Inspection on 10/08/09 for Royston Nursing Home

This inspection was carried out on 10th August 2009.

CQC 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.

Other inspections for this house

Royston Nursing Home 10/02/10

Royston Nursing Home 11/12/09

Royston Nursing Home 11/08/08

Royston Nursing Home 17/07/07

Royston Nursing Home 07/02/07

Royston Nursing Home 24/05/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Royston Nursing Home Brighton Road Clayton Hassocks West Sussex BN6 9NH Lead Inspector David Bannier Key Unannounced Inspection 10th August 2009 10:00 DS0000065926.V376727.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Royston Nursing Home Address Brighton Road Clayton Hassocks West Sussex BN6 9NH 01273 845603 01273 842018 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) Care Reminiscence Limited Manager post vacant Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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 categories: 2. Old age, not falling within any other category - (OP) The maximum number of service users to be accommodated is (17). Date of last inspection 11th August 2008 Brief Description of the Service: Royston is a care home, which is registered to accommodate up to seventeen residents in the category (OP) old age, not falling within any other category. It provides personal and nursing care. Royston is located in the rural village of Hassocks and is a detached threestorey property, which provides accommodation in single, and double bedrooms located on the ground, first and second floors. There are also two lounges, which are located on the ground floor. A vertical passenger lift provides access to all floors. The registered provider of this service is Care Reminiscence Ltd, who has appointed Mrs Elizabeth Herbert as the responsible individual to supervise the management of the care home. The post of manager is currently vacant. Current fees are from £587.00 to £625.00 per week. Royston Nursing Home DS0000065926.V376727.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 0 star. This means the people who use this service experience poor quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assurance Assessment prior to the inspection. The information received from this document will be referred to in the report. We also sent out surveys to four residents and to six care staff. They are entitled “Have Your Say About…” and give residents and staff an opportunity to give us their opinion about the care and services this care provides. Completed surveys were not available when this report was produced. A visit to the care home was made on Monday 10th August 2009. As this was an unannounced inspection we gave the manager and provider no notification of our intention to visit. We saw all eight residents and spoke to six of them and observed care practices. This helped us to form an opinion of what it is like to live in this care home. We also spoke to two staff who were on duty in order to gain a sense of how it is like to work at the care home. We also viewed some of the accommodation and examined some records. The visit started at 10am and was completed by approximately 4.30pm. The responsible individual and the acting manager were present during our visit and provided us with information about the service. We gave feedback of our findings to them at the end of our visit. What the service does well: Some communal areas of the care home are comfortable and homely. Residents have been able to personalise their own accommodation with their own furniture and other possessions. Relatives and friends of residents are able to visit when they choose. They are made welcome by the staff. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 6 Some activities are provided within the care home. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 7 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Royston Nursing Home DS0000065926.V376727.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 Royston Nursing Home DS0000065926.V376727.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home needs to be updated so prospective residents can be sure of the facilities on offer before deciding to move in. The care needs of prospective residents have been assessed. It is not clear if this process is completed before they move into Royston Nursing Home. Royston Nursing Home does not provide intermediate care. EVIDENCE: During our last visit we formed a judgement that information about the home still needs to be updated so people can be sure of the facilities on offer. The * Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 10 statement of purpose did not include details about the number and size bedrooms provided at Royston. As this was outstanding from our previous visit we made a requirement stating this must be met by 20th September 2008. In response we received an improvements plan from the responsible individual informing us that, “A completely new revisited and revised Statement of Purpose is being drafted.” We were also informed that this would be done by mid October 2008. The AQAA states that the care home, “provides every facility to the potential resident in making an informed decision based on an informed choice. The home has an array of documents which range from the Statement of Purpose, the Service User’s Guide and brochures written in simple language which are understandable and easily digested.” During this visit we were shown the Statement of Purpose. We could find no evidence that the document had been revised or redrafted to include all the information required. The acting manager and responsible individual were unable to confirm that a revised Statement of Purpose had been produced. As this requirement is outstanding from our previous visit, it will be dealt with in correspondence separate from this report. During our last visit we formed a judgement that pre-admission assessments are carried out to ensure that the home can meet people’s needs. The AQAA states that, “Fully comprehensive and documentation is available for reference prior to admission followed by visits, short stays and one month trail period. This is done with a view to see whether Royston Nursing Home can meet the needs of the resident and whether staff are qualified enough in these domains.” Since our last visit we received an alert from the East Sussex Adult Services in which an allegation of abuse was made. The outcome of the investigation provided to be inconclusive. However, the investigation did identify that pre admission assessments were not completed prior to the commencement of respite placements. During this visit we identified the names of three residents for case tracking purposes, one of whom had been admitted since our last visit. Documents and records seen confirmed that the needs of the identified residents had been assessed. Documentation examined included information about the reason for the admission, the residents medical history, their current medication, and details of their current physical care needs. However, as records seen had not been dated it was not clear if assessments had been carried out before residents have been admitted. We spoke to the acting manager about this in order to clarify that records must be accurately dated so they can provide evidence that assessments have been carried out prior to admission and it can be confirmed the care home is able to meet the resident’s identified needs. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 11 Residents we spoke to confirmed they felt well cared for. Staff on duty were able to clearly demonstrate they know about the needs of newly admitted residents. We could find no evidence that intermediate care is being provided at Royston Nursing Home. Royston Nursing Home DS0000065926.V376727.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been drawn up for each resident. They need to be improved to ensure that the staff team have clear and detailed information about services users’ needs and wishes. Medication has not always been stored securely in order to protect residents accommodated. Residents have been treated with respect and their right to privacy has been upheld. EVIDENCE: During our last visit we formed a judgement that, although there is a care planning and monitoring process in place, it needs to be improved to ensure Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 13 that the staff team have clear and detailed information about services users’ needs and wishes. Examples identified that, whilst several residents were being nursed on pressure relieving mattresses, care plans did not provide details of assessments which identified the appropriate pressure setting for each resident. One care plan stated that a resident, “needs hoisting, make sure the correct sling is used.” There was no indication or instruction to staff with regard to which hoist or sling should be used. Some residents’ care plans identified that the person “has a need for stimulation” but did not indicate how that should be provided. Daily records were in place, but were basic. Entries included “All care given”, “Eating and drinking well”, and “All nursing care given”. There was no detail with regard to what that meant in practice. A requirement was made with a timescale for completion by 20th September 2008. In response, the registered provider’s improvements plan stated that, “The care planning model will be reassessed and if need be, revisited to be fully comprehensive. Risk assessments will be carried out and recorded on a regular basis. Daily records would also be upgraded to be comprehensive and more potent with relevant information.” The improvement plan also confirmed that this would be completed by mid October 2008. The AQAA returned to us by the registered provider confirmed that residents’ needs “are incorporated into individual plans constituting of the reference document clearly highlighting the residents’ personal and health care – and the detailed means to be used to towards their delivery.” On this occasion we examined care records of three identified residents. From care records seen, from observation and discussions with staff on duty we noted that residents accommodated were frail and required significant levels of nursing care in order to meet their needs safely. Four residents required pressure relieving mattresses, at least two residents had in dwelling catheters, and two residents required a pureed diet. Several residents needed assistance when walking and needed to use a hoist when transferring from bed to chair. However, we could find no evidence that care plans had been reviewed and amended to meet the requirement made during our last visit. We discussed this with the acting manager and the responsible individual. They were unable to confirm that improvements had been made to care plans as required. Whilst care plans include details of residents identified needs they do not routinely include clear information for staff to follow so they know the action they are expected to take to ensure they have been met. As this requirement is outstanding from our previous visit, it will be dealt with in correspondence separate from this report. Information provided in the AQAA stated that, “With the help of aids and appropriate equipment, staff ensure that care is person-led, promoting maximum independence, with required levels of flexibility and variation to that wishes and choices are fully respected.” There was evidence that confirmed care plans have also been routinely reviewed. The acting manager informed us this is carried out monthly. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 14 However, the majority of entries included “no change” or “to continue with the same care plan.” It was not clear from records seen if the review included discussion with the resident, their relative, any health care professional or social worker involved with their care. This means that, whilst reviews have been carried out there was no evidence to demonstrate residents care needs have been kept up to date and individual resident’s wishes have been taken into account when care plans have been drawn up. We noted that care records also include details of appointments with residents doctors or district nurses. However, there was little or no information in care plans with regard to any diagnosis made and subsequent treatment prescribed. It was unclear, therefore, what nursing and care staff are expected to do to ensure any treatment is carried out. We saw all of the residents accommodated during the morning. Four were in their rooms and in bed, two of whom were asleep. We spoke to the two residents who were awake. Four residents were downstairs in the lounge asleep in front of the television. We saw no evidence of poor care or poor practices. We observed that residents we spoke to were clean and tidy in appearance. We noted that care staff on duty were providing support and care to residents in an appropriate manner. We spoke to one member of staff who explained to us the level of care that they were expected to provide to identified residents. During this visit we looked at care records and medication records. They had been well maintained and were up to date. We were informed by the responsible individual that medication could not be stored securely. We examined the facilities provided and saw that that cupboards being used to store medication could not be locked. As this was of concern we discussed this with the acting manager and the responsible individual. Before we left the care home we noted that medication had been moved to lockable cupboards. However, we advised the responsible individual that this was a temporary measure and facilities must be obtained without delay to ensure medication is stored securely at all times according to current legislation. We noted that a facility to store controlled drugs securely was available. However, we were informed that currently such medication is not in use. We noted that only trained nursing staff are responsible for handling and administering medication. We observed care practices and found that staff are respectful when speaking to residents and ensure residents are treated with dignity when personal care is being provided. Staff were seen to address residents using the name and title they prefer. Staff were seen to knock on the doors to residents private accommodation and wait for a response before entering. Royston Nursing Home DS0000065926.V376727.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines in the home are designed to ensure tasks are completed rather than allowing residents to have control over their lives or encouraging residents to make choices about what they wish to do. Basic activities are offered by the home. They do not take into account the hobbies and interests of residents. The home supports residents in maintaining contact with family and friends. Residents have not been given a wholesome, appealing and well balanced diet. EVIDENCE: During our last visit we formed a judgement that activities needed to be improved to provide interest and stimulation for people. We found that whilst a Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 16 programme of activities was provided, this was basic and included hairdressing, chiropody and nail care as activities. When we asked the manager how residents, particularly those who are being cared for in bed, are provided with interest and stimulation, we were advised that staff spent time with them on a one to one basis. However, records did not show any evidence of this and there was no record of outings in the community. Information supplied by the registered provider in the AQAA informed us that, “We provide a well diversified spectrum of activities and recreational items individually and in groups as per choice, wishes and performances of residents.” One this occasion we noted that an activity programme was on display on the notice board in the front hallway of the care home. The programme had not changed since our last visit. We noted that, on the day of our visit the activity planned to take place at 2pm was to be cards and needlework. We went down to the lounge in order to observe the activities provided. Four residents were sitting in the lounge with a cantilever table in front of them or within easy reach. One resident had a pack of large format playing cards in front of her. We were informed that the member of staff had just finished a game with the resident. We were then shown a plastic box which contained a piece of embroidered cloth with a selection of coloured threads and needles which had been sitting on the window sill behind the resident. The resident told us that they enjoyed needlework and crochet work. Whilst this was going on the other residents were waiting their turn to take part. One resident had fallen asleep. Our visit became the main point of interest in the room whilst we spoke to each resident in turn. Following discussion, the acting manager confirmed that this is the usual way residents are provided with activities. They are engaged with the member of staff on a one to one basis, waiting their turn until the member of staff becomes available to them. There has been no change since our last visit. The activities provided are basic. There was very little information in care plans with regard to residents’ interests and hobbies. There was still no evidence of outings or activities which take place in the community. We saw posters on the notice board advertising musical entertainers who are due to visit the care home. However, the information provided did not include the dates of their visit. We noted that care records include details of residents’ families and next of kin, including telephone numbers, so that they may be contacted. The acting manager informed us that there is an open policy with regard to visitors; they are welcome at any time. Although we did not meet anybody, we were informed residents do receive visitors on a regular basis. We also noted that the visitors’ book confirmed this. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 17 We could find no evidence that residents are able to exercise choice and control over their lives. Whilst we noted four residents were in bed during our visit, it was not clear if this was out of necessity or by choice. We spoke to two of these residents who were watching television. One resident told us, “There is nothing else to do.” The overall impression was that routines were designed to ensure tasks are completed and not necessarily to meet the needs of residents For example, two residents were asleep in bed. Despite this, a domestic assistant was vacuuming carpets in an area near to one resident’s room. The door was open and the noise generated by this activity was clearly disturbing the resident. A radio in the resident’s room had been switched on but had not been tuned into the station properly, making it very difficult to listen to the programme. We did not observe the staff ask the resident if they wanted to retune or turn off the radio. Staff on duty appeared to be very busy during the morning, but did not spend time with residents. Another resident who was watching television in their room told us, “This is better than speaking to the nurses.” During our last visit we made a judgement that there was no evidence to show that residents’ dietary and nutritional needs were being met. We made a requirement that the home must contact a nutritional expert in order to assess residents’ nutritional needs and to give advice on suitable, healthy diets, with a timescale of 20th September 2008. In response the registered provider drew up and sent us an improvements plan. This stated that “A qualified nutritionist has come to do training with us on nutrition. Advice, guidance, leaflets were given to us by the nutritionist. The registered manager will monitor the progress.” During this visit we could find no evidence to confirm that all residents’ nutritional needs had been assessed and advice had been obtained from a nutritionist with regard to healthy and appropriate diets. Following discussion with the responsible individual and the acting manager, they were unable to confirm that action had been taken to ensure this requirement has been met. As this is outstanding from our last visit, it will be dealt with in correspondence separate from this report. We met the cook, who informed us they had commenced working at Royston the week before. We were informed that the main meal of the day would be Toad in the Hole, boiled potatoes, carrots, broccoli and gravy followed by either lemon posits or bread and butter pudding. One resident had selected chicken as an alternative to the main meal. We were also advised that, whilst residents did not require any special diets, two residents needed to have their food pureed. Royston Nursing Home DS0000065926.V376727.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is place to ensure residents know that any complaints they make will be listened to, taken seriously and acted upon. Residents are not being protected from abusive and neglectful practices EVIDENCE: During our last inspection we noted that there was a complaints procedure displayed in the care home. There was also a record of complaints received together with details of any investigation carried out by the manager and outcomes fed back to the complainant. We noted that the method of recording made it difficult to track back through complaints received. The manager agreed to make improvements to the system. Information supplied in the AQAA stated that, “The home practices and encourages an open door policy in communication of complaints and protectors. As a matter of fact, informal and formal interactions always used as Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 19 effective mechanisms to invite comments, views, suggestions, criticisms and advice from every quarter directly and indirectly involved with the welfare of every resident.” This document also informed us that the care home had received two complaints in the last 12 months. They had been resolved within 28 days and neither had been upheld. During this inspection we saw that the complaints procedure was on display in the front hallway and readily visible to visitors. We also noted that the new name and address of the Commission was not included in the procedure. We spoke to the acting manager about this, who agreed to ensure the procedure is amended appropriately. We did not examine the complaints record on this occasion. We have been informed of two safeguarding adult alerts since we last visited this care home. We have also been advised that, in February 2009 the investigation into one has been completed. Whilst the outcome was inconclusive the investigation identified some concerns related to the day to day management of the care home. A pre admission assessment was not completed prior to the commencement of the respite placement of a resident. There was a lack of communication between the care home, family members and a district nurse who provided regular support to the resident when they were at home. This would have helped staff to understand the needs of the person particularly when problems arose during the placement. During this visit we could find no evidence that the manager had reviewed and amended the policies and practices for admitting residents in light of the outcomes of this investigation. We would expect that the findings of such investigations should be considered by the manager to ensure policies and practices in the care home protect residents and ensure their safety and wellbeing. During our last visit we found no evidence to show that the staff team have the training and skills to ensure that the people in their care are protected from all forms of harm or abuse. We made a requirement that, to ensure service users are protected from risk of all forms of abuse and harm, the staff team must attend safeguarding training and that training records must reflect this. This had to be done by 20th September 2008. In response the registered provider gave us an improvements plan which stated, “Staff would be provided with appropriate training. This will be implemented by the registered manager. Lists of courses and evidence of such bookings to be provided by mid November 2008.” The AQAA stated that, “Protection is uncompromisingly adhered to and staff are trained to take cognisance of any shortfall of protection and illustration of abuse in the widest definition of the term.” During this visit we looked through a selection of staff records. We could find no evidence that staff had received training in identifying and reporting abusive and neglectful practices. We spoke to the responsible individual and Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 20 the acting manager. They could not confirm that such training had been provided. We spoke to a member of staff who was on duty. They were able to identify different forms of abuse and they informed us that they would notify the manager if they witnessed abusive practices. The member of staff could not confirm they had received training. This requirement is outstanding from our last visit and will be dealt with in correspondence separate from this report. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not live in a well maintained environment. Standards of cleanliness at Royston are not sufficient to ensure it is pleasant and hygienic for residents. EVIDENCE: During our last visit we made a judgement that improvements are needed to the standards of furnishing, decoration and cleanliness of the environment. We formed the impression that, overall the home looked shabby and was in need Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 22 of updating and refurbishment. Lounges were comfortable and homely, but the furniture was old and some was in poor repair. Bedrooms have been personalised but many were still in need of updating and redecoration. Much of the furniture was old and needed replacing. New carpets had been fitted to some communal areas, but carpets in many bedrooms and on the stairways were old and stained. They were in need of deep cleaning or replacing. Bedding was very thin and old looking. In the laundry we saw pillows that had been washed and were waiting to go back on beds but were stained. We also saw that the standard of cleanliness throughout the home needed to be improved. We made a requirement that improvements needed to be made to ensure the premises is kept in a good state of repair externally and internally and should be kept clean and hygienic with a timescale for completion of 20th September 2008. In response the registered provider has drawn up an improvements plan stating, “Cleaning staff to be made aware of such requirements. Cleaning staff members’ hours to be increased (if needs be) to ensure cleanliness and hygiene. This will be done by the registered provider and the manager by 15th October 2008. Regular upgrading of environment both external (through painting and tidying) and internal (furnishing) to be addressed on an ongoing basis.” The registered provider has supplied us with an AQAA which states, “The home is recognised for following uncompromisingly high levels of cleanliness. Every precaution is taken to ensure the safety and comfort of our residents. There exists a physical environment development policy which ensures continuous upgrading of the interior and exterior of the building. Repainting and replacement of old furniture has been carried out continuously in the last 12 months.” During this visit we visited the private accommodation of all residents along with the communal areas, including the conservatory and the lounges. Whilst these areas were clean, there was no evidence that old and worn out furniture had been replaced, new carpets had been fitted or new bedding had been provided. There was evidence that residents have been encouraged to bring personal effects and small items of furniture in order to make bedrooms as individual as possible. We spoke to the responsible individual and to the acting manager. They were unable to confirm that furniture, equipment, carpets, bedding and soft furnishings had been replaced since our last visit. During our visit we noted that the four residents who were not in bed remained in the front lounge. We observed that a light fitting had a large piece of paper attached to it. When we moved closer we noted that it was a hand written notice which said “Do not switch on please.” The acting manager informed us that an electrician had visited to fit a chandelier in the centre of the room. The electrician had left the notice. It was not clear to us when the chandelier would be fitted. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 23 The second lounge and the conservatory were not used by residents. We observed that the conservatory was furnished with two plastic tables and five armchairs. Large pots of paint were on the tables and a lawn mower was near the door. We mentioned this to the acting manager, observing that the current state of the room was not very welcoming to residents. There is also a large step to negotiate in order to get over the lintel of the door. Residents accommodated would not be able to manage this without assistance. Residents are also expected to access the conservatory by going through the garden at the rear of the property. There is no covered walkway; residents would be prevented from using this area of the care home during cold and wet weather. We also visited the kitchen, the laundry and several bathrooms and toilets. We found the standard of cleanliness in these areas as no more than adequate. We discussed the importance of high standards of hygiene and cleanliness in specific parts of the care home with the acting manager. This is with particular regard to these areas in order ensure adequate safeguards against the spread of infections. The cook advised us that they had spent some time cleaning the kitchen, but there was still much to do. Not all surfaces in the laundry areas were easily cleanable. There were cobwebs and dirt between the walls and ceiling. This requirement is outstanding from our last visit and will be dealt in correspondence separate from this report. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the homes recruitment procedures and practices. Staff have not received induction training, mandatory and specialist training to ensure they are competent to do the work expected of them. EVIDENCE: During our last inspection we found evidence that there was sufficient staff on duty to meet the needs of residents accommodated. During this visit we noted that two care assistants were on duty and supported the acting manager in providing for the needs of the eight residents accommodated. There was also a cook and a domestic to provide food for residents and to ensure the premises are kept clean. After lunch the acting manager was supported by one care assistant. We noted that the cook, who also undertakes caring duties, agreed to stay on duty to ensure residents’ needs were met whilst the manager helped us with the inspection. The night staff commence duty at 8pm and continue through until 8am the following day. During this period a qualified nurse and a care assistant are available to assist Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 25 residents. From discussions with the acting manager and the staff, information contained within care records and from direct observations and speaking to residents we concluded that there was sufficient staff available to meet residents’ current care needs. During our last visit we found evidence that confirmed appropriate checks and documents are obtained for each member of staff before the start work in the care home. This means that vulnerable residents have been protected. On this occasion we looked through the records of two staff who had been recruited since we last visited. We found evidence that the registered provider had obtained all necessary checks including written references, proof of identity and criminal record checks before staff commenced work. At our last inspection we made a judgement that, to ensure that the staff team have the skills and knowledge they need to support the people in their care, mandatory training and regular supervision must be provided. Training records also needed be kept up to date and in good order. We also made a requirement with a timescale for completion of 20th September 2008. The registered provider’s improvements plan stated that, “A gap analysis to be carried out with indications of areas of focus, on a priority basis for staff training. A list of formal staff training identified and commissioned for staff to attend. On an informal basis, staff performances would be monitored and assessed. This will enable management to use every instrument effectively to address shortcomings in staff performances during their delivery of care. Examples include handing over, staff supervision, staff meetings, and where need is felt, one to one meetings.” Information provided in the AQAA stated that, “Staff members have continuously been exposed to latest skills development and new areas of knowledge by attending different training programmes.” During this visit we looked through a selection of staff records. We could find no evidence of staff supervision, staff meetings or one to one meetings. There was no evidence of training programmes for individual staff or records of training undertaken, including induction training for newly appointed staff. We spoke to the acting manager and the responsible individual. They were unable to confirm that staff had received structured induction training or mandatory training in subjects such as health and safety, fire prevention, moving and handling. They could not provide evidence of specialist training in terms of understanding the aging process, basic nursing procedures and care of the elderly. They were also unable to confirm that staff had received supervision or had been expected to attend regular staff meetings. We spoke to staff on duty who were able to explain in the care they provided to residents in basic terms. However, they were unable to confirm they received training in the tasks expected of them nor had they received supervision by the manager. This requirement is outstanding from the last inspection report and will be dealt with in correspondence separate from this report. Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 26 Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The responsible individual was unable to demonstrate the care home has been run in the best interests of residents. EVIDENCE: We have been advised of changes to the management of Royston Nursing Home since we last visited. The registered provider has informed us that, following the resignation of the previous manager, this post became vacant at Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 28 the end of April 2009. The registered provider has informed us of the arrangements which have been made to manage the home on a day to day basis whilst a new manager is recruited. We have also been advised of change to the responsible individual. This took place at the end of July 2009. An amended certificate has been issued to reflect these changes. During this visit we met the acting manager, who was on duty. We also met Mrs Herbert, the current responsible individual, who kindly agreed to being present during our inspection. During our last inspection we made eight requirements which are referred to throughout this report. As a result the registered provider issued us with an improvements plan detailing the actions that would be taken, by whom and the date by which they would be completed. Information provided in the AQAA stated that, “Management practices are an open door policy and staff are encouraged to have regular formal and informal meetings regarding the smooth running of the home. Care plans and risk assessments are drawn up with the help of residents and their next of kin/friends and reviewed regularly. Staff are being supported on a continuous basis through training. During this visit we could find no evidence that the identified requirements have been met. Whilst details can be found in the appropriate sections of this report, some examples include no evidence that assessments of residents’ needs are carried out before admission, no evidence that care plans give staff clear guidance with regard to how residents’ needs are to be met, no evidence of staff training, no evidence of staff supervision or staff meetings. Whilst we found no evidence of poor care practices, this does indicate that the care home has not been run in the best interests of residents. Information supplied in the AQAA confirmed the registered provider has taken appropriate steps to ensure the premises and equipment within the care home is safe for use. For example, gas and electrical appliances have been checked and maintained regularly. Royston Nursing Home DS0000065926.V376727.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X X X 2 Royston Nursing Home DS0000065926.V376727.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 2 Standard OP9 OP12 Regulation 13(2) 16 (m) and (n) Requirement Timescale for action 21/09/09 3 OP30 18 (c ) When medication is being kept it must be securely stored according to legislation. People who use this service must 21/09/09 be provided opportunities to engage in social, community and recreational activities that meet their needs and are in keeping with their wishes and expectations. Newly appointed staff must be 21/09/09 provided with structured induction training to ensure they understand their role and what is expected of them. 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 Royston Nursing Home DS0000065926.V376727.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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