs with no footplates in place and their feet dragging on the floor and we also saw two staff physically lifting a service user from their chair into an armchair. Service user’s rights, independence and choices are not respected because they are not receiving basic care in the way they need and choose and comments from people included, “The staff are very good, very dedicated but you can’t overcome the lack of staff, you wait a long time to get up, I would have liked to get up earlier”, and “staffing remains a major problem, they take a long time to answer the bell and I can’t get up or go to bed when I like. I have a wash down every day but would like a bath now and again. The food is o.k. it’s not bad at all but sometimes I would like to be taken out for a push in my wheelchair”. Another person told us that they had asked to go to bed at 7.45pm the previous night and had finally been attended to at 11.45pm. This person said that they had been told off by a staff member for keeping ringing the bell and also said that it was not unusual for them to be kept waiting to get up until lunchtime. In a returned survey a service user told us “ due to the low staffing levels my needs are not always met”. The home works with a number of other healthcare professionals and one person who is in the home having respite care said that they felt they were well looked after. In a satisfaction survey another service user said, “ I had excellent nursing when I recently suffered a chest infection”. The home has policies and procedures in place regarding the storage and administration of medication, which is only administered by registered nurses. During the visit we saw the morning monitored dose packs left unattended in an open room near the front door of the home and we immediately brought this to the attention of the manager, who said she would speak to the nurse responsible. Gaps were also found in the Medication Recording Sheets (MAR). Rectory House Nursing Home DS0000052037.V365469.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): 12 13 14 and 15 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. Although there is a variety of fresh, home cooked meals available, the lack of assessments and recording means that there is no way of showing how people’s nutritional needs are being met. EVIDENCE: The home has recently employed a day care co-ordinator who is in the process of setting up activities such as craftwork, music, use of the new sensory room, some outside entertainment and a church religious service are also on offer. Although there were some sessions recorded in the activities logs, this was not sufficient to provide regular stimulation and interest for the people living in the home. We saw that records are kept for some individual one to one sessions with people but as many people living in the home are cared for in bed, they are often on their own for long periods of time. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 15 In a returned survey a service user told us, “ music sessions are the only entertainment available to me” and several service user told us that they felt lonely and isolated. One person said, “ my wheelchair has been broken for three months and I don’t get out of this room, I go from the bed to the chair and back. The staff are kind but they don’t have the time to come and talk to me as they are always so busy. It has all made me very depressed.” Some activities had been recorded for this person but not often enough to address their isolation. The manager told us that a new wheelchair was now on order. People told us that they could have visitors at any time and a family room has been provided so that people can have their families with them when they are ill or at the end of their lives Menus and food records showed that people are offered a variety of fresh, home cooked meals and we saw people being asked what choice they would like. Most people eat their meals in their rooms and many people need staff support. One person told us that they enjoyed having a cooked breakfast in bed but as the staff did not have the time to cut it up for him and he had poor pressure in his arms, he dropped most of it and often went hungry. Also as there are no nutritional assessments or records of what people actually eat or drink so there is no way of assessing how people’s needs are being met. We saw that records of people’s weights were very out of date, having last been recorded in January 08. The manager said that they had recently been carried out for all service users and were on the computer but we did not see them to verify this. Concerns were also highlighted regarding people’s nutrition by the number of hot and cold drinks we saw unused on the bedsides of people who could not reach them or were too unwell or unable to feed themselves. Rectory House Nursing Home DS0000052037.V365469.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): 16 and 18 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. Although complaints are recorded and acted upon, the people living in the home are not protected from risk of abuse or harm by there being poor working practices in place and all staff not being aware of safeguarding procedures. EVIDENCE: The home has policies and procedures in place regarding complaints and concerns and a copy of the complaints procedure is posted on the notice board. We saw the complaints book and this showed us that complaints are recorded and acted upon and outcomes fed back to the complainant. The Commission has received four formal complaints about care practice being provided in the home and these have been investigated by the manager or registered provider. Two people told us that they were not happy with the responses they received. There has also been one safeguarding investigation leading to a POVA (protection of vulnerable adults) referral. A service user told us that although they were unhappy about the care they were receiving they did not complain, as they did not want to “rock the boat” as when they did they were shouted at by care staff. Another service user also told us that they were shouted at for being too slow and trying to do things for themselves. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 17 Although there are policies and procedures in place regarding the protection of people from abuse or harm, records showed that all staff had not attended safeguarding training and two staff members that we spoke to were not aware of the correct procedures to follow. During the visit we saw two occasions where nurses ignored service users needs and people also had their needs and wishes unmet by having to wait for long periods to have their bell answered or receive the care they needed. Rectory House Nursing Home DS0000052037.V365469.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): 19 21 22 25 and 26 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. The home is generally dirty and unhygienic, with broken equipment in place and risks to people by poor infection control practices. EVIDENCE: Despite the majority of people in the home being unwell or being cared for in bed, there was no working bath in the home, service users told us that they had not had a bath for some time and this was confirmed by looking at personal care records. There was a large shower room but this looked unused and dusty and was filled with equipment and had hoist slings all over the floor. Many people’s ensuite bathrooms were also unusable being filled with wheelchairs, commodes and continence aids The home was generally dirty and unhygienic with some bed tables being covered in spills and dried food. Toilets in two rooms were very dirty and soiled, as were commodes in two other rooms. Carpets in communal areas Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 19 such as the stairs and landing were worn and dirty and in several service user’s bedrooms carpets were dirty and some rooms had a smell of urine. We saw that clinical waste had been placed in a bathroom in a white sack in a white bin without a lid on, which is an infection control hazard and in one bedroom a service user’s bin had some clinical waste in it and was overflowing. There was an armchair on the middle floor lounge that was badly ripped on the arms and was an infection control hazard. In two rooms, one of which was unoccupied, we saw oxygen cylinders with no safety notice in place and wheelchairs without their footplates fitted and these were also dirty and in a poor state of repair. The toilet in the unoccupied room was also very soiled. A housekeeper told us that she was the only cleaner on duty for three floors so she was only doing the minimum but most rooms looked as if they had not been cleaned regularly. In a survey a service user told us “ the cleaners are very good, very helpful but there just aren’t enough of them” A staff member told us, “it is very stressful working here with equipment such as baths, hoists and wheelchairs not working”. On the ground floor a new extension has been build with ensuite bathrooms, doors leading to the garden and built-in nursing equipment. There is also a new sensory room, sensory garden and a family room for people to stay if their relative is unwell. On the second floor, decorators were in the process of painting doors, but as all of the rooms were occupied, there was very little privacy and respect for people when their doors were opened. Several people’s bedroom doors had been wedged open with such things as wedges, a weight, a pillow and a Velcro opener, which could have put people at risk in the event of a fire occurring. When we asked the manager about this she said that the organisation had a “closed door” policy, so service users should not wedge their doors open. We noted that as many of the people whose doors were wedged open were cared for in bed, it could not have been them who wedged open the doors. One person had their door closed but had a wedge behind it told us, “ I hate having the door closed and have asked for an automatic fixture but have been told that I will have to pay for it myself”. Rectory House Nursing Home DS0000052037.V365469.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): 27 28 29 and 30 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. Although the people living in the home describe the staff team as kind and caring, their needs are not being met due to low staffing levels and a lack of staff training and support. EVIDENCE: Staffing rotas and comments from service users; families, professionals and staff showed us that there are not sufficient staff in place to meet the needs of the people currently living in the home. There were three care staff on the ground and second floor and two staff on the second floor with two registered nurses working across all floors. Although the care staff on duty were very busy at all times, people were still waiting a long time to receive care and attention, this was especially the case as several service users need two staff to assist them, for example with using hoists. There seemed to be very little hands on support for care staff from the two trained nurses on duty who spent most of their time in the treatment room. We spoke to one of the nurses who was an agency nurse and asked her what her duties were. The nurse gave us a list of her responsibilities and this did not include personal care or helping people at mealtimes, when asked about this the nurse replied, “yes we help if we have the time”. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 21 A member of the care staff told us, “We just don’t have enough staff at the moment and as both clinical team leaders have left we don’t have anyone to relate to or to or support us. We need more staff on each floor, better communication and supervision”. The manager told us that she was aware of the shortage of staff and was discussing this with the providers. We observed a doctor visiting a service user waiting for almost ten minutes before being taken to see the person he was visiting. The doctor said that generally he thought the care in the home was fine but there was always trouble finding staff or getting the information he needed when visiting patients We looked at the staffing records for four people and this showed us that the home carries out good recruitment processes; each of the files contained the required documentation including references and a current Criminal Bureau Check (CRB). When looking at training records we saw that all staff training was not up to date and this included mandatory training such as first aid, fire and health and safety. A Requirement made at the last visit has not been met in that all staff have not yet received up to date moving and handling training. During the visit there was a training manager in the home carrying out an audit and she told us that the organisation was auditing the home, identifying shortfalls and would then ensure that training was undertaken. There was no evidence to show that any of the staff team had received training in the care of elderly people or people with dementia even though they are caring for people with these needs. There are supervision records in place for care staff but none for any ancillary staff and the manager told us that she had been advised that supervision for these people was not necessary. Rectory House Nursing Home DS0000052037.V365469.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): 31 33 35 37 and 38 Quality outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. There is no evidence to support that the home is run in the best interests of the people living there and there are risks related to poor health and safety practices. EVIDENCE: The manager is a Registered Nurse and has worked at the home for three years but has not as yet been registered. The atmosphere in the home was not open or positive; staff had low morale and were reluctant to talk to us. Service users also told us that staff team were unhappy because they were always short staffed. Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 23 There is a quality assurance system in place and a company survey had recently been carried out in the home with good results. However the survey for service users was very limited in the questions it asked and did not ask whether there were enough staff on duty or if the service users felt they were well cared for. The home looks after some money for service users and these records were checked and we are satisfied there is a safe system in operation. Staff supervision for some staff is in place and is discussed in the previous section. We noted some unsafe practices during the inspection relating to medication management, infection control, poor manual handling by staff physically lifting people and when moving service users in wheelchairs and staff fire training is out of date. Rectory House Nursing Home DS0000052037.V365469.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 X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X 1 1 X X 1 1 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 1 1 Rectory House Nursing Home DS0000052037.V365469.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. No. 1. Standard OP4 Regulation 12 (1) Requirement Timescale for action 15/07/08 2. OP7 12 (1) a and b The home must keep the changing needs of the people living there under review in order to ensure that it can meet their individual and diverse needs. Care plans must be reviewed and 15/07/08 updated to reflect the actual nursing and care needs of people, especially relating to personal care choices. Risk assessments, both personal 15/07/08 and environmental must be updated and recorded and pressure relieving mattresses should be set at the correct rate to ensure they meet the needs of individual service users. Assessments must be carried out 15/07/08 in order to ensure that people’s nutritional needs are met and records must be kept of food and fluid intake in order to be able to monitor people safely. Medication must not be left 15/07/08 unattended and records must be kept up to date to show that people receive their medication DS0000052037.V365469.R01.S.doc Version 5.2 3. OP8 12 (1) a and b 4. OP8 12. (1) a and b 5. OP9 13. (2) Rectory House Nursing Home Page 26 6. OP26 7. OP21 8. OP18 9. OP27 10. OP30 11. OP30 12. OP36 13. OP38 correctly. In order to protect the people living in the home from risk of harm, infection control systems must be put in place and regularly monitored and the home must be kept clean and hygienic 13.4 (c) The home must have the necessary equipment such as working baths, showers, hoists and wheelchairs in good working order. 13. (6) In order to ensure that the people living in the home are protected from risk of abuse or harm all staff must attended safeguarding training and be aware of the procedures to follow. 18.1 (a) There should be staff in sufficient numbers with the required skills and qualifications to safely meet the needs of the people living in the home. 13. (4) All staff members should attend training in moving and handling and should ensure that the people in their care are moved safely. This was a Requirement at the last visit. 18.1(c) Training such as all mandatory training and training in the specific needs of the people living in the home must be provided to ensure that staff have the skills to provide good care for people in the way they need and wish. 18. (1) (c) All of the staff team, including ancillary staff should have regular supervision in order to offer them support and monitor practice. 23.4 Advice should sought from the fire department on how people can safely have their bedroom doors open if they wish to do so. 13. (3) DS0000052037.V365469.R01.S.doc 15/07/08 15/07/08 15/07/08 15/07/08 28/07/08 15/07/08 15/07/08 28/07/08 Rectory House Nursing Home Version 5.2 Page 27 This was a Requirement at the last visit. 14. OP31 8 (1) In order that there is overall safe monitoring and guidance for the home and that it is run in the best interests of service users, the registered provider must ensure that there is a registered Manager in place All areas of the home that are accessible to service users must be kept safe and health safety issues, such as the use of oxygen cylinders be monitored and recorded. 15/07/08 15. OP38 13. (4) c 15/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Rectory House Nursing Home DS0000052037.V365469.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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