CARE HOMES FOR OLDER PEOPLE
Shevington Court Nursing Home Holt Lane Rainhill Merseyside L35 8NB Lead Inspector
Daniel Hamilton Unannounced Inspection 10th March 2006 09:45 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 Shevington Court Nursing Home DS0000005472.V280747.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. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Shevington Court Nursing Home Address Holt Lane Rainhill Merseyside L35 8NB 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) 0151 4931345 0151 4308431 Southern Cross Care Management Limited Mrs Brigid Alexander Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (46), Physical disability of places over 65 years of age (46) Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service Users to Include up to 46 (OP), up to 46 PD(E) and up to 46 PD aged 55 years and over. Service users to include up to 5 under the age of 55 out of the total number of 46. The Service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 14th June 2005 Date of last inspection Brief Description of the Service: Shevington Court is a residential care home, which is registered to provide nursing care for up to forty-six older people, including older people with a physical disability. The Registered Provider is Southern Cross Care Management Limited. Mrs Bridget Alexander has been the registered home manager for the past six years and has over 30 years experience of nursing care provision. Shevington Court is located within a suburb of St. Helens and is close to local amenities. The home is situated off the Prescot to St. Helens Road and provides ground floor accommodation to include 46 single bedrooms, 1 smoking and 3 non smoking lounges, 2 dining rooms, a hair dressing room, 10 toilets, 4 bathrooms with adapted baths and 2 shower rooms. The home is surrounded by a pleasant garden and patio area that is accessible by wheelchair. Car parking space is available at the front of the premises. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 8 hours. It was an unannounced visit that included a complaint investigation and was conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There had been no cause for any additional visits to the home since the last routine inspection in June 2005. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The manager, five staff members and six of the forty-one residents were spoken with during the visit and their views obtained of the home. Comment cards were also left in the home to enable people to feed back their views on the service provided. What the service does well:
Shevington Court presented as a homely and caring environment. Residents interviewed complimented the Registered Manager and spoke highly of the care provided by the staff team. A resident said; “I think the care is very good. The staff are there to help me. I can’t fault it in any way.” Staff were observed to be chatting freely with residents and visitors were welcomed into the home. The home had developed a comprehensive care planning system to ensure the health, personal and social care needs of residents were identified and planned for. Residents spoken with confirmed that they were able to exercise choice and control over their lives. For example, a resident said; “I have my own routine and I can do as I wish.” Likewise, another resident said; “It’s free and easy in this place.” A choice of meals was provided for residents and their preferences and dietary needs were catered for. One resident reported; “The chef is good. He caters for your preferences and there are two choices for each meal.” None of the residents spoken with had any complaints about the service and residents were confident that if they raised a concern or complaint the issue would be addressed. One resident stated; “I have no complaints, I am really very happy at the moment. The matron is very approachable.” Recruitment practice was sound and provided safeguards for the people living in the home. Protection of Vulnerable Adult (POVA) and Criminal Record Bureau (CRB) checks had been carried for all new staff as part of the home’s recruitment process. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 6 The home had policies in place to promote Health and Safety in the home and records had been maintained to demonstrate that the premises and equipment in use had been appropriately maintained. 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.
Shevington Court Nursing Home DS0000005472.V280747.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 Shevington Court Nursing Home DS0000005472.V280747.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): None of the above standards were assessed. Not Applicable EVIDENCE: Standard 3 was assessed at the last inspection and was met. Standard 6 is not applicable, as Shevington Court does not provide ‘intermediate care.’ Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 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 and 9 There is a clear and consistent assessment and care planning system in place to provide staff with the information they require to meet the needs of the service users. Shortfalls in medicines handling were evidenced that potentially put residents at risk. EVIDENCE: Comprehensive assessments are undertaken for each service user upon admission to the care home. From the assessment and various risk assessment tools a plan of care is then drawn up. The care plans seen were personalised and well maintained with evidence that service users, were applicable and relatives were involved in regular reviews and in the development of the plan. On a few of the care plans the content of information recorded was discussed with matron as needing to be more specific in relation to some of the risks identified. Registered nurses spoken too had a good understanding of the care and needs of the people they were supporting and understood their role and importance of review and updating of care plans. A specialist pharmacy inspection was undertaken during the visit, as a recent complaint had highlighted concerns in respect of medication handling. Record keeping, administration, disposal and storage practice was examined.
Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 10 The receipt of medication in to the home was not accurately recorded and some handwritten Medication Administration Records (MAR) were not always accurate. For example, drug strengths, dosage instructions, dates and BNF warnings were often omitted and some medication was incorrectly recorded. Furthermore, records were often confusing and difficult to audit trail. The main reason for this was staff using several different MAR to cover a one month period. Examination of MAR evidenced numerous recording errors. For example, a resident had been prescribed isosorbide mononitrate 60mg and this was not signed as administered on 30/01/06. Likewise, a residents MAR for adcal d3 was not signed as administered on 9/03/06 and 28/02/06. Other recording errors were noted also. MAR demonstrated that the administration of medicines was not consistent. On the day of the inspection, medication administration rounds did not start until approximately 10.30 am. It was recognised that an attempt had been made to have an earlier round and this should be further developed. Evidence was also seen of medication not being given at the right time in relation to food and of staff not making accurate and contemporaneous records of administration. Systems were in place to record unwanted medication in a dedicated book, which staff signed. Advice was given on how the records and security of medication awaiting disposal could be improved. Suitable arrangements were in place to store medication and medication trolleys were clean, tidy and suitable to the needs of the home. Advice was given on the storage of medication i.e. insulin in use and the need to scrutinise patient information leaflets, to ensure medication is stored at the correct temperature. Control drugs were appropriately stored in a controlled drugs cupboard and a suitable register was used for recording. All entries were clear and accurate at the time of inspection. Regular checks were made of controlled drug stock levels. Medication audits were being undertaken by management. The registered manager was advised to review the current tool, to ensure all issues raised during the inspection were included. For example, general audit trailing and direct observation of medication handling, to ensure staff have the required competence to administer medication. A more detailed report of the pharmacy inspection is available from the Commission for Social Care Inspection upon request. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 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): 14 and 15 Residents were empowered to take control of their own lives, in order to maintain their independence and preferred lifestyle. EVIDENCE: Residents interviewed confirmed that they were able to determine how they wished to lead their lives and that the home was not regimented. Comments from three residents included; “I have my own routine and I can do as I wish”; “It’s free and easy in this place” and “I have complete control of my life. I can come and go when I want.” Rooms viewed were personalised with pictures, ornaments and personal possessions. Following a recommendation at the last inspection, the manager had made arrangements for the menu to be updated to include a choice of meals for each sitting. At the time of the visit, this was not available for residents to view. Residents spoke highly of the food provided. Feedback from three residents included; “The food is lovely and there are choices to chose from”; “The food is out of this world. The cook is excellent. He goes out of his way to cater for my dietary needs” and “The chef is good. He caters for your preferences and there are two choices for each meal”. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 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 Complaints had been appropriately addressed and residents were confident that their concerns would be listened to and acted upon. EVIDENCE: The home had a complaints procedure, a copy of which was displayed in the reception area of the home. Details of the procedure were also included in the Statement of Purpose / Service User Guide. Since the last visit the policy had been updated to include the address and telephone of the Commission and a copy was displayed in the reception area of the home. The complaint register showed that one complaint had been received from the relative of a resident since the last visit. The complaint concerned care practice and records showed that the complaint had been appropriately and fully investigated by the home. The Commission for Social Care Inspection had also received one complaint, which was investigated during the inspection. This complaint concerned the home’s communication with other health care professionals and the ordering of medication and collection of prescriptions. Requirements and recommendations were made to improve future practice. Residents spoken with reported they had no complaints and that they were confident that the matron would address any concerns. Feedback from three residents included: “I think the care is very good. The staff are there to help me. I can’t fault it in anyway”; “I have no complaints, I am really very happy at the moment. The matron is very approachable” and “I’m quite satisfied here. It suits me fine. The staff are first class. I’ve no complaints whatsoever.”
Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 13 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): None of the above standards were assessed. Not applicable. EVIDENCE: Standards 19 to 26 were assessed at the last inspection and all were met. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 14 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): 28, 29 and 30 Recruitment procedures were robust and provided appropriate protection for the people living in the home. Some staff had not completed all the necessary training, to ensure competency in their role. EVIDENCE: The manager reported that the home employed 8 registered nurses, 6 night care assistants and 20 day care assistants. Records showed that only 3 of the twenty-six care assistants had completed a National Vocational Qualification (NVQ) at level two or above (11.53 ). However, certificates were available for only one member of staff (3.84 ). An additional 10 staff were working towards the award at the time of the visit. Once qualified, this will bring the number of qualified staff to (49.9 ). Since the last inspection, the home had employed 12 new staff. Recruitment records were checked which showed that all new staff had been confirmed in post following receipt of a Protection of Vulnerable Adult (POVA) check. Only eight of the twelve staff had received the results of a Criminal Record Bureau (CRB) from the organisation’s head office at the time of the visit. Files also contained two references, proof of identity including a recent photograph, a health / medical declaration and contracts of employment. Following a recommendation at the last inspection, the manager had updated the matrix record for statutory training. The manager was advised to record the dates of training on the matrix in addition to the course title. Copies of individual training records and certificates for training courses were also available on files. Three training records were viewed. Two records provided
Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 15 evidence of safe working practice training including: Moving and Handling; Health and Safety; COSHH; Fire Safety and Food Hygiene Training. However, none of the records viewed provided any evidence of first aid or infection control training. One staff had completed questionnaires only. Three files were checked to review induction training. None of the files contained a record of induction / workbook to evidence induction training. The manager reported that two staff had not returned their induction records following the completion of training and was able to show documentary evidence that she had requested the workbooks for filing. Furthermore, one member of staff was still in the process of completing the induction workbook at the time of the visit. Staff interviewed confirmed they had received an induction and a range of safe working practice training. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 16 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): 33, 35 and 38 There was limited information available, to demonstrate that the home was run in the best interests of the people using the service. Records of financial transactions were not accessible, to confirm the financial interests of residents were safeguarded. EVIDENCE: The Registered Provider commissioned a three yearly external audit of all operational areas within the home. Furthermore, the Regional Manager completed Regulation 26 reports each month. Additional audits were undertaken by the manager and the organisation’s health and safety officer. The manager reported that questionnaires were distributed to six residents during October 2005 as part of the home’s quality assurance process. There was no evidence available to confirm this at the time of the visit, because a file could not be located. The manager reported that the results of questionnaires were not published. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 17 Residents meetings were completed every three months however minutes were available for only one meeting on 25/11/05. The manager reported that she did not act as an appointee for any of the residents. All the residents, with the exception of one person, looked after their financial affairs with support from family members or solicitors. The organisation’s head office was responsible for issuing invoices to residents or their appointed representatives every four weeks. Personal money belonging to residents was paid into a residents’ bank account. The home looked after personal money for 34 residents. Individual records of expenditure were requested for five residents, however the records were not available for inspection as the home did not maintain written records and the electronic records could not be accessed due to an IT system failure. No hard copies were available and money had been pooled in the safe. The home had a health and safety policy in place and a fire and building risk assessment had been completed. Some staff had not completed all safe working practice training as identified in standard 30. The manager reported that 17 places had been booked for infection control training on 10/02/06 and evidence was seen to confirm this. Records showed that the fire alarm system was tested on a weekly basis and that a monthly check on the emergency lighting and fire extinguishers was undertaken. Water temperatures were regulated with thermostatic valves and the temperature was checked at each outlet on a monthly basis. All service / maintenance certificates were available for inspection and records were well maintained. Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 3 Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 19 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 Standard OP9 Regulation 13 (2) Requirement The registered manager must ensure all medication is accurately recorded on receipt into the home. The registered manager must ensure all medicines are administered and recorded as prescribed with reference to handwritten records, copycat signing errors and the general organisation of the records. The registered manager must ensure all medication awaiting disposal is securely stored and appropriate records are made. The registered manager must ensure all staff that administer medication are competent to do so. Staff must receive an induction and have training in safe working practices (see main report for course details). Induction records and training records must be kept. [Previous timescale of 01/09/2005 not met]. Evidence must be available to verify the quality of care
DS0000005472.V280747.R01.S.doc Timescale for action 31/03/06 2 OP9 13 (2) 31/03/06 3 OP9 13 (2) 31/03/06 4 OP9 13 (2) 31/03/06 5. OP30 18/19 30/06/06 6 OP33 24 30/04/06 Shevington Court Nursing Home Version 5.1 Page 20 7 OP35 17(2) provided at the home is kept under review and to confirm regular consultation with service users and their representatives. A written record of all money held on behalf of residents must be maintained at the home and accessible for inspection and balances must not be pooled. 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP9 OP9 OP9 Good Practice Recommendations Management audits of the medication handling must be regular and targeted. Patient information leaflets should be available for all medicines kept in the home. All handwritten medication administration records should be double-checked and countersigned. The manager is advised to review the organisation of the medication rounds, to ensure all medication is administered promptly and at a time that is appropriate to the needs of individual residents. The updated four week printed menu should be made available for residents to view. 50 of the home’s care staff should have a National Vocation Qualification in Care (NVQ) at level 2 or equivalent. 5 6 OP15 OP28 Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Extracts may not be used or reproduced without the express permission of CSCI Shevington Court Nursing Home DS0000005472.V280747.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
