Inspection on 11/12/09 for Royston Nursing Home

This inspection was carried out on 11th December 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 10/08/09

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 11th December 2009 10:00 DS0000065926.V378384.R01.S.do c Version 5.3 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.V378384.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.V378384.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.V378384.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 12th October 2009 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. A manager has been appointed, but has yet to register with the Commission. Current fees are from £587.00 to £625.00 per week. Royston Nursing Home DS0000065926.V378384.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 stars. 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. We requested the registered provider complete and return an Annual Quality Assurance Assessment. We requested this was returned to us by 5th November 2009. As this was not returned prior to the inspection we are unable to refer to important information this would have provided us about Royston Nursing Home. A visit to the care home was made on Friday 11th December 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 who are currently being accommodated at the care home and spoke to five of them. We also observed care practices. This helped us to form an opinion of what it is like to live in this care home. We 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 3.45pm. The responsible individual and the manager were present and provided us with information about the service. We gave feedback of our findings to them at the end of our visit. We served a Code B notice to the manager, who was the most senior member of staff on duty at the beginning of our visit. We went through this document with manager. We explained that the notice had been served as several requirements have remained outstanding since August 2008. We also explained that, if any requirements made previously remain outstanding after this visit, we will be serving a statutory requirement notice against the registered provider. What the service does well: Residents have been able to personalise their own accommodation with their own furniture and other possessions. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.2 Page 6 Relatives and friends of residents are able to visit when they choose. They are made welcome by the staff. Residents are provided with a choice of wholesome, home cooked food. Some activities are provided within the care home. What has improved since the last inspection? What they could do better: Care plans need to include clear information for staff to follow with regard to how the identified care needs of each resident should be met. All staff need to be provided with training with regard to the work they are expected to carry out. This should include structured induction training, training in identifying abuse, health and safety, fire safety training, and understanding the needs of elderly people. This will ensure they have the necessary knowledge and skills they require to provide good quality care to residents. We made requirements at the end of our visit in August 2009 with regard to the above improvements. The care home has been unable to confirm they have been fully met and they, therefore, remain outstanding. This will be addressed in correspondence separate from this report. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.2 Page 7 Staffing levels must be provided in sufficient numbers to ensure the safety and wellbeing of residents. The registered provider must carry out and record regular visits to the home to monitor the day to day management of the care home. This will ensure the home is being run in the best interests of residents. All staff must be appropriately supervised on a regular basis. This will ensure they have the support and guidance they need to carry out the work expected of them. A quality assurance system needs to be put in place, which takes into account the views of residents and their relatives. This will ensure the home is being run in accordance with the stated aims and objectives of the provider. If you want to know what action the person responsible for this care home is 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.V378384.R01.S.doc Version 5.3 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.V378384.R01.S.doc Version 5.3 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. Prospective residents have been provided with accurate information about the care home so they can be sure of the facilities on offer before deciding to move in. The care needs of prospective residents have been assessed, but the information obtained has not been fully recorded. This process is not always completed before they move into Royston Nursing Home. Royston Nursing Home does not provide intermediate care. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 10 EVIDENCE: During our visit in August 2009 we formed a judgement that information about the home needed to be updated so prospective residents can be sure of the facilities on offer before deciding to move in. We visited again in October 2009 and were shown a revised copy of the statement of purpose, which included information required by current legislation. We were also advised by Mrs Herbert that this document would issued to residents who are currently accommodated at the care home and to prospective residents who show an interest in being admitted to Royston. During our visit in August we formed a judgement that, whilst the care needs of prospective residents had been assessed, it was not clear if this process had been completed before they moved into the care home. During this visit we examined the care records of four residents, one of whom had been admitted since our last inspection. An assessment form was in place which covered the following areas: daily living skills, hearing, attitude, sleep patterns, elimination, adaptations and aids, mobility, general appearance, skin condition, language problems, and general nursing observations. In addition there is information about the general diagnosis of the residents and a summary of their nursing care needs. We noted that not all the assessment areas had been completed. For example there was no information about the resident’s sleep patterns, nor was there information about the aids the resident required. Following discussion we discovered that the resident does need attention at night and also they use a wheelchair and Zimmer frame to mobilise. We also noted that the assessment had been carried out on the day the resident was admitted. The manager informed us that this was due to the resident being admitted in an emergency. We could find no evidence of the care home providing intermediate care. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 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. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have not always been drawn up for each resident from the day of admission. They still need to be improved to ensure that the staff team have clear and detailed information about residents’ needs and wishes. This means residents’ health care needs may not have been fully met. Medication has been stored securely in order to protect residents accommodated. Records of medication administered have not been kept up to date. Residents have been treated with respect and their right to privacy has been upheld. EVIDENCE: Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 12 During our visit in August 2009 we formed a judgement that care plans had been drawn up for each resident. However, they needed to be improved to ensure that the staff team had clear and detailed information about services users’ needs and wishes. During our visit in October 2009 we judged that care plans still did not contain sufficient information for staff to follow to ensure they know what is expected of them to ensure residents needs have been met in accordance with their wishes. We sampled a selection of care records during this visit and found that improvements had not been made as required. In one instance care plans had only been drawn up five days after the resident had been admitted. Care plans that had been drawn up did not cover all the resident’s needs identified by the pre admission assessment. There were no risk assessments in place regarding pressure area care, nutrition or moving and handling. Care records stated that care plans must be evaluated or reviewed at least monthly or as required where necessary. In some instances, care plans had not been reviewed since September 2009. We noted that one resident needs to use a catheter, but there was no care plan to provide directions to staff in terms of its care and management. The resident’s care record did include a record of when the catheter should be changed. However, according to this record, the catheter was not changed until six weeks after the record stated it was due for renewal. We spoke to the manager about this, who was unable to explain why this had occurred. A care plan had been drawn up for a resident who is bed bound. The care plan stated that the resident needs to be turned or repositioned at least two hourly. We were shown a separate book in which are recorded the times the resident has been moved. There were several occasions when the resident was not turned with this frequency. Some gaps in the record are over three hours, whilst others are up eight hours before the next turn is recorded. On other occasions the last turn recorded was 7.30pm in the evening and the next record was not until 8am the following day. We discussed this with the manager who informed us that the resident had been turned but the record had not been accurately maintained. When we asked the manager what they had done about this they were unable to provide us with an answer. It was therefore, unclear if the staff had been informed of the importance of recording such details. We discussed the importance of having care plans in place with the manager. Whilst we observed no poor care practices during our visit, the lack of care plans means that the manager has no way of monitoring them to ensure care staff are meeting residents’ needs and that vulnerable residents are not at risk of being neglected or abused. It also means that care staff do not have Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 13 information to follow with regard to what action they should take to ensure the resident’s needs have been met, which also takes into account the resident’s preferences and wishes. The provision of care plans which provide clear and detailed information for staff to follow is a requirement made at our visit in August 2009. The provider has been unable to provide evidence to demonstrate this has been fully met. This will be addressed in correspondence separate from this report. Residents we spoke to confirmed they were well cared for. One resident told us, “The staff are ever so kind, I have no complaints.” We observed the interactions between residents and staff who were on duty. They demonstrated they treated residents respectfully and in a kindly manner. We also noted that the staff ensured residents were treated with dignity when personal care is being provided. Staff were seen to address residents using the name and title they preferred. Staff were also seen to knock on the doors to residents’ private accommodation and wait for a response before entering. During our visit in August 2009 we noted that medication has not always been stored securely in order to protect residents accommodated. During this visit we noted that medication was securely locked away in a medication trolley. We also examined medication records. We noted that, in one or two instances, records of medication administered had not been kept up to date. There were instances where the record had not been completed and also instances where the record had not been initialled, as required by the home’s procedure, but was ticked. This means that it is not clear if residents have received medication as prescribed. We spoke to the manager who agreed to take the necessary action to ensure records are accurately maintained and are up to date. We noted that some residents have been prescribed medication, such as pain and constipation relief on an as required basis. However, care plans we examined did not include any directions to staff with regard to the circumstances when such medication should be administered and the dosage to be administered. One resident has been prescribed medication for a diabetic condition. The manager advised us that the resident’s blood is tested regularly and the resulted recorded. The care plan states that the District Nurse needs to be called when the test reading is high. The care plan does not include information which clarifies what a high reading would be for the resident. We spoke to the manager about this, but they were unable to tell us why this information had not been recorded. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 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. 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 adequate 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 continue to be 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. A programme of activities are offered by the home when the activities coordinator is on duty. 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 been given a wholesome, appealing and well balanced diet. EVIDENCE: Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 15 During our visit in August we found evidence which confirmed that routines in the home were designed to ensure tasks are completed rather than allowing residents to have control over their lives or encouraged residents to make choices about what they wished to do. Basic activities were offered by the home. They did not take into account the hobbies and interests of residents. During our visit in October we found that the care home had appointed an activities organiser who works from 10am to 4pm each day. We were advised of the activities which had been organised for residents. This included bingo, carpet bowls and word search puzzles. On this occasion we observed four residents who were sitting in the lounge. One resident was reading a magazine, one resident was sitting doing nothing whilst the other two were asleep. The television was on but no one appeared to be watching it. The time was approximately 10.30am. We noted that there was a small book shelf which included large print books in a corner of the room. There was also a book of equipment which included a set of skittles and soft ball the size of a football. During this period, of about half an hour no members of staff came into the room. Staff on duty were busy helping residents with personal care needs. We observed no activities taking place in which residents could participate. We spoke to Mrs Herbert about this, who informed us that the activities coordinator does not work on this day. We asked about the alternative arrangements made so that residents who would like this, are provided with some meaningful activity. We were informed that the care staff will arrange something for residents later in the day. We asked if this means that an additional carer is made available to ensure residents’ needs can continue to be met. Mrs Herbert was unable to confirm this. During our visit we observed no activities had been arranged for residents. We also looked through care plans. We could find no information about residents’ interests or hobbies that had been recorded. We were given copies of previous weeks activities programmes and noted they included a manicure session, film, hairdressing, exercise, pedicure, art and craft, music and games. The programme was also on display on a notice in the front hallway of the care home. During our visit in August we found evidence which confirmed residents maintain contact with family, friends, representatives and the local community as they wish. During this visit we noted that care records include details of residents’ families and next of kin, including telephone numbers, so that they may be contacted. Residents we spoke to confirmed that they are able to keep in touch with family and friends. We also noted, from information recorded in the visitors’ book, that residents receive regular visits from families and friends. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 16 During our visit in August we formed a judgement that residents had not been given a wholesome, appealing and well balanced diet. We also made a requirement that the provider must seek advice from a nutritional expert with regard to the dietary needs of identified residents. On this occasion Mrs Herbert showed us a report from a nutritional expert which demonstrated advice and guidance had been provided with regard to appropriate nutrition and diets for the needs of residents accommodated at Royston. We also spoke to the cook who told us about the main meal of the day that was being prepared. This consisted of a choice of battered cod, cod in butter sauce or sausages with chips, peas and carrots or baked bean followed by a choice of jam roly poly with custard, fresh fruit or strawberry whip. The cook also informed us of the special diets that were currently being catered for. This included diets for residents who are diabetic and also those who required liquidised meals. We were given copies of recent menus to look through. They demonstrated that a varied, wholesome and nutritious diet has been provided. Residents we spoke to confirmed they were satisfied with the food provided. They informed us meals were provided in sufficient quantities for their needs and that they were to their liking. We noted that, since our last visit, a new dining table and chairs had been provided. The new furniture was sufficient to accommodate up to eight residents. We were informed that those residents who are not bed bound do like to take their meals in the dining room. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 17 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. Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Residents may not be protected from abuse. EVIDENCE: During our visit in August 2009 we found evidence that confirmed a complaints procedure is in place to ensure residents know that any complaints they make will be listened to, taken seriously and acted upon. During this visit we noted that a written complaint procedure was on display in the front hallway of the care home. We also examined the complaint record and noted that no complaints had been recorded since our visit in August. During our visit in August we formed a judgement that residents were not being protected from abusive and neglectful practices. We could find no evidence that staff employed to work at the care home had been provided with Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 18 training in how to identify different types of abuse and neglect and how any instances they witness should be reported. As a result we made a requirement that the provider must provide all staff with appropriate training. During this visit we examined staff training records. They demonstrated that whilst eleven people had received this type of training, there were a further seven staff who had not attended the training session. We were informed that some staff only works one day each week and that Mrs Herbert thought that others, such as the handyman, did not require such training. Following discussion, Mrs Herbert could not confirm that a further session was planned to include those staff who had not yet been trained. The provision of training to all staff in identifying different types of abuse and how to report any abusive practices that has been witnessed is a requirement which was made after our visit in August 2009 . The provider has been unable to provide evidence to demonstrate this has been fully met. This will be addressed in correspondence separate from this report. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well-maintained environment. The home is clean and pleasant. EVIDENCE: During our visit in August 2009 we formed a judgement that residents did not live in a well maintained environment. Standards of cleanliness at Royston were not sufficient to ensure it is pleasant and hygienic for residents. As a result we made a requirement that the provider must ensure that the premises Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 20 is kept in a good state of repair, externally and internally and is kept clean and hygienic. During this visit we noted a number of improvements. All vacant bedrooms have been redecorated, and provided with new beds, bedding and curtains. Some rooms have been fitted with new carpets; Mrs Herbert informed us that others will be recarpetted in the near future. Mrs Herbert also informed us that new furniture had been ordered and should be delivered in the next few days. As mentioned previously, a new dining room suite had been provided so that those residents who wanted to could take their meals in the dining room. The dining room had also been redecorated and provided with new curtains. We had been made aware that the local Food Safety Officer had visited in September 2009 and had made eleven requirements related to the kitchen and provision of food. Mrs Herbert showed us a copy of a report of subsequent visit which demonstrated that these requirements had now been met. We also noted that the exterior of the premises had been redecorated and rubbish from the garden had been cleared. We noted the overall impression at this visit was that the premises is now clean, fresh and well looked after. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 21 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, 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. The numbers and skill mix of staffing levels provided may not meet residents’ needs. Residents may not be in safe hands at all times. Staff may not be trained and competent to do their jobs. EVIDENCE: During our visit in August we found 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 is kept clean. During this visit we noted that one care assistant was on duty with the manager providing for the needs of the eight residents accommodated. A cook and a domestic were also on duty as before. When we arrived the manager informed us she was in the process of helping a resident and asked if she could Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 22 finish what she was doing. We agreed to this and sat in the lounge observing routines for approximately half an hour. We examined copies of staff rotas. They confirmed that there is a trained nurse on duty 24 hours a day. From 8am to 8pm each day the trained nurse is supported by a care assistant. We noted that, when she is on duty, the manager is also the trained nurse on duty. From 8pm to 8am each night care is provided to residents by a trained nurse and a care assistant who are awake and on duty. It was not clear if staffing levels provided are determined by dependency levels of residents accommodated. We found no evidence of such an assessment tool in care records seen. We noted that, on the day of our visit, there were three residents who were being cared for in bed. Apart from at the beginning of our visit, the manager was present and provided us with information during the course of our visit. This meant that, for the majority of the time, one care assistant was available to residents. During our visit in August 2009 we formed a judgement that staff had not received induction training, mandatory and specialist training to ensure they are competent to do the work expected of them. As a result we made a requirement that the provider must provide all staff with mandatory training including fire safety, moving and handling, health and safety and infection control. A further requirement was made in that the provider must provide all newly appointed staff with structured induction training. During this visit we looked at staff training records. They demonstrated that twelve of the staff employed at the care home have received mandatory training in the areas identified above. However, six staff had not received such training. Following discussion, Mrs Herbert was unable to explain why all staff had not received appropriate training. Mrs Herbert was unable to confirm there were plans to provide additional sessions to ensure such training is provided in future. The provision of mandatory training to all staff is a requirement made at our visit in August 2009. The provider has been unable to provide evidence to demonstrate this has been fully met. This will be addressed in correspondence separate from this report. We were informed that one new member of staff had been appointed since our visit in August. During our visit in October we noted that this member of staff had been appointed but had not received structured induction, despite the requirement being made. During this visit we were shown a form which had been completed and demonstrated that this person had been introduced to the procedures of the care home. For example the member of staff had been shown the fire evacuation procedures, care plans and had been introduced to residents. It was not clear when this had taken place as the form had not been Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 23 dated. However, there was no evidence that this had followed Skills for Care guidance and provides a structured induction into the principles of good quality care. When we asked Mrs Herbert and the manager about this they were unable to confirm this guidance had been followed. The provision of structured induction training for newly appointed staff is a requirement made at our visit in August 2009. The provider has been unable to provide evidence to demonstrate this has been fully met. This will be addressed in correspondence separate from this report. During our visit in August, from evidence seen we formed a judgement that residents have been protected by the homes recruitment procedures and practices. As no further recruitment had taken place since our last visit in October 2009, we did not examine recruitment records on this occasion. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 24 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, 25, 36 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 provider has appointed a manager to take responsibility for the day to day running of the care home. The home has not been run in the best interests of residents. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff have not be promoted and protected. EVIDENCE: Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 25 The post of registered manager has been vacant since April 2009. The registered provider has appointed a manager, who has submitted an application to register with us. This is in the process of being determined. During our visit in August 2009 to formed a judgement that the responsible individual was unable to demonstrate the care home has been run in the best interests of residents. We visited again in October 2009 to monitor compliance with requirements which had not been met since August 2008. We found that overall, the findings of this visit were that improvements for the benefit of individuals in the care home had been made. The responsible individual could not provide us with evidence which demonstrated that all requirements made after our visit in August 2009 had been fully met and that improvements have been embedded in care practices. During this visit we found several shortcomings with regard to the day to day running of Royston Nursing Home. Whilst the needs of a prospective resident had been assessed, from evidence seem this had taken place on the day they were admitted. It was five days after admission that care plans were drawn up for one resident, but they did not cover all the identified needs of the resident. Other care plans did not provide clear information with regard to the needs of residents and how they are to be met. They have not been routinely reviewed although care plans indicate they should be evaluated at least monthly. New staff have not received structured induction. All staff have not received training in identifying and reporting different forms of abusive practices. All staff have not received mandatory training. The dependency levels of residents have not been regularly assessed to ensure there are sufficient staff on duty to meet their needs. We were informed that one staff meeting has taken place since August 2009. We looked at the minutes of the meeting which indicated that Mrs Herbert chaired the meeting. There have been no resident meetings during this period. We have noted previously that routines in the home have been designed to ensure tasks have been completed and not to support residents in making decisions and choices about their own lifestyles. Mrs Herbert informed us that she visits Royston on a regular basis. However, there was no evidence that she has visited in accordance with Regulation 26 to monitor the day to day management of the care home. Mrs Herbert also confirmed that a quality assurance system was not in place to review progress, to identify shortfalls in the provision of care and services, and to identify action that needs to be taken to rectify them. The manager was unable to confirm she has ensured all staff employed at Royston have been regularly supervised. This means that there is no evidence Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 26 that the manager, or the responsible individual has provided leadership and support to enable staff to give good quality care to residents. Mrs Herbert informed us that the care home does not deal with residents’ personal finances. It is expected that each resident, their family or representative deals with such matters. One resident we spoke to confirmed that their relative deals with their financial affairs for them. Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 27 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X N/A 1 X 1 Royston Nursing Home DS0000065926.V378384.R01.S.doc Version 5.3 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18 Requirement There must be sufficient numbers of care staff on duty to provide for the needs of residents. This will ensure residents safety and wellbeing is maintained at all times. Regular visits must be undertaken and recorded by a representative of the provider at least on a monthly basis. This will ensure the day to day running of the care home is appropriately supervised. Effective quality assurance and quality monitoring systems, based on seeking the views of residents and relatives must be put in place. This will ensure residents’ needs have been met in accordance with the home’s aims and objectives All staff employed at the care home must be appropriately supervised. This will ensure all staff receive the guidance and support they need to carry out the work DS0000065926.V378384.R01.S.doc Timescale for action 18/01/10 2 OP33 26 18/01/10 3 OP33 24 18/01/10 4 OP36 18 18/01/10 Royston Nursing Home Version 5.3 Page 29 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.V378384.R01.S.doc Version 5.3 Page 30 Care Quality Commission South East Region 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). 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