Inspection on 23/05/08 for Southcrest Nursing Home

This inspection was carried out on 23rd May 2008.

CSCI found this care home to be providing an Poor service.

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

Southcrest Nursing Home 23/06/10

Southcrest Nursing Home 14/07/09

Southcrest Nursing Home 16/02/09

Southcrest Nursing Home 22/02/07

Southcrest Nursing Home 14/09/05

Southcrest Nursing Home 18/04/05

Southcrest Nursing Home 03/11/04

Southcrest Nursing Home 02/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG Lead Inspector Sandra J Bromige Key Unannounced Inspection 23rd May 2008 07:30 X10029.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 Southcrest Nursing Home DS0000004103.V364218.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 and Care Homes for Adults 18 – 65*. 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. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southcrest Nursing Home Address 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG 01527 550720 01527 550738 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) Dr Sabarathnam Ananthram Mrs Kalpana Ananthram Gail Elizabeth Gilbert Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (3), Physical disability of places over 65 years of age (40) Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All persons admitted within category PD must be at least 55 years of age and on a named basis, with the prior agreement of the registration authority The Home to allow 1 named resident between the age of 61-65 years of age. 22nd February 2007 Date of last inspection Brief Description of the Service: Southcrest Nursing home is a forty-bedded care home providing nursing care for people over the age of 65 years. Accommodation is provided on three levels/floors (in single or double occupancy bedrooms), and there is a passenger lift and two staircases to all levels. There is a variety of aids and adaptations around the building to allow people to move about more independently. There are communal toilets, bathrooms and lounges on each floor. The home is situated on the perimeter of central Redditch, and local services and resources can be easily and readily accessed. The fees are not published in the service user guide but are available upon request from the manager. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We, the commission undertook an unannounced inspection of this service over one day by one Inspector. This was a key inspection – this is an inspection where we look at a wide range of areas. Before the inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the manager for completion. The AQAA is a self-assessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Some of the manager’s comments have been included within this inspection report. During the visit to the home care records, staff records and other records and documents were inspected. Surveys were sent out and received from residents (0), staff (13) and general practitioners (2). There was a tour of parts of the accommodation and interviews with staff, including the manager. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents and their relatives. One complaint has been received about this service in the last 12 months and this was referred to the home to investigate. There have been four safeguarding incidents since May 2007 relating to behaviour of staff, training, quality of care plans, management of medication and wound care. This has been investigated by Worcestershire County Council who are the lead agency for safeguarding adults. The manager has co-operated with the agencies and has taken action in response to the allegations and subsequent investigation. What the service does well: What has improved since the last inspection? Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 6 The home has reviewed the statement of purpose, service user guide and statement of terms and conditions of stay. Prospective residents are able to spend the day at the home to view its facilities. The variety of food offered on the menu has improved and the quality of the service of food. The home has introduced a new nutritional screening tool. A record of complaints is now in place. Two new central heating boilers have replaced the old one. Radiators can now be individually controlled in each room. The corridors have been painted and the ‘strip’ lighting has been replaced on the ground floor. The internal trainer for fire and moving and handling has attended relevant training updates. What they could do better: The home’s contract needs to be reviewed to include information for residents about nursing contribution so that they are aware of how this affects their fees. The pre-admission assessment needs to be sufficiently detailed to enable staff to formulate a care plan necessary to ensure residents needs can be met. Care plans need to be sufficiently detailed to enable staff to understand and meet the health and care needs of the residents. The documentation used to assess the risk of use of bedrails should be reviewed to ensure that the home consider all areas of risk. Regular maintenance checks should be carried out and recorded when bedrails are in use. A system needs to be introduced to ensure that medication is being stored at the correct temperature so that it is not at risk of ‘going off’ or breaking down. A care plan should be written for the management of pain and should include details for the administration of medication prescribed ‘when necessary’ for pain management. The adequacy of the privacy curtains in shared rooms should be reviewed to make sure their privacy and dignity is maintained at all times. Staff should ensure when discussing residents care needs that the information cannot be overheard by other people to ensure the information remains confidential. The home should review the activities provided and ensure that social care plans are in place for all residents to ensure their social and religious needs are met. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 7 All complaints should be recorded and acted upon in accordance with their policies and procedures so that people can be confident that any concerns or complaints are listened to and acted upon. A review of the décor and furnishings should be carried out to make sure the home is safe, clean and bright and residents have the necessary furniture available to ensure their comfort. The home’s practice and procedures for the management of infection control need to be reviewed to prevent any cross infection. Robust recruitment procedures need to be put into place to protect residents from any potential harm. New staff need to received induction training appropriate to their role and updates of further training e.g. moving and handling at regular intervals to make sure residents and staff are not placed at risk of harm. The competency of the trained staff needs to be reviewed to ensure they have the skills and knowledge to identify and plan the care needs of the people living in the home. The home needs to seek the views of the people living in the home and their relatives and use this information to improve their service delivery. The owner needs to carry out monthly unannounced visits to the service to monitor the quality provided. Regular checks should be carried out of window restrictors to ensure the safety of the residents. The health and safety poster should be completed to ensure staff know who to contact in the event of an incident. 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. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents need more information about how the home manages the ‘free nursing care’ payments to ensure they are fully aware of how this affects their individual fees. Robust pre-admission assessments are not being carried out by the home to ensure they are able to meet the residents care needs. Intermediate care is not provided by this service. EVIDENCE: A copy of the home’s statement of purpose and service user guide is available in the home. It is recommended that this be on display where visitors sign in Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 10 and can be picked up and read by prospective residents rather than being kept in the office. The home’s contract has been reviewed, although it does not give any information about how the home takes into account the ‘free nursing care’ payments as part of the fees. Contracts were not available for two residents case tracked. The pre-admission assessment for a recently admitted resident was not thorough and did not provide enough information to enable staff to formulate a care plan. The Community Care Assessment for this resident was not received by the home until the day after admission, thus the home were not fully aware of the care needs of this resident prior to admission. The Annual Quality Assurance Assessment identifies their pre-admission assessments ‘could be more in depth, so new documentation needs to be constructed’. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using this service cannot be sure that their care needs will be met as care plans are not in place for all residents care needs and are not being reviewed as needs change which places residents at risk of harm. Improvement is needed to the home’s management of medication to ensure that residents are placed at risk of harm. Residents’ privacy, dignity and confidentiality are not being maintained at all times. EVIDENCE: Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 12 We looked at the care of three residents. A resident who had been recently admitted did not have any care plans in place. Care staff were spoken with who were looking after this resident. A carer told us they ‘do not know a great deal about X’. They were not aware if the resident could stand or if they were able to get out of bed, if they had any swallowing problems or about their toilet needs. They had not received any information about skin care or if the resident had any special dietary needs, for example, diabetes. The care assessment for this resident showed they were in need of assistance with all their care needs and was at risk of choking when eating. Discussion with care staff confirmed that this resident had received care that morning from one carer, the resident had not been shaved and had received no oral care. One carer had repositioned the resident for breakfast and did not use any equipment such as a slide sheet. The resident was seen at 11.00hrs lying in bed on their side with no pyjamas on only a vest. There was faeces on the vest and bottom sheet. The resident had not been shaved, and had no access to the call bell and there was not a drink within reach. The resident was observed being fed at lunchtime; they were lying in bed on their back. This is evidence of poor care and places the resident at risk of harm. A number of residents were up, dressed and sitting in the lounge on the ground and first floors at 7:30am. The care plan for one of these residents was seen. The care plan did not show that this was the resident’s choice to get up and go back to bed early. The resident confirmed it was their choice to get up early. The daily care chart for that week showed they had been getting up anytime between 6:00am and 9:05am and was going back to bed between 2:30pm and 3:15pm. The risk assessments for this resident were poor. For example, the bedrail risk assessment did not show consideration of compatibility of the bedrails with the bed or if there were any gaps where the resident could injure themselves. The nutritional risk assessment showed the resident had lost 10kg between 7th-23rd April 2008. The feeding care plan had not been reviewed, the dietary needs chart had not been reviewed since 21st November 2007 and there was no evidence to show this weight loss had been discussed with the general practitioner. The resident’s Malnutrition Universal Screening Tool (MUST) had not been reviewed since 28th February 2008 despite the frequency of reviewing stated as ‘monthly’. Another residents Malnutrition Universal Screening Tool (MUST) showed the resident had lost 8.5kg between 28th Jan – 24th April 2008. An entry in the care plan date 31st March 2008 stated ‘refer to general practitioner due to weight loss’. This was not done until eight days after this entry. A nutritional supplement was prescribed, although the care records do not demonstrate that this has been given. An entry dated 25th April 2008 indicates the need for the resident to have a high protein diet. The registered nurse when asked stated the resident was on a normal diet. The manager stated that all residents are Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 13 on a high protein diet and the chef confirmed this. This is poor practice as it is not person centred care. Discussion with the manager confirmed that she had undertaken a recent care plan audit on the 8th may 2008 and the outcome showed there were a lot of shortfalls in the care plans. The trained nurse had been given one week to update the care plans. This had not been followed up by the manager at the time of the inspection. The management of medication needs improving. A resident’s medication administration record showed they were prescribed an antidepressant, although there was no information in the care plan about depression/mood problems. There was no evidence to show that prescribed nutritional supplements for two residents were being given. A resident was taking paracetamol suspension ‘when necessary’, but it was not clear form the care plan why the resident was taking this medication. Staff were applying sudocrem to a resident’s bottom, it was unclear if this was prescribed or being used as a homely remedy. The tub of sudocrem in use did not have the resident’s name on it to enable staff to identify it belonged to that resident particularly as they were in a shared room. A recently admitted resident’s medication had not been listed on the pre-admission assessment to enable the home to check this against the medication upon admission. Aqueous cream was prescribed for another resident on the medication administration record. The registered nurse stated it was for dry skin but this was not in the care plan. There were warning notices where oxygen was used. We advised that more specific wording could be used such as ‘compressed gas, oxygen, no smoking, no naked lights’. Two oxygen cylinders were stored in the treatment room; one did not belong to a resident. The manager was advised to return this cylinder. Refrigerated medication was being stored within the correct temperature range. The temperature of the treatment room was not being monitored. The random medication audits done were accurate. Residents’ privacy, dignity and confidentiality are not maintained at all times. For example, the morning handover was conducted in the office by the entrance to the home and the door was left open, a hygiene care plan for a female resident referred to the resident as ‘him’ and ‘his’. The privacy curtains in a shared room did not fully enclose both beds. The name on the outside of a resident’s wardrobe stated ‘Doris’. This was not the resident’s name. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are not being supported in a person centred approach to enable them to maintain their individual social, recreational and cultural activities. A choice of a varied menu is provided and staff provide support to residents who need assistance with meals, although for highly dependent residents the care records do not evidence their nutritional needs are being met which may place them at risk of harm. EVIDENCE: Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 15 The care records for an identified resident had a poorly completed life history, there was no information about their religious practices or social interests. There was no social care plan. The pre-admission assessment for a recently admitted resident did not contain any information about the residents next of kin or contact details, social circumstances of religious needs. There was no social care plan in place. A carer spoken with was not aware of the dietary needs of this resident. A carer stated they arrange visits to meet residents religious needs if the resident request it. There are ‘no regular visits by clergy’. Care staff confirmed people come in one to two times each week to provide social entertainment such as the music man and exercises and another lady comes in for two hours each day. Care staff ‘try and meet their needs’ but ‘staff do not do activities’. Written information from care staff stated the home should ‘give staff more training in stimulating and encourage users to do more than watch TV’. ‘The service does have a lady who comes in to play games but it would be nice to see users going out more i.e. cafes for drinks or shopping’. There was musical entertainment on the afternoon of the inspection, which residents appeared to enjoy. The manager confirmed that residents and relatives are being consulted through meetings other than the acceptance form for their care plan. Residents were seen eating in one of the dining rooms, the lounge or in their rooms. Staff were seen assisting residents in a discreet and sensitive manner. The lunch on the day of the inspection was fish pie which was sampled and was very tasty. The manager and chef confirmed that all residents are given a high protein diet. This is not good practice as residents dietary needs are not being considered in a person centred approach. Please refer to the healthcare section of this report regarding the nutritional needs of high dependency residents. Relatives were seen visiting the home at various times of the day. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service does not provide a robust and effective complaints procedure and are not protecting the people who use the service from abuse which places them at risk of harm. EVIDENCE: The home’s record of complaints was seen. A complaint relating to the care of a resident case tracked was seen in the care records. The information relating to this complaint was not in the complaints file when seen and there was no evidence to show the manager had contacted the complainant. There was evidence of a verbal complaint received in May 2008. The issue had been addressed but there was no evidence to show the manager of the service had communicated this to the complainant. The home’s complaints procedure was seen. It is evident that the manager is not following the home’s procedure for the management of complaints. Two care staff spoken with were not aware of the home’s complaints procedure. The training matrix submitted by the service on the 30th May 2008 shows that none of the care staff employed by the home have received any training about their complaints procedure. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 17 We were invited into the home at 7:30hrs by the night staff, no one asked to see our identification. This was the first time this Inspector had been to the home. There have been four safeguarding incidents since May 2007 relating to behaviour of staff, training, quality of care plans, management of medication and wound care. This has been investigated by Worcestershire County Council who are the lead agency for safeguarding adults. The manager has cooperated with the agencies and has taken action in response to the allegations and subsequent investigation. Two care staff records were seen. Neither contained any evidence that the home did a Criminal Records Bureau check prior to their employment. An immediate requirement was made. A week after the inspection the manager sent us information stating the one carer did have a POVA check in her file, although this was not seen at the time of the inspection. Two care staff spoken with have not received any training from the home about safeguarding people, although they were clear of the action they would take. The training matrix submitted on the 30th May 2008 shows that one registered nurse and 16 care staff have not received any training about safeguarding people. None of these care staff have NVQ two or above. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit from improvements to the décor and furnishings provided by the home so that it makes it a brighter and more pleasant environment for them to live in. Aspects of management of infection control need improving to ensure residents are not at risk of cross infection. EVIDENCE: Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 19 The décor in the home is ‘tired’ and is in need of redecoration. Carpets in the corridors of all three floors were badly stained in places. Lounge and dining room carpets were also badly stained. The manager stated the carpets in the corridor on the ground floor have been ordered but not for the lounge. Stained carpets give the home a poor appearance and are also a risk of cross infection. Only rooms of residents case tracked were seen. One was shared. The privacy curtains did not fully enclose both beds. The furniture was ‘tired’. One resident did not have a bedside cupboard, there were no pictures on the walls and neither resident had an over bed table provided. The lock on the door was not of the ‘approved’ type, as it did not enable the residents to unlock and get out of the room in one single action. A single room upstairs had a window restrictor in place. The resident was in bed and did not have access to a call bell. There was no over bed table thus the resident was not able to reach their drink as it had been placed on the side by the washbasin. There were family photographs and pictures on the wall. Dorguards were fitted to doors which were held open. A fire extinguisher seen had been serviced in June 2007 which is within the required timescale. Staff confirmed there were plenty of aprons and gloves provided and staff were seen wearing them. The shared bedroom had three bars of soap and two drinking beakers by the washbasin and there was no means of identifying which resident they belonged to. This creates a risk of cross infection. The washbowls in this room were wet and had not been cleaned and dried after use. One was labelled with the name ‘M’. Neither of the residents were called by this name. This is poor practice. A recently employed carer spoken with had not received any infection control training. The training matrix submitted on the 30th May 2008 shows one registered nurse and 13 care staff have not received infection control training. None of these care staff have NVQ two or above. The laundry room only had one washbasin and the manager confirmed this is used for soaking clothes. A hand wash basin needs to be providing for staff to wash their hands as the same hand wash basin should not be used due to cross infection. The flooring in front of the machines is in need of repair to prevent any infection control issues. There was a hole in the laundry room door of partial depth which needs repairing as it may be a fire risk. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are sufficient staff numbers provided, although there are shortfalls in the competency of the trained staff in relation to care plans which has the potential to place residents at risk of harm. The recruitment procedures and induction training for new staff is not robust and places residents at risk of harm. EVIDENCE: The staffing levels were satisfactory for the day of the inspection. Agency care staff were being used to supplement the staffing numbers at the time of the inspection. Staff numbers depend on the numbers of residents in the home. At the time of the inspection there were 32 residents, staff stated if they reduce to 30 residents the staff numbers are reduced. This is reflected in the staffing rotas seen. Discussion with staff confirmed these numbers. Staff felt Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 21 there were enough staff on duty as long as they had three care staff for the middle floor. The training matrix shows that one registered nurse has not received training for care planning. In August 2007 issues were raised through safeguarding about the quality of the care plans in the home at the conclusion of this investigation in December 2007 it was identified there was a new registered nurse who needed training and guidance in this area. The quality of the care plans seen during this inspection was poor. The manager has conducted a recent care plan audit on 8th May 2008 and found there was a lot of shortfalls in the five care plans audited, although this had not been followed up within the given timescale from the audit. Recruitment files for two care staff were seen. These were of a poor quality. There was only evidence seen of one reference being obtained for both staff. Both staff had started work prior to receipt of a Criminal Records Bureau or POVAfirst check. A week after the inspection the manager sent information to us stating they had received a POVA check for one of the care assistants but this information was not seen at the inspection. The interview checklist for one person was poorly completed. There was no documentary evidence of induction training other than some training certificates. One care assistant confirmed she only worked with another person for one day and the second care assistant stated she was ‘shown things by staff and worked with another carer for one and a half weeks’. Since starting work at the home one care assistant stated they had only received fire, moving & handling, food safety and health and safety training, their personnel file confirmed this. This person did have an NVQ level two in care. The second care assistant stated she had only received fire training, their personnel file confirmed this. The training matrix shows that 10 staff have NVQ level two and training is planned for nine further care staff. The manager confirmed she does not carry out Nursing and Midwifery Council Personal Identification (PIN) Number checks for the trained staff she only sees their cards. These are not proof of registration and PIN checks should be done prior to employment and upon renewal of their PIN. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Robust systems are not in place for the management and administration of this service, there is no effective quality assurance system or procedures to Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 23 monitor the safety of bedrails or window restrictors which has the potential to place residents at risk of harm. EVIDENCE: The registered manager has been working at the home for five years. She has obtained her Registered Managers Award 4 in management and undertaken recent training for example, dementia awareness, Mental Capacity Act and fire. She has not had any moving & handling in the last 12 months. The training matrix shows this training is required. Her hours are supernumerary as she is not included in the staffing numbers. When asked about quality assurance systems for the home she stated ‘she struggles with this’. They have recently employed a ‘Human Resource’ person to assist with induction, job descriptions and policies and procedures. The manager confirmed that she has not held meetings with residents and relatives as part of the ongoing consultation about the quality of the service. The policies and procedures have not been reviewed in the last 12 months and she has not carried out any medication audits. A care plan audit was done on the 8th May 2008, although the follow up of the shortfalls of this audit is overdue. An Annual Quality Assurance Assessment was returned which was very brief in parts. The Annual Quality Assurance Assessment states they seek the views of people who use the service through questionnaires but there was no evidence provided to show this had taken place at the time of the inspection. The Dataset did not give any dates to show when the home’s policies and procedures were last reviewed. The Annual Quality Assurance Assessment does not give a reliable picture of the service. Evidence of monthly unannounced visits by the provider were requested. They were not available and she stated they have not been done since September 2007. Records of the management of residents monies for a resident case tracked were seen to be satisfactory. A fire risk assessment was available dated 19th October 2007. The home received a visit from the fire officer in January and March 2008. Outstanding items for attention were identified at the visit in March 2008. The manager confirmed there were two items that had not been addressed by the time of the inspection, one was due to be addressed in July 2008 and the second item they did not have a date for this to be done. This should be arranged as a matter of urgency. The manager when asked for bedrail and window restrictor maintenance checks stated they do not have any. An external contractor carries out the water checks for Legionella ands the last recorded visit was May 2008. Hot Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 24 and cold water outlet checks are recorded but it was not possible to identify how often they are done as the entries were not dated or signed. The manager stated they are done weekly. The health and safety poster on display in the home was not completed. The training matrix shows that 21 care and ancillary staff required fire and moving and handling training. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 1 3 1 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 1 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 1 34 X 35 3 36 X 37 X 38 1 Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5A, 5B Requirement The contract must contain information as to whether a nursing contribution is to be paid by residents as detailed within the Regulations so that prospective and existing residents are fully aware of how this affects their individual fees. A pre-admission assessment must be carried out prior to admission and sufficiently detailed to enable staff to formulate a care plan that is necessary to ensure residents needs can be met. Care plans must be in place and sufficiently detailed to enable staff to understand and meet the health and care needs of residents. Robust recruitment procedures must be carried out to ensure all the information required under this Regulation and associated schedules are obtained prior to appointment to ensure residents are protected from harm. An immediate requirement was made. DS0000004103.V364218.R01.S.doc Timescale for action 31/07/08 2 OP3 14(1) 29/06/08 3 OP7 15(1)(2) 31/07/08 4 OP29 19 23/05/08 Southcrest Nursing Home Version 5.2 Page 27 5 OP26 13(3) 6 OP30 18(1) 7 OP30 18(1)(3) 8 OP33 24 9 OP33 26 Practice and procedures for the management of infection control must be reviewed to ensure that residents are not placed at risk of cross infection. New staff must receive induction training appropriate to their role upon employment and updates at regular intervals to ensure that residents and staff working in the home are not placed at risk of harm. The competency of the registered nurses must be reviewed to ensure they have the skills and knowledge to identify and meet the residents care needs. The home must make arrangements to seek views of residents, their relatives and other stakeholders and use this information to improve service delivery. The Provider must carry out monthly unannounced visits to the service in accordance with this Regulation to monitor the quality of the service being provided to the people who live in the home. 06/07/08 29/06/08 31/07/08 31/10/08 27/06/08 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 OP7 Good Practice Recommendations The bedrail risk assessment documentation should be reviewed to ensure the home consider all areas of risk prior to the use of bedrails to ensure the resident is not placed at risk of harm. A system should be introduced which demonstrates that medication is stored at a safe temperature in order to DS0000004103.V364218.R01.S.doc Version 5.2 Page 28 2 OP9 Southcrest Nursing Home 3 OP9 4 5 OP10 OP10 6 OP12 7 OP16 8 OP19 9 OP29 10 11 OP38 OP38 ensure that people who use the service are protected from harm. It is recommended that there is a care plan for the management of pain which describes the care to be given to the identified resident. This should include details for the administration of medication prescribed ‘when necessary’ for pain management. The adequacy of the privacy curtains in shared rooms should be reviewed to ensure that residents’ privacy and dignity is maintained at all times. Staff should ensure when discussing residents’ care needs that the information cannot be overheard by other residents or visitors to the home so that they maintained confidentiality at all times. The home should review the activities provided to ensure that suitable activities are available in the home and within the community for all of the people who use the service to ensure their social, recreational and religious needs are met. The home should ensure all complaints are recorded, investigated and acted upon including responding to the complainant in a timely and robust manner in accordance with their own procedures to make sure residents and staff can be confident that any concerns and complaints are listened to and acted upon. A review of the décor and furnishings provided by the home should be carried out to ensure the home is safe, bright, and clean and that residents have the necessary furniture available to ensure their comfort. Confirmation of registration with the Nursing and Midwifery Council should be carried out by the home prior to employment of trained staff and upon renewal to ensure that residents are not placed at risk of harm. The home should carry out regular checks of bedrails and window restrictors to ensure that residents’ safety is maintained at all times. The health and safety poster should be completed so that staff know who to contact in the event of a health & safety incident taking place in the home. Southcrest Nursing Home DS0000004103.V364218.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI. 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