Inspection on 24/05/06 for Royston Nursing Home

This inspection was carried out on 24th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Royston Nursing Home 10/02/10

Royston Nursing Home 11/12/09

Royston Nursing Home 10/08/09

Royston Nursing Home 11/08/08

Royston Nursing Home 17/07/07

Royston Nursing Home 07/02/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Royston Nursing Home Brighton Road Clayton Hassocks West Sussex BN6 9NH Lead Inspector Mr D Bannier Key Unannounced Inspection 24th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 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 Mrs Ann Guy Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A Maximum of 17 service users may be accommodated. Date of last inspection 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 a detached three-storey 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 property is located in the village of Clayton, approximately half a mile from Hassocks. The registered provider of this service is Care Reminiscence Ltd, who has appointed Mr Ramprakash Beeharry as the responsible individual to supervise the management of the care home. Mrs Anne Guy is the registered manager and is responsible for the day to day running of the care home. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report has been written using new methods introduced on 1st April 2006. Some evidence used to assess standards has been gathered before this visit took place. For example, information has been used from the registered provider’s action plan that sets out how the requirements from the last inspection will be met; information has also been used from written reports of visits to the care home made by representatives of the registered provider. This visit was unannounced and started at 10am. It was the first time this service has been inspected since it was registered with the current providers on 9th December 2005. It took place over seven hours and was conducted by Mr David Bannier and Ms Helen Tomlinson. The inspectors looked at those standards that are about how new residents are admitted to the care home; how residents are cared for; the daily life and social activities provided for residents; how the care home deals with complaints and how they protect residents from abuse; the environment in which residents live; how staff are recruited and trained; and how the care home is managed. Several residents were spoken to, along with a relative who was visiting the care home in order to gain a sense of how it is to live at Royston. Inspectors also spoke to five staff that were on duty in order to gain a sense of how it is to work at the care home. The communal areas were viewed along with a number of residents’ bedrooms. Inspectors also saw the kitchen, laundry and sluice rooms. A selection of records was also seen. Mrs Anne Guy was also present from 2pm and kindly assisted the inspectors with their enquiries. What the service does well: Residents are able to keep in touch with their relatives and friends. There are enough staff on duty provide the care needed by residents currently living at Royston. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Residents were admitted without an assessment being carried out to confirm the home could meet their needs. This care home does not provide intermediate care. Quality in this outcome area is poor. EVIDENCE: The inspectors looked at the care records of four residents. They had been admitted since the care home has changed ownership. Two residents had no pre-admission assessments on file. One resident had been assessed the day after they had been admitted. One resident had been assessed on the same day as they had been admitted. This meant there was very little information recorded about each resident. The information that was recorded had been provided by their respective families, but did not include any information about the care and nursing needs for each Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 9 resident. It was therefore not clear what the needs of residents were and whether the care home was able to meet them. The records of one resident, who had been assessed, indicated the resident might have dementia. As Royston is not registered to provide care for elderly people who have dementia, it was unclear if the resident’s needs could be appropriately met by this care home. On applying to become the registered provider of Royston, Mr Beeharry was advised that the size of identified bedrooms are too small to allow for staff and equipment to be used both sides of the bed when required. There was no evidence to confirm that any environmental risks had been considered prior to admission. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents had care plans documented. However not all care plans were based on assessments of health needs or had a management plan in place. The general storage, recording and administration of medication safeguarded the residents. Some individual issues of concern regarding the use of medication were noted. There was no evidence to confirm that residents are treated with respect and their right to privacy has been upheld. Quality in this outcome area is poor. EVIDENCE: A care plan had been drawn up for each resident. However there was no evidence to confirm that the care and nursing needs of each resident had been assessed. The care plans seen varied in the amount and quality of the information recorded. Some had good detail regarding needs and actions to be taken; others were confusing with a repetition of a need being reproduced on Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 11 each plan of care. There was no evidence of the resident or relative being involved in the development of the plan. This means that the information to staff regarding how residents’ individual needs should be met is not clear. Staff do not know if residents have specific wishes regarding how care is to be provided. Moving and handling assessments were present. These were detailed and included the risks presented by the environment. A hoist was present for the one resident who needed this. Nutritional assessments were in place. Residents were weighed monthly. In one resident’s record bruising was noted in the daily notes and not entered in an accident or incident record. There was no evidence to confirm that this had been investigated. The storage and medication records were examined. Some medication administration sheets had been handwritten and the writing was unclear. An issue of one resident who was on a variable dose of a sedative was discussed with the manager. There was no clear rationale for this or how to assess the necessity for the first dose or additional doses. This means that staff have no clear guidelines to follow. The resident may be at risk of possible abuse and the staff may be at risk of allegations of abuse. There were no controlled drugs on the premises and no medication kept in the fridge, although a designated fridge was available. Medication was given only by the qualified nurses. Four residents were in their rooms during the morning. It was noted that doors to residents’ bedrooms were open. It was not clear if this was at the express wish of the residents or if staff had simply forgotten to close them. Doors had not been fitted with locks. It was, therefore, not clear what the arrangements are to respect residents’ privacy if, for example, the resident had to go into hospital for treatment. A member of staff showed the inspectors around the home. From direct observation of care practices on the day it was not clear if residents have been treated with respect and their right to privacy has been upheld. The inspectors were advised of the residents who occupy each bedroom. In three bedrooms two residents were sharing the accommodation. On each occasion there did not seem to be any account taken with regard to the privacy of the residents. Whilst privacy screening was available the manner in which care is provided was of concern. There was no evidence to conform that residents who are sharing have made a positive choice to do so. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 12 Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Whilst some activities had been arranged, it is not clear if this is on a regular basis. There was no evidence to confirm that the lifestyle experienced in the care home does satisfy residents’ social and recreational interests and needs. Arrangements have been made to ensure residents maintain contact with family and friends. There was no evidence to confirm that residents have been helped to exercise choice and control over their lives. There was evidence to confirm that residents had been provided with a wholesome balanced diet. Presentation of the food and also the surroundings needs improvement to ensure they are pleasant and encourage residents’ appetite. There was no evidence, which confirmed residents with diabetes, that are diet controlled, are having their condition carefully monitored. Mealtimes are set by the routines of the care home and not for the convenience of the residents. Quality in this outcome area is poor. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 14 EVIDENCE: The inspector noted that the coordinator was also a senior carer whose name also appeared on the staff rota. The rota also showed that the coordinator also appeared as a carer on the same day as they were expected to arrange activities for residents. Following observations of care provided, the inspectors noted that residents were highly dependent on staff to meet their care needs. It was, therefore, not clear to the inspectors how the activities coordinator could arrange activities whilst providing care at the same time. The inspectors spoke to a resident who said that they used to like to knit and to crochet. This resident also said, “The staff are very good. There is nothing much to do.” One visitor was seeing their mother. This person told the inspectors they are very happy with care and staff. The staff were described as “ Very friendly and very helpful. They are always present and can usually be found in the back lounge sitting with residents. It is a very clean home. Mum is very happy. Ann, the manager, runs a tight ship. The food very good and mum’s health has improved. Mum likes her room although it is shared; it feels as if it is hidden and private.” There was very little evidence to confirm that residents have been helped to exercise choice and control over their lives. An example of this can be found under Standard 10 when residents were expected to vacate the front lounge so that staff could use the room for a training session. The lifestyle residents experience in the care home is driven by routines and not by personal preference and individual choices. The rota of the catering staff dictates mealtimes; residents are served where they happen to be, either in their own room or in one of the two lounges. The main meal of the day was chicken pie with a potato topping, carrots and cauliflower followed by bread and butter pudding. There is no separate dining room at Royston. Residents therefore, eat their meals from cantilever tables in the lounges and/or their bedrooms, depending on where they were sitting during the morning. This means mealtimes are not a social event when residents come together. Individual meals are put on plates by the chef in the kitchen and transported to the residents on trays by the care staff. Staff had changed into striped bibs before serving the food. The inspector spoke to the chef who confirmed they had obtained qualifications in catering including the basic food hygiene certificate. The inspector noted that the portions served were very generous. This may not be helpful as oversize portions can put off elderly people from eating. In addition, the food on the plate was predominantly white and was not appealing to the eye. It Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 15 was also of concern that no alternative cooked option was made available to residents who may not want the meal provided. The inspectors were informed that the care home caters for residents who have diet-controlled diabetes. A sweetening product is substituted for sugar when their food is prepared. However, it was not clear how nursing staff were monitoring and regulating the food intake of residents to ensure they have an appropriate diet. Some residents required help with eating their food. Residents in the smaller lounge where afforded help with this in an appropriate manner. However, as mentioned in an earlier section, the inspector saw one resident who is bed bound, being helped to eat their food by a member of staff who was standing by the resident’s bedside. This was also brought to the attention of the manager. It was agreed that it would have been more appropriate and respectful of the member of staff had sat on a chair beside the resident’s bed to help them. The registered provider had drawn up a written menu and had put a copy on a table in the hallway. This means that residents and the relatives are able to see for themselves the meals that have been planned for the week ahead. However, there was no evidence to demonstrate that residents have been offered an alternative choice to the main meal of the day. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The registered provider has drawn up an appropriate complaint procedure and had made arrangements to record any complaints that have been received. There was evidence that residents and their relatives are confident they can make complaints and they will be listened to. Current practices and procedures do not ensure residents are protected from abuse. Quality in this outcome area is poor. EVIDENCE: The inspector saw that a written complaint procedure was on display in the front hallway of the care home. This provided information to residents and the relatives with regard to how they should make a complaint, if it should be necessary. The manager has kept a record of complaints received. The manager also informed the inspectors that no complaints had been received since the new provider has taken over. The manager was able to confirm how complaints are dealt with. This includes ensuring it is recorded, carrying out an investigation into the details and writing to the complainant with the outcome of her investigations. Following discussion, the manager advised the inspectors of a current incident. The Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 17 inspectors advised the manager to ensure this is recorded even though the process is not yet complete. The manager was advised to ensure she records details of who made the complaint, the nature of the complaint, any action she has taken, including details of any investigations, and also the outcome. Discussions with residents did not include how complaints are dealt with. However, as there is currently a complaint under investigation that provided evidence to confirm that residents and relatives know that they can make complaints. The inspector spoke to three care staff that were on duty during the inspection. They were able to confirm they have received training in identifying different types of abuse and reporting such allegations. Training records seen confirmed that staff are in receipt of such training. It was of concern to note that according to a care plan, one resident has bruising. Records seen could not confirm how the bruising had occurred. The manager informed the inspectors that the resident was prone to bruising. However, this was not included in risk assessments or in the subsequent care plan with advice to staff regarding how the resident should be handled to avoid bruising. In addition, there was some discussion regarding the administration of a prescribed sedative to a resident by injection. Records seen did not provide clear guidance to staff with regard to when and why this should be administered. Some concern was also expressed regarding the recorded information, which did not give clear guidance regarding the dosage to be administered. Following discussion, the manager did not appear to appreciate the need for clear, recorded guidance for staff to follow with regard to either of the above issues. This would ensure residents are not at risk of abuse and staff are not at risk of having allegations of abuse made against them. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Residents do not live in a safe, well-maintained environment. The home is not clean, pleasant and hygienic. Quality in this outcome area is poor. EVIDENCE: On applying to become the registered provider of Royston, Mr Beeharry was advised that the premises does not allow for the services set out in the Statement of Purpose, to be provided. This is particularly with regard to the provision of nursing care in identified bedrooms. The size of identified bedrooms is too small to allow for staff and equipment to be used both sides of the bed when required. This also has a bearing on Health and Safety legislation with regard to providing staff with a safe working environment. In addition, there are insufficient bathrooms that can be fitted with appropriate equipment so that assisted bathing can be provided. One bedroom has been identified which also includes a route to a fire exit. This means that the privacy of the resident living there is compromised. Mr Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 19 Beeharry was asked to consider the opinion of the Fire Officer with regard to the suitability of this bedroom to accommodate residents. It was also strongly recommended that Mr Beeharry arranges to have the environment assessed by a suitably qualified Occupational Therapist. Mr Beeharry was also advised that he should take the advice of the Health and Safety Executive on these matters. It was also pointed out to Mr Beeharry that, given the constraints of the premises, the provision of nursing care to the number of residents for which the home is currently registered to accommodate may not be possible in future, unless he is able to find a satisfactory solution. There was no evidence available at this visit to confirm Mr Beeharry had taken appropriate action to address identified areas to ensure the environment is safe for residents accommodated, and for staff working at the home. Several items regarding the maintenance of the care home were identified during the visit. Ramped access to the back was through the fire exit and down a ramp. This was not swept clean and had leaves etc which could become slippery. The brambles had grown over the hand rails. The gap between the rails was very narrow. The nurse said ambulances took residents out of the home this way on a stretcher. A cord to a Velux window was broken. A member of staff said no residents used the shower as it was not in full working order or easy for staff to use. A toilet seat was not correctly fitted and swivelled. In a bedroom a window was broken and had a sign on it to say do not use. It was not clear how long this equipment had been out of action and when it would be repaired. The sluices were not clean and racking was rusty and could not be cleaned for infection control purposes. In the ground floor sluice nurses would have to lean over the clinical waste bin to access the sluice or hand wash basin. The laundry floor was not cleanable as floor tiles had been removed and were laying broken on it. Bare concrete was left. No specific staff were allocated to the laundry. It was unclean with dirty walls and racking. There was no clean and dirty area. There was rodent poison on the floor. On asking staff they said they had had a mouse, but this was no longer a problem. The bathroom, which staff said was mostly used, had dead flies in the bath. Dirty laundry was either carried outside the home on the fire escape or through a domestic kitchen, used by staff that lived there and storing food for the residents. This also meant moving and handling of heavy linen skips was taking place. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The registered provider has ensured there are adequate staffing levels to ensure residents’ needs are met by the numbers of staff. However, it was not clear if the all new staff have received induction training to ensure they have the appropriate skills to meet residents’ needs. The registered provider has not ensured residents are in safe hands at all times. The registered provider has not ensured residents are supported and protected by the home’s recruitment policy and practices. The registered provider has not ensured all new staff have received structured induction training and are competent to do their jobs. Quality in this outcome area is poor. EVIDENCE: The inspectors were informed that, at the time of their visit, there were fifteen residents accommodated at Royston Nursing Home. The inspectors noted that there was three care assistants on duty when they arrived. In addition, a qualified nurse was in charge of the shift. There were also a chef who was responsible preparing and cooking meals and a housekeeper who was responsible for keeping the care home clean and tidy. This person also orders food supplies and carries out general administrative duties. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 21 The inspectors concluded that staffing levels, including ancillary staff, were sufficient to provide for the current needs of residents who are accommodated. The registered manager was unable to confirm residents are in safe hands at all times. This is due to the current recruitment practice where staff commence work without all necessary documentation being obtained. The inspector examined the records of four staff who had been recruited since the current provider took control of this care home. He has recruited two qualified nurses and two care assistants. According to records seen it has not been the practice to obtain criminal record checks before staff commence work at the care home. There was no evidence to confirm that the registered provider has ensured the conditions set out in the regulations have been met until all necessary checks have been returned. Staff on duty informed the inspector that they have received a range of mandatory training including moving and handling, basic food hygiene, fire training, and health and safety training. In addition training had been provided in Understanding Dementia; Nutrition in the Elderly; Wound Care; and Parkinson’s disease. One member of staff confirmed she had obtained NVQ at level 2 and was due to complete the same qualification at level 3 in the near future. Staff training records examined confirmed the training provided. One member of staff confirmed they had received induction training. This included basic care of the residents and how to use a hoist safely. However, there was no record of such training, nor was their evidence of induction training provided to those staff that have been appointed by Mr Beeharry. The manager was advised that she should obtain workbooks from Skills for Care to ensure all new staff receive structured induction training and that it is recorded in their files. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 A person who is fit to be in charge is managing the home. The rota Mrs Guy works means she unable to discharge their responsibilities fully. The home is not being run in the best interests of the residents. An appropriate secure facility has been provided for residents to deposit money and valuables for safekeeping. The health, safety and welfare of residents and staff have not been protected. Quality in this outcome area is poor. EVIDENCE: Mrs Ann Guy is the registered manager. She is a qualified Level 1 nurse and was appointed to the post before Mr Beeharry became registered as the provider of the care home. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 23 According to the rota Mrs Guy works 36 hours per week at the care home. These hours are made up by working three twelve-hour shifts on Monday, Tuesday and Thursday. Apart from Thursday, when on shift Mrs Guy is the nurse in charge of the care home. Mrs Guy informed the inspectors that she uses Thursday to catch up on her paperwork. However, should it be necessary due to staff shortages or if there is problem, Mrs Guy will also become the nurse in charge. The inspectors advised Mrs Guy this in not satisfactory as her rota does not allow her to carry out her responsibilities as the registered manager. For example it is not clear when staff meetings and staff supervision take place. In addition, it is not clear who carries out assessments of prospective residents, reviews and updates their care plans and meets with relatives to discuss issues when Mrs Guy is not on duty or when she is responsible for the shift as the nurse in charge. There is evidence that demonstrates prospective residents have been admitted without an assessment of their care needs. This has resulted in one resident being admitted to a room which is clearly unsuitable for them. A risk assessment has indicated that the resident is at high risk due to the environment. All other residents accommodated are considered to be at medium risk. Residents are sharing rooms when this does not meet their individual needs and has a negative impact on their rights to privacy and dignity. Care plans do not include clear information to staff regarding how residents’ needs are to be met. There is no evidence to confirm residents and their relatives have been consulted when care plans have been drawn up. Staff have been appointed before important checks and documentation to prove they are fit to work with vulnerable adults have been obtained. New staff have not received structured induction training to provide them with important information about how the home runs and what their role is. There is no evidence to confirm that the registered provider is visiting the home on a monthly basis to ensure it is being run in accordance with good practice guidelines and within the requirements of current legislation. Mrs Guy confirmed that she has no dealings with residents’ financial affairs. Their relatives or an appointed agent such as a solicitor usually handles this. One resident told the inspector that their son has been appointed as Power of Attorney and pays the home’s fees on their behalf. The home has a facility for residents to deposit money and valuables for safe keeping. Mrs Guy informed the inspectors that, at present, no residents are making use of this. Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 24 A resident had a hoist in their bedroom. This was a shared room with little space between beds. This person is not weight bearing and a hoist was to help staff get this person into and out of bed. Privacy screens were present. A member of staff said when they were hoisting this resident they had to put the screen right up to the other resident’s bed. The resident’s bed was an ordinary divan without wheels. Staff said they lift it up to move it away from the wall to be able to help the resident in bed. The manager said the care home had five beds that were adjustable height. They could not move these between rooms, as there was no one on the staff team strong enough to do this. Moving and handling practices in the bathrooms were unsafe. A member of staff described how staff lifted residents from wheelchairs to the parker bath. They said it was “very hard,” and staff had bad backs. As mentioned earlier no accident or incident records were completed for bruising noted to a resident without known cause. Records seen showed that fire alarm testing had been conducted weekly and the emergency lights had been tested regularly. Staff had also received instruction and training at regular intervals prescribed by fire safety regulations, Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 25 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 x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 1 x x x x x x 1 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 x x 1 Royston Nursing Home DS0000065926.V292638.R01.S.doc Version 5.1 Page 26 NA 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 OP3 Regulation 14(1)(a) Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it is practicable to do so, the needs of the service user have been assessed by a suitably qualified or suitably trained person. Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative, prepare a written plan (“the service user’s plan”). The registered provider should amend service user plans to ensure they include clear information as to how service user’s needs are to be met. The registered person shall make suitable arrangements to ensure the care home is conducted in a manner which respects the dignity and privacy of service users. The registered person shall having regard to the size of the care home and the number and DS0000065926.V292638.R01.S.doc Timescale for action 20/07/06 2 OP7 15(1) 20/07/06 3 OP7 15(1) 20/07/06 4 OP10 12(4) 20/07/06 5 OP12 16(2)(m) 20/07/06 Royston Nursing Home Version 5.1 Page 27 6 OP18 13(6) 7 OP19 23(1) 8 OP19 23(2)(f) 9 OP26 23(5) 10 OP26 13(3) 11 OP29 19(1)(b) 12 OP30 18(1)(c ) (i) needs of service users consult service users about their social interests, and make arrangements to enable them to engage in local, social and communal activities. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Subject to regulation 4(3), the registered person shall not use premises for the purposes of the care home unless the premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. The registered person shall have regard to the number and needs of the service users ensure that the size and layout of rooms occupied or used by service users are suitable for their needs. The registered person shall undertake appropriate consultation with the authority responsible for environmental health for the area in which the home is situated. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall not employ a person to work at the care home unless subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. The registered person shall, having regard to the size of the DS0000065926.V292638.R01.S.doc 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 Page 28 Royston Nursing Home Version 5.1 13 OP30 17(2) (Schedule 4.6(g) 14 OP33 10(1) care home, the statement of purpose and the number and needs of service users ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including induction training. The registered person shall maintain in the care home the records specified in Schedule 4. In this instance this includes a record of all persons employed at the care home, including in respect of each person, a record of all training undertaken, including induction training. The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of service users, carry on or manager the care home (as the case may be) with sufficient care, competence and skill. 20/07/06 20/07/06 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.V292638.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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