Inspection on 18/11/05 for Rushall Care Centre

This inspection was carried out on 18th November 2005.

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

Other inspections for this house

Rushall Care Centre 19/08/09

Rushall Care Centre 04/11/08

Rushall Care Centre 05/09/07

Rushall Care Centre 05/07/06

Rushall Care Centre 23/08/05

Rushall Care Centre 11/10/04

Rushall Care Centre 27/08/04

Rushall Care Centre 17/02/04

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rushall Care Centre 204 Lichfield Road Rushall Walsall West Midlands WS4 1SA Lead Inspector Mrs Amanda Hennessy Unannounced Inspection 18th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 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. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rushall Care Centre Address 204 Lichfield Road Rushall Walsall West Midlands WS4 1SA 01922 635328 01922 642393 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) Exceler Healthcare Services Limited Ashbourne Homes Limited Maxine Ann Murphy Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 39 Frail elderly over the age of 60 of which 5 may be terminally ill, where the terminal illness commenced prior to admission Date of last inspection Brief Description of the Service: Rushall Care Centre is a care home providing nursing and personal care for up to thirty-nine older people. The home was opened in 1990 and is a purpose built, three storey building. The home offers mainly single accommodation and has two communal lounges and a dining room. There is a passenger lift giving access to all three floors. Laundry and catering services are provided within the home. It is owned by Exceler Healthcare Services Ltd and Ashbourne Homes Ltd. The home is located in Rushall, close to all local amenities and on a main bus route to Walsall town centre, limited car parking is available. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken between 9.15 and 17.00 hrs by two Inspectors. The inspection included a tour of the building, case tracking four service users, talking to visitors, service users and staff, a review of medication, a check of maintenance records and a check of a number of policies and procedures. Rushall Care Centre is owned by Exceler Healthcare Services and Ashbourne Homes Limited. Mrs Maxine Murphy is the Registered Manager. Eleven of the previous nineteen requirements have been fully addressed. Twenty requirements were made as a result of this inspection. What the service does well: What has improved since the last inspection? Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 6 Pre admission assessments of service users needs are comprehensive and also detail any equipment that the service user requires prior to their admission to the home. The Home manager also now confirms that, following the service users assessment of need, that the home will be able to meet their needs. Care records and care risk assessments have also improved ensuring that service users needs are met. As a result of the requirements of the assessments additional pressure relieving equipment and specialist beds are now available to assist staff in caring for service users. The manager has addressed the concerns in relation to inadequate staffing levels due to staff sickness. 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. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 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 Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 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 Service users have a comprehensive assessment of their needs giving assurance that the home is able to meet their needs. EVIDENCE: Service users have a comprehensive assessment of their needs before coming to live in Rushall Care Centre. Pre-admission assessments are undertaken by either the Manager or another senior nurse with the involvement of the service user and their representative whenever possible. These assessments now identify equipment required by the service users such as height adjustable beds and appropriate pressure relieving equipment. The Home Manager now writes to the prospective service user confirming that the home is able to meet their needs should they wish to come and live at Rushall Care Centre. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 9 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): 7,8,9,10 Care planning is comprehensive and meets service user’s needs. Medication practice and storage is inadequate and unsafe. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: A considerable improvement was seen in care records. Plans of care and care risk assessments for the risk of pressure sores, moving and lifting, nutrition, continence, the risk of falls and the use of bedrails are available for all service users. Care plans and risk assessments are reviewed at least monthly alongside the service user or their nominated representative. Service users state that they are able to access specialist medical and nursing services alongside dental, optical and chiropody services this was also confirmed by care records seen. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 10 Medication practices and particularly the storage of medicines were found to be a concern. The treatment room was not locked as required. A substantial number of medicines were left in the unlocked treatment room and the unlocked clinical store waiting for return. The ordering of dressings was found to be wasteful with a large number of type and size of dressings ordered for service users which were not being utilised. A large number of dressings, creams and some medicines were found to be out of date. Some limited life items once opening had no date of opening as required. Insulin had been inappropriately pre drawn and was found in the fridge which is unsafe practice. A number of gaps were seen on the medication administration record which would question whether the medicine had been given. Staff must also use the appropriate and identified code if they do not administer the medicine. A review of records of controlled drugs identify unsafe and inappropriate practice and although some drugs had been signed for they remained in the drug cassette. A review of the times that medicines are given has been undertaken. Lunchtime medications were still being given out at 15.00hrs it was highlighted that some medicines may have been required earlier. Service users spoken to said that they are treated with respect. Staff were seen to knock on bedroom and bathroom doors before entering. Privacy curtains are provided in double bedrooms. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 11 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): 13,14 Services users are able to exercise choice and control over their lives and maintain contact with friends and family. EVIDENCE: Service users and visitors spoken to during the inspection said that their visitors are also always made welcome by staff. Visitors are able to visit at any time that is convenient to the resident. Service users spoken to said that they have control over their lives they are able to get up and go to bed when they wish, have a choice of meals and are able to choose whether they take part in the activities and social events. One recent incident highlighted how the Manager has successfully resolved a conflict between service users when their choices have directly opposed the wishes of service users. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 12 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): 16,18 The home has policies and procedures to highlight concerns and complaints but policies needs to identify contact with other agencies to fully safeguard and protect service users from abuse. EVIDENCE: The home has an appropriate complaints procedure. The complaints procedure is displayed in the reception area and is also enclosed within the statement of purpose. A review of the homes complaints log identified proactive recording and management of all complaints with a record of actions taken for all events. Three complaints have been made directly to the Commission for Social Care Inspection and were found to be partially upheld. Complaints received direct to the Commission for Social Care Inspection highlighted shortfalls in staffing levels, the lack of general cleanliness and mal odour of the home. Service users spoken to said if they had any concerns they would discuss them with the Home Manager. The home has appropriate policies for staff to highlight concerns whilst feeling safe to do so. An adult protection policy dated August 2000 is available but needs to be updated to reference the local authority adult protection policy and the “ No secrets” guidance to identify appropriate contact with the Police, Social Services and the Commission for Social Care Inspection. All staff receive resident wellbeing training which includes ‘what is abuse. Staff spoken to Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 13 demonstrated a good awareness of what constitutes abuse and required actions if abuse is suspected or has been alleged. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 14 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): 19,26 The home is generally clean and homely although would be improved by refurbishment. Improvements to the home would assist in safeguarding service users from the risk of cross infection. EVIDENCE: The home was found to be generally clean, tidy and homely. Refurbishment and decoration are ongoing but slow resulting in some areas looking “tired”. There was a malodour in the lounge which may have resulted from the stained armchairs. There is a downstairs lounge and dining room with another lounge upstairs. The downstairs lounge does appear crowded and there is a need to review the communal space available. Service users’ bedrooms are pleasant with most adorned with photographs and other treasured belongings making them homely and welcoming. Work to replace the front upstairs windows that currently cannot be opened is due to commence shortly. The home suffers from a lack of appropriate storage for wheelchairs, hoists and scales. No services users bedrooms have locks despite an ongoing requirement. An Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 15 unused bathroom has been converted into a clinical storage room but the existing bath and toilet cistern and pipe work must be removed. The damp damage to the wall by the window must be addressed as it compromises the storage of incontinence pads and other medical supplies that are being stored in this room. The home has appropriate infection control practices although further improvements are required. The laundry does meet required standards and has appropriate policies and procedures for the management of dirty laundry. The broken tiles around the door must be replaced and the worn laundry floor must be repaired to meet infection control guidelines. The (external) laundry door requires repair to prevent against intruders. The requirement for a mechanical sluice to be available on the first and second floors has not been met. A mechanical sluice would effectively clean commode pots and minimise the risk of cross infection. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 16 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): Staffing levels and the skill mix of staff meet service users needs. EVIDENCE: Staffing levels at the home for 35 service users are: 08.00- 14.00 2 trained nurses and 5 care staff (with one carer starting at 07.00hrs) 14.00-20.00 2 trained nurses and 4 care staff 20.00- 08.00 1 trained nurse and 3 care staff. Staff levels have been reviewed following complaints about staff shortages made directly to the Commission for Social Care Inspection due to short term sickness. Agreement has been made that the above staffing regime does meet the needs and dependencies of service users accommodated. Staff sickness is being managed. The home has eight of its twenty care staff with at least National Vocational level two qualification (NVQ). An additional four care staff are currently undertaking their NVQ which will give more that 50 of its care staff with NVQ level 2. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 17 All new staff receives induction training although the Manager was unable to confirm that this is to National Training Organisations standards. Staff training provided ensures that staff are able to meet the changing needs of service users. Staff do not undertake foundation training as they are encouraged to enrol to undertake NVQ training. All staff confirmed that they receive at least three training days each year. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 18 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): 35,38 The home has appropriate management structures in place to safeguard service users. Individual staff members must ensure that they take appropriate actions to ensure that service users are fully protected from harm or accident. EVIDENCE: Secure facilities are available for the safe keeping of service users personal money and valuables. Written records are available for all transactions which detail the reason for the withdrawal and two signatures, receipts are available as proof of purchases. Money that was randomly checked in the safe was found to be correct and equal the balance identified. Regular external audits of service users personal money is undertaken. The majority of services users have their finances managed by their families or by the Court of Protection. The home manager identified that they do manage the money of one service user, this should also be transferred to the Court of Protection. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 19 Procedures to protect service users include regular checks on the fire alarm, emergency lighting, fire extinguishers, nurse call points and hot water. Records identify that staff regularly attend mandatory training in fire safety, moving and handling, food hygiene, health and safety and resident welfare. There is a need for staff to also attend training in first aid and infection control. Maintenance records and contracts were reviewed and were found to be up to date. The five yearly electrical installation test is due at the end of November 2005. Hazard data on substances that are hazardous to health are available in all areas that the chemicals are being stored or used. Service users safety is compromised by medicines that are left in plastic bags in unlocked rooms. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 20 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 2 x x 2 Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 21 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 3 4 Standard OP9 OP9 OP9 OP9 Regulation 13(2) 13(2) 13(2) 13(2) Requirement The treatment room and clinical room doors are kept locked at all times. The practice pre drawing up insulin ceases with immediate effect. Medicines waiting for return are kept in locked cupboards/ containers. A review of all medicines, dressing and creams is undertaken and all outdated medicines are returned. A date of opening is identified on all “ short life items”. There are no gaps on the medication administration record- with an appropriate code recorded for the non – administration of medicine. Required records are maintained of controlled drugs, with two staff signatures available to confirm administration. Medication is administered at required times and required intervals. The protection of vulnerable adults policy must be updated to DS0000020795.V265065.R01.S.doc Timescale for action 19/11/05 19/11/05 19/11/05 19/11/05 5 6 OP9 OP9 13(2) 13(2) 19/11/05 19/11/05 7 OP9 13(2) 19/11/05 8 9 OP9 OP18 13(2) 13(6) 19/11/05 31/12/05 Rushall Care Centre Version 5.0 Page 22 10. OP19 23(2)(f) 11. OP19 23(4) 12 13 14 15 16. OP19 OP19 OP19 OP19 OP22 23(2)(d) 16,23 16,23 16,23 23(2)(l) 17. OP24 12(4), 13(4) link and meet the requirements of the local authority protection of vulnerable policy. A review of procedures must be undertaken that highlights actions to be taken when a bed bound service user needs to be moved from one floor to another. Not met this requirement should have been addressed by 31/10/05. Alternative door closures to conform to the required standards and linked to the fire alarm system must be fitted. This requirement was not met doors were seen to be wedged open with the inappropriate use of furniture. Partially met- some door closures have been purchased but more are required to enable residents to have their doors left open, some doors were also wedged open with furniture. The stained lounge chairs must be effectively cleaned or replaced. The registered provider must forward the measurements of communal space available. The damaged laundry door is repaired . The cracked toilet on the top floor is replaced. There must be sufficient and appropriate storage available for items such as wheelchairs, hoists and linen. Partially met- new arrangements are in place for the storage of wheelchairs, but additional storage is still required. Doors to service users private accommodation must be fitted with locks to service users capabilities and accessible to DS0000020795.V265065.R01.S.doc 31/12/05 31/12/05 31/03/06 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 Rushall Care Centre Version 5.0 Page 23 18. OP24 13(5) 19. OP25 23(2)(p) 20 OP26 13(3) 21 22 OP26 OP26 16(2)(k) 13(3) 23 OP26 13(3) 24 25 OP35 OP36 20 18(2) 26 27 OP38 OP38 13(4) 13(3) staff in an emergency. Service users must be provided with keys unless the risk assessment suggests otherwise. This requirement was not met. Adjustable beds must be provided for service users who require assistance with moving and handling. Partially met, The home now has five height adjustable beds- this requirement should have been addressed by the 1/6/05. All bedrooms must have windows that can be opened and conform to recognised standards. Not met- plans are in place to replace nine windows shortly. Automatic sluicing disinfectors must be installed on the first and second floors. Not met this requirement should have been addressed by 1/12/04 The home must be kept free of any mal odour. The toilet cistern, bath and associated pipe work must be removed from the upstairs clinical store. The damp damage must also be addressed and the walls repainted. The broken tiles in the laundry must be replaced and the laundry floor must be repaired to ensure that it is impermeable. The Home’s staff must not manage the finances of any service user. The registered person must ensure that all staff have access to supervision. Partially met- supervision has commenced but need a record of the supervision sessions. Staff must receive first aid training. Staff must receive infection DS0000020795.V265065.R01.S.doc 31/03/06 31/12/05 31/12/05 28/11/05 31/12/05 28/02/06 31/12/05 31/12/05 31/03/06 31/03/06 Page 24 Rushall Care Centre Version 5.0 28 OP38 13(4) control training. A copy of the electrical installation test certificate is forwarded to CSCI. 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Photographs are available of pressure sores to assist staff to evaluate the progress of healing. Rushall Care Centre DS0000020795.V265065.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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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