Inspection on 25/07/07 for Shawside Nursing Home

This inspection was carried out on 25th July 2007.

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

Shawside Nursing Home 13/12/07

Shawside Nursing Home 07/11/06

Shawside Nursing Home 05/01/06

Shawside Nursing Home 21/06/05

Shawside Nursing Home 09/12/04

Shawside Nursing Home 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Shawside Nursing Home 77 Oldham Road Shaw Oldham Lancashire OL2 8SP Lead Inspector Michelle Haller Key Inspection 09:30 25 July 2007 th 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 Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shawside Nursing Home Address 77 Oldham Road Shaw Oldham Lancashire OL2 8SP 01706 882290 01788 816940 taylorve@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited 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 Home 150 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (57), of places Physical disability (120), Physical disability over 65 years of age (120) Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. The manager to be supernumerary at all times. No more than 90 places to be used for nursing care. No service users under 55 years of age to be accommodated into the home. One named service user above 39 years of age may be accommodated in the home. A minimum of 630 nursing staff hours must be provided each week. A minimum of 630 care hours must be provided on Beech House each week. One named service user under the age of 65 years to be admitted to Beech house in the category DE(E). The home is registered for a maximum of 150 service users to include: *up to 57 service users in the category of OP (Old age not falling within any other category). *up to 120 service users in the category of PD (Physical disability under 65 years of age). *up to 120 service users in the category of PD(E) (Physical disability over 65 years of age). *up to 30 service users in the category of DE(E) (Dementia over 65 years of age). 7th November 2006 Date of last inspection Brief Description of the Service: Shaw Side is a care home that provides 24-hour residential and nursing care for up to 150 service users. Care First Health Care Limited, a part of BUPA, owns the home. Shaw Side is situated on the outskirts of Shaw and is approximately three miles from Oldham town centre. Local shops, libraries, GP surgeries and pubs are available in Shaw centre, which is about a ten-minute walk away. Bus services are available close by. The home provides accommodation in five separate units or houses. Car parking facilities are provided close to each house and garden areas are Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 5 accessible both at the front of the home and at the rear of each house. All bedrooms are single, none have en-suite facilities. Accessible toilets are situated close to bedrooms and communal areas. Some of the bedrooms have patio windows that open onto the garden areas, all bedrooms overlook the grounds. Each house has its own assisted bathing facilities and walk-in showers are also available. A copy of the home’s last inspection report was available from the main reception of the home. Communal lounge and dining areas and a small servery are available in each house. Kitchen facilities and laundry facilities are located within the main reception buildings. The current weekly fees range from £333 to £595 dependent on the package of care required. Further details regarding fees are available from the manager. Additional charges are made for hairdressing, newspapers and other personal needs. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors completed this key inspection for the Commission for Social Care Inspection (CSCI). This visit was unannounced which means the manager of the home was not informed that we were coming to inspect. We spent time in each of the four units looking at care files, records, correspondence and other documents which are kept in respect of people living in the home and receiving nursing and residential care. A number of people were interviewed including people living in the home and their relatives to see what they thought about the care and service they received. We also spoke to members of staff and asked them about their training and how they were recruited. The project manager who is currently managing the home in the absence of a registered manager was also involved in this inspection. Information received about the service prior to the inspection such as letters of complaint or concern and telephone calls have also been used as evidence for the inspection process. These came from sources such as visiting professionals, relatives, visitors to the home, and the local council. As a result of the concerns expressed to us by visitors, and other professionals this inspection was undertaken sooner than we had planned. Additional information was also provided in the CSCI surveys we sent out prior to the inspection, 12 service user surveys and three surveys from relatives were returned. The manager also completed and returned the CSCI Annual Quality Audit Assessment (AQAA) and this also provided information that has been included in this report. The AQAA is a document the CSCI send out and the management of the home complete it telling us what they think of the service they provide. We ask them to tell us what they do well, what they have improved on, and what they need to do better. The previous CSCI inspection report is available on request. The charges at Shaw Side range from: £333.00 to £595 plus top up from the PCT. What the service does well: The home continues to provide a peaceful and relaxing environment. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 7 People living in the home were generally complimentary about staff, reporting that they do listen and try to do what is requested. People said ‘All the staff in this house are helpful and very caring and work as a team.’ The management operate an open door policy for people and their relatives who reported :’The office door is always open for you to discuss anything you are not happy about.’ The open door policy of the management team is appreciated. People appeared well cared for with attention to hair, nails and clothing coordination. Residents said that staff listened and respected their wishes in relation to personal care and socialisation. Medication practices are safe. Visitors were welcome into the home. Complaints were treated seriously and investigated properly as the home’s procedures requires. However there is some evidence that whilst complaints are initially acted upon, sometimes what is put right, does not stay right. Employment recruitment practices were safe so staff who may have posed a risk to residents were not employed. What has improved since the last inspection? What they could do better: The management of BUPA must ensure that the person leading the home is suitably qualified and compentent to do so. Recruitment to this position is important and this position needs to be filled so that the staff have stable leadership which improves the outcomes for people living at the home. BUPA must make sure that the management systems in the home are worked to by all staff, and that monitoring of the service takes place by the person Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 8 nominated by BUPA to do the monthly visits (Regulation 26). A copy of this report must be sent to the Commission For Social Care Inspection monthly. The manager must ensure that the management of people’s pressure areas improves significantly in all aspects of practice. Evidence of when the sore starts and what steps are being taken by staff to prevent/improve the wound must be fully documented. This will allow the manager and visiting health care professionals to be sure that the staff understand what needs to be done, how and why. Referal to healthcare professionals for further advice needs to be documented to show that the staff understand when they need extra help. Doing all this will ensure that anyone at the home with a pressure sore receives the right treament from the right people. The manager must make sure that infection control polices, guidelines and procedures continue to be put into practice by all staff and provide evidence that this is being monitored. The laundry system needs to be improved to prevent clothes being lost. Staff must receive protection of vulnerable adults training. The manager should monitor people’s satisfaction with the meals provided at Shaw Side. The manager should also make sure that activities provided meet the needs of people in the home. Complaints are listened to, but the manager needs to have effective systems in place to make sure that what they put right, stays right. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 9 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 Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (NMS 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that new people are only admitted to the home following a full assessment of needs that has been carried out by people trained to do so. EVIDENCE: In total the assessments for more than 15 people were examined. Each contained a detailed assessment of needs that had been completed prior to or very soon after admission to the home. Information included general health needs, moving and handling needs, mood and emotional wellbeing, nutritional status and family involvement, The service is currently in the transition between two filing systems and the new system allows for the inclusion of additional social information. In most cases this had also been completed. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 11 Eleven people out of the twelve who returned Service users CSCI questionnaires felt that they had received enough information about the facilities at Shaw Side Nursing Home. People who were interviewed stated that they been admitted from hospital and due to their health at the time had very little choice about the move, but also felt that in the main their needs were met. People reported - ‘I made an independent visit prior to her moving in and staff were very welcoming and the manager asked lots of questions.’ And, ‘I had visited people here for a number of years before moving in.’ Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there is clear evidence of some good practice in relation to health and personal care, there is a serious failure in one crucial area of health care, the impact of which is great enough to risk the health of a significant number of people. EVIDENCE: Care plans were examined and these provided sufficient information to deal with general health needs such as mobility, opticians, dental health, podiatry, medication reviews, infection control issues and continence needs. The newly developed assessment and care planning process enables the recording of detailed information and, depending on the assessment ‘score’, will also ‘trigger’ the development of specialist risk assessments concerned with moving and handling, diet, mental health, infection control and all other aspects of health and social care. Letters and correspondence and daily Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 13 records also confirmed that people had received medical care and specialist and routine check-ups, including hospital appointments. The information and quality of information provided in daily records, charts and care plans varied, and though always written a respectful manner some reporting was vague and lacked clarity. For example staff had written on food intake charts- ‘soft diet taken’ with out mentioning the actual food eaten to enable a more accurate idea of the actual nutrition consumed. The medication record sheet was examined and no omissions were noted and medication was stored correctly. The main issue at Shaw Side is the failure to provide adequate pressure area care for a substantial number of people living in the home. Discussion with the manager and care staff identified a significant number of people with broken pressure areas many of which had progressed to an unacceptable level of damage. Examination of the care plans and other records pertaining to tissue viability and nutritional status identified a serious lack of effective assessment, planning, implementation of intervention and monitoring. It was not possible to track how a pressure sore had developed as staff did not record the results of any ongoing assessment or monitoring, and although body charts and photographs were in use these appeared to have been put in place only once the sore had progressed and additional advice from the tissue viability nurse was required. The nurse in charge reported that 20 people in one house visited were on pressure relieving mattresses. The pressure area risk assessments and care plans for all of these people were examined and none of them provided sufficient information about how to prevent the development of sores or how to use the equipment that was in place. Many care plans instructed staff to support people to change position every 4 hours, although examination of positioning records suggested that in the main people were being supported in changing position 2 to 3 hourly. There were no instructions concerning the weight of the individuals in correlation to the pressure to be applied to specialist mattresses or cushions. Daily records did not always demonstrate that pressure areas had been observed and the condition of the skin monitored and recorded. And on occasion when the development of problem was noted there was nothing to demonstrate that staff took steps to intervene and ensure that the area remained in tact. There is a major issue of delay in respect of intervening to prevent the development and progression of pressure areas. A tissue viability assistant practitioner from the PCT was interviewed as part of the inspection process and she was keen to confirm that staff generally followed instructions and nursing plans developed to deal with pressure wounds. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 14 These issues and other less major concerns with health care were discussed with members of the Shaw Side management team. Infection control was procedures were observed and in the main staff were observed putting on aprons when dealing with food. Personal care was not observed however the assistant practitioner stated that in the main care staff used basic infection control methods such as hand washing, wearing gloves and aprons when necessary. The interaction between people and staff was observed throughout the day and it was noted that people were approached respectfully and with kindness. Staff routinely provided support in a dignified manner asking them what they wanted, and preparing them for any procedures that needed to occur, for example moving and handling. Comments about the staff and support provided was generally positive, everyone who was interviewed gave positive feedback about care and staff attitude, they reported, ‘ I have yearly check up.’ And ‘staff are fine with me, they keep things private.’ In total 15 CSCI surveys were returned and the majority of the respondents reported that they felt that the correct health care was ‘always’ provided and two people felt that this was ‘usually’ the case. People commented that ‘All the staff are helpful, very caring and work as a team’; ‘Doctors are called for if needed’; ‘The house manager responds quickly to any deterioration in mum’s condition- calling the doctor and informing me straight away.’ Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the main, the manager ensures that people are able to make choices in their lives and steps are taken to provide social, educational, cultural and recreational activities that meet peoples expectations. EVIDENCE: There are three activities co-ordinators who work for 21 hours each employed at Shaw Side. The activities calendar displayed in the units indicated that pastimes included a library service, walks in the ground, sing-a-long, reminiscence, big bingo and gardening and arts and craft. People also stated that special occasions such as birthdays are celebrated. During the morning a reminiscence session was observed and staff appeared to take an active interest in the opinions and experiences of those participating. The daily records did not indicate whether people had participated in activities although there was information in care plans and assessments about their interests and hobbies. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 16 People who were interviewed stated that they would participate in some activities such as dominoes or watching entertainment, but that they enjoyed reading or has family who came to take them out. Only one of the people who returned a survey was completely satisfied with the activities. The majority felt that activities met their needs ‘sometimes.’ Comments about activities included: ‘My mum has enjoyed some trips…but these are rare and only occur once a year.’ The activities records were examined and it was noted that in the main only the same six or so people participated in all the activities. This issue needs to be addressed. People are supported to maintain good relationships and contact with their families and friends. It was noted that family contact was documented and a lot of information about people had been gathered through staff spending time with the person and their relative and communication with relatives appears appropriate. Comments included ‘They always phone to tell you if something has happened.’ And ‘There are no problems with visitors my son and grandson can visit when they like.’ All respond identified that staff would listen to them and when ever possible respond to requests. The social history and life story information that has been collated for each person demonstrates the management’s commitment to providing individualised and person centred activities, however further action is required to realise this. Routines in the home do appear to be flexible. Some people were still having their breakfasts late into the morning as this was their choice. Staff were observed offering meal choices at lunchtime, and if neither option was wanted other suggestions were made. The menus suggest that the meals in the home are nutritional and varied and the menu includes quiches, pies, fish and chips, carrot and coriander soup, hotdogs and onions, meat and potato pie, haddock and potatoes, chicken in white wine sauce and salmon. Sandwiches are served as an alternative at each meal and people said they disliked this stating ‘Sometimes the meals are not very good- mum does not enjoy sandwiches.’ Although other negative comments were made about the meals in the main people were positive and stated: ‘You can have what you like- you don’t have to have what’s on the menu. I usually enjoy a cooked breakfast- this morning Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 17 we had back pudding.’ presented and tasty.’ And ‘The food is excellent the soft menu is well Lunchtime was observed, care staff provided support to those who needed assistance and people said that they had enjoyed the meal, which was quiche and baked beans. The dining areas were clean and furniture was pleasant to use and free of stains. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are informed about how to complain or comment about the home and overall felt to be listened to. Procedures are in place to protect people living in the home from abuse. EVIDENCE: In the main, people who commented stated that they were aware of how to make a complaint and detailed the steps taken by the home to inform them of the complaints procedure. The majority of people felt that when they complained these were taken seriously although they were not always resolved, this was especially related to missing clothing. Comments included, ’They listen and act but then things tend to slide back and they need another reminder.’; ‘The office door is always open to you to discuss anything you are not happy about.’; ‘when I have had occasion to complain, the complaint was taken seriously and dealt with.’ Although they knew how to complain one person felt that senior managers were remote and did not spend enough time with people on a one to one basis. The complaints record was examined and the information confirmed that complaints were dealt with fairly and transparently. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 19 Staff have not received protection of vulnerable adults training and this needs to be addressed. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment of Shaw Side meets people’s needs and promotes their comfort and independence. EVIDENCE: A tour of two of the houses at Shaw Side was completed and these were, in the main, clean and well furnished. Many people had personalised their room s with items bought from home or purchased since their admission. A number of the carpets in the bedrooms of one the houses does need attention in that they appeared stained and in one case the bed room held a unpleasant smell, however this was the exception. Discussion with the person in charge confirmed her awareness of the problem and she stated that replacing flooring was included in the BUPA plans for this house. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 21 Aids and adaptations such as handrails and heightened toilet seats were in place, and people were observed mobilising independently. Although each house has a small kitchen the equipment is not domestic and so it would be difficult for people to be involved in making drinks or preparing or cooking food. Some people felt that the cleanliness in the home had deteriorated over a period of time and also reported that at times there were insufficient clean sheets and so these were not changed as often as they would like and sometimes the beds were left unmade. Records of the staff meetings also indicated that this was a problem that they had brought to the attention of managers. Sheets were provided through using those from another unit that is closed. In the main people made positive comments about the environment for example: ‘They come and clean everyday, do the floors, damp dust there are two domestics on.’ ; ‘I like this room- I’ve been able to swap.’; and ‘My room is delightful.’ Although this person does also assess that some upgrading is needed. The majority of people who returned surveys felt that the home was always or usually free from bad odours. On the day of inspection this was the case in all the communal areas visited. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In spite of there being sufficient staff on duty and staff receiving training, the outcomes to people living in the home have been compromised by poor practice. EVIDENCE: The manager stated that each unit was fully staffed, and acknowledged that this had not been the case for some time. The staffing ratio for one unit was checked, there were 26 people living on the unit , with six care / nursing staff including the nursing sister and 2 domestic staff providing support. The majority of respondents felt that there was sufficient staff on duty. Peoples experiences included: ‘When I press the buzzer they come pretty quickly.’; ‘ Yes they seem to cope alright unless someone is off unexpectedly.’; ‘The house manager and the junior sister always make time to chat and pass on anecdotes about mum. There are usually 1 or 2 carers around who can be called upon if others are working in residents rooms.’ and ‘The staff are busy but they are available.’ Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 23 It was felt that if there were more staff available they would have time to talk to people or go out on an individual basis. Staff files were examined and each contained job application, references, start date and up-to-date criminal record bureaux checks and POVA firsts. A gap in employment history for one person was noted and this was discussed with the acting manager. A recent recruit was interviewed and she described the process she went through to gain employment. This included completing an application and attending for interview, she provided two references and documents for completion of the criminal record check and POVA first. This person stated that she was still on induction and was currently shadowing senior staff and completing an induction workbook. An area of concern brought to the attention of CSCI has been a lack infection control training and adequate supervision in relation to basic care practises. BUPA have introduced an in-house infection control training package and identified and infection control link nurse. This role is not yet fully developed and the effects in relation to improving policies, guidelines and practice were not fully inspected on this occasion. The management of pressure areas in the home is poor. This was confirmed through our visit and in evidence presented to us by visiting professionals. Whilst BUPA have now started to address this it is of concern that systems were not previously in place to prevent this occurring. BUPA have established specialist nurses who will become experts in pressure wound care and who will cascade their knowledge to staff at Shaw Side and also be able to provide prompt nursing intervention and guidance so that situations do not deteriorate. Staff who were interviewed were part way though completing the course and were clear about using when to use gloves and aprons and the importance of hand washing in relation to infection control. The training records confirmed that the following training had occurred had been provided since the previous inspection: continence promotion and the management of incontinence; dementia care; people handling and risk assessments facilitators refresher; managing violence; nutrition; ‘yesterday, today and tomorrow training in dementia care; male catheterisation; record keeping and care planning; assessment and administration of medicines; professional communications; key skills in communication; BUPA care home induction and fire safety. The manager must be able to demonstrate that staff have receive protection of vulnerable adults training, first aid and pressure area care training. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 24 The lack of evidence concerning tissue viability training and clinical monitoring is of particular concern as the manager has received letters of concern regarding pressure area care and the organisations own monitoring systems have highlighted a higher than expected number of severe pressure sores occurring in the home. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management systems in place have been insufficient to ensure that the people living in the home receive an acceptable provision of care. EVIDENCE: The home has been without a registered manager for some months, and this lack of leadership has resulted in the service delivered by staff not being of an acceptable standard overall. Comments have been made about the concerns regarding pressure sore care, and since the manager left concerns have been made to social services by visitors regarding the level of care afforded to residents. BUPA have now put into place a project manager to drive up standards until a permanent manager is appointed is run the home. This Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 26 person had only been at the home a short time before this inspection took place. Whilst it is acknowledged that this person is now providing a leadership role within the home, and BUPA have produced an action plan for this project manager to follow to ensure the care provided in this home is improved, it is of concern to CSCI that the management structure of BUPA did not recognise and act quickly enough when standards in this home started to deteriorate. This person works closely with other senior managers in BUPA and Shaw Side is undergoing a full audit of all its systems in particular infection control and pressure area care. Residence meetings have lapsed, the minutes of the last meeting indicate that this occurred over one year ago. The managers are in the process of completing the quality audit that includes a customer satisfaction questionnaire. Information in the AQAA indicated that a record of all financial transactions is maintained by the home and the BUPA finance department audits these finances. Information provided in the AQAA indicated that equipment and services had been maintained and serviced within the timescales recommended by the manufacturers and associated regulatory bodies. The records examined on the day of inspection verified this information. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 1 Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 12 Requirement Timescale for action 17/08/07 2 OP31 8 3 OP33 26 4 OP30 18 The health and welfare of people living at the home must be promoted to ensure that people receive appropriate treatment in identifying and reducing the risk of the development of pressure sores in the home. This is to show that people admitted to the home are kept safe and well. A manager must be appointed to 30/10/07 the home and who makes application to be registered with the Commission For Social Care Inspection. A copy of the Regulation 26 30/08/07 visits undertaken by a representative of BUPA must be sent to the CSCI monthly to demonstrate that they are fulfilling their functions on behalf of the provider. Staff must receive training in the 30/10/07 protection of vulnerable adults. This will help staff understand the different types of abuse, and how to act if they suspect anyone living at the home has been abused. This will keep people safe. DS0000025453.V345098.R01.S.doc Version 5.2 Shawside Nursing Home Page 29 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. 2 3 4 5 Refer to Standard OP29 OP15 OP12 OP21 OP16 Good Practice Recommendations The registered person should ensure a full working history is obtained before the employment commences. Meals should be monitored by the management to make sure that they are serving is what people want to eat The activities need to be kept under review so that people living at the home are stimulated and interested in what is going on around them. The system of laundering clothing needs to be looked at to see if the number of clothes going missing can be reduced. The management need to make sure that when they resolve complaints, that systems are in place to prevent a reoccurrence of the complaint. Shawside Nursing Home DS0000025453.V345098.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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