Inspection on 08/05/08 for St Benedict`s Nursing & Residential Home

This inspection was carried out on 8th 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

St Benedict`s Nursing &... 06/11/08

St Benedict`s Nursing &... 09/05/07

St Benedict`s Nursing &... 06/06/06

St Benedict`s Nursing &... 24/01/06

St Benedict`s Nursing &... 16/08/05

St Benedict`s Nursing &... 20/01/05

St Benedict`s Nursing &... 16/04/04

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Queensmount

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Didsbury Court Rest Home

Belma

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

CARE HOMES FOR OLDER PEOPLE St Benedict`s Nursing & Residential Home St Benedict Street Glastonbury Somerset BA6 9NB Lead Inspector Justine Button Key Unannounced Inspection 8th May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Benedict`s Nursing & Residential Home DS0000003287.V364823.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. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Benedict`s Nursing & Residential Home Address St Benedict Street Glastonbury Somerset BA6 9NB 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) 01458 833275 01458 833402 stbenedictsnursinghome@hotmail.com Mr David Edwin Wills White Manager post vacant Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to 9 beds for personal care. Date of last inspection 05/09/2007 Brief Description of the Service: St Benedicts Care Home provides nursing to older persons over the age of 65 yrs. It has been developed from a large domestic dwelling house with a purpose built extension. It is within easy walking distance from the town centre of Glastonbury, although up a slight hill. Accommodation is on two floors, with a four-person lift. There is a level patio area approached from the lounge and there is a garden area to the rear. There are 26 single rooms and 6 double rooms. 29 rooms have en-suite facilities. The home provides nursing care for up to 30 people and personal care for up to 9 older people. Experienced nursing and care staff deliver the care. The accommodation is maintained and experienced staff provide a full catering and domestic service. The current fees are from £487 to £535 per week St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out over one and a half days by one inspector. The manager Ms. Caroline Walter was on duty on the day of the inspection. The inspector would like to thank Ms. Walter and the duty staff for their time and hospitality shown to the inspector during their visit. The home completed an Annual Quality Assurance Assessment, AQAA, which was received by us the CSCI following the visit to the home. A number of service user surveys were sent to the home. To date none of these have been returned to us. The content of the Comment cards will therefore be included in the next inspection report for the home. The AQAA completed by the home described the ethnicity of all people currently living at the home as white/British and over 65 years of age. The inspector was able to see and observe staff interactions with many residents, meet several relatives, discuss care issues with staff and discuss the management of the home with senior staff. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the home’s Statement of Purpose, staffing rosters, menus, the home’s complaint’s file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: In September 2007 the previous home manager retired. This manager had been at the home for a considerable period of time and had in-depth knowledge of service. Following the retirement of the previous manager one of the senior nurse has been recruited to this role. This manager has yet to registered with us, the CSCI, despite being in post for over six months. Managers are required under the Care Home Regulations to be registered with us to ensure their suitability for the role. An application, therefore, needs to be forwarded to us without delay to ensure that no additional action is taken. The new manager, Ms Caroline Walter, is very enthusiastic and keen to make improvements to the care and service provided. Despite this a number of issues were identified at this inspection that require additional action by the staff team at St Benedict’s. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 7 The home does not currently provide up to date information in the form of a statement of purpose and service user guide. Copies of the homes terms and conditions are available to all people living at the home however these do not conform to guidance issued by the Office of Fair Trading. During the inspection it was noted that staff had commenced employment prior to all necessary checks being completed. References that had been obtained in some cases were not satisfactory. Robust recruitment checks are required to ensure the safety of the people living at the home. Systematic processes of comprehensive quality assurance should be implemented to ensure that any weaknesses in service are promptly identified and risks of harm and injury are managed and minimised e.g. reliable in-house risk assessments, for audit of medicine records and for assessment of care planning would have identified the related weaknesses before this inspection took place. Concerns have been raised with us with regard to two incidents that one individual had experienced while using a hoist at the home. It could not be confirmed that appropriate action has been taken by staff to ensure the safety of people at the home when using this equipment. The care planning process completed does not provide adequate detail to staff. Assessments are not completed to an adequate standard to ensure that the health and care needs of people at the home are identified and appropriate care and support provided. The management of medication is not well managed in all areas and could potentially put people at risk. During a tour of the building it was noted that a number of people’s toothbrushes were dry and the top of the toothpaste was hard. This leads the inspector to believe that people had been supported by staff to clean their teeth or dentures. This issue was raised at the last key inspection. 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. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 8 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 St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 9 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): 1,2, 3, 4, 5. Standard 6 does not apply to this home Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not provide adequate information to prospective people thinking of moving into the home nor those who are currently living at the service. Contacts are not in line with the Office of Fair Trading guidance Preadmission assessment ensures that the home can meet people’s needs prior to moving into the home. People and or their representatives are able to visit the home prior to they move in. EVIDENCE: The home provides information to people living at the home or those thinking of moving in. This information takes the form of a statement of purpose and service user guide. These documents are available in the foyer area of the St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 10 home. The information contained in the documents however is not relevant as it has not been update for several years. The information does not contain the most recent inspection report. All people living at the home are provided with a copy of the terms and conditions of their stay. The terms and conditions however do not state the room to be occupied nor do they clearly state the services to be provided with in the fees paid. Due to this they do not comply with the guidance issued by the Office of fair trading. Extra charges are met by service users for newspapers, hairdressing, trips/outings, personal toiletries/items and special requirements. Preadmission assessments completed for people moving into the home by a senior member of the nursing team. The inspector was able to see evidence that prospective service users were fully assessed prior to being offered a placement at the home. Completed pre-admission assessments were seen to be in place in service user care plans examined. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 11 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, 10, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s care planning processes require additional development. Care plans need to promote a person centred approach to care and give clear guidance to the staff on the needs of the individuals living at the home. People who live in the home have access to appropriate healthcare professionals. Healthcare needs are not met in full including care in oral hygiene and the care and treatment of wounds and pressure sores. The home does not follow the correct procedures for the management and administration of residents’ medication. Staff interact with residents in a kind and respectful manner. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four service users were case tracked at this inspection. This involved meeting with the service users, examining care and related records and viewing their bedrooms. The care plan for one individual was viewed. A pre-admission assessment had demonstrated that the individual had moved into the home just a few months prior to the inspection. The pre-admission assessment stated that the individual was at risk of sustaining pressure damage. Despite this a “Waterlow” score had not been completed by staff. “Waterlow” is a tool used by nurses to assess the risk of developing pressure damage. A regular change of position is required for people who are at risk or who have pressure damage. As the “Waterlow” score had not been completed it could not be confirmed how frequently a change of position would be appropriate for this individual. The care plan developed for staff did not give clear guidance to staff only stating, “change position regularly”. The individual was unable to move or change position independently. The moving and handling assessment had been completed however this was not specific stating only that a hoist was required. The plan did not state which hoist was to be used. Different slings for use with a hoist are required dependant on the needs of the individual and should take into account such issues such as the individuals weight to ensure that the correct sling is used. In addition the preadmission assessment identified that the individual had issues with swallowing diet, fluids and had a poor appetite. Good hydration and nutrition is paramount in the prevention of pressure sores and maintaining good health in older people. Despite the issues of poor swallowing and appetite being identified the staff had not completed a nutritional assessment. As the assessment had not been completed it could not be confirmed that appropriate care plans which give staff clear guidance to the staff on the care needs of the individual had been developed. The plans did not demonstrate that neither the individual nor their representative had been involved in the development or review of the plans. The plans did not detail the individual’s likes and dislikes and involvement in the plan of care would enable personal preferences to be documented for staff. The plan for a second individual was viewed in detail. Concerns had been raised with us from a local community nurse that this individual had been involved in two injuries relating to the use of a hoist. A moving and handling assessment had been completed however this was not specific and did not state the hoist to be used. It could not be confirmed therefore if the accidents were due to the incorrect hoist being used. Despite two falls from the hoist a falls risk assessment had not been completed nor was the moving and handling assessment reflective of these incidents. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 13 The information received from the funding authority prior to admission stated that this individual had issues with depression and had been seen by a psychiatrist. There was no care plan in place for this aspect of the individuals care needs. The weight records for this individual had been completed spasmodically. This showed that the individual had been loosing a small amount of weight each time the weight had been completed. A nutritional assessment had not been completed. A care plan for eating and drinking had been developed however at no time did the plan of care state that weight loss had occurred. The plan did not detail any action that staff should be taking to prevent additional weight loss. The remaining plans were ambiguous containing comments such as “ensure footwear is appropriate” and “ensure regular nightly checks” Staff need to ensure that comments made in the assessments and care plans are detailed and give clear instructions to the care staff. The plans do not currently reflect a person centred approach. Likes and dislikes were not well documented. The senior nurse on duty on the day of the inspection stated that the care plan documentation was due to be changed over the next few weeks. The new documentation would be completed with a person centred approach in mind and would include input from the individual concerned or their representative. The development of the care planning system will be welcomed. A number of people at the home had pressure ulcers. Wound care plans were viewed for all these individuals. The plans did not contain tracings, photographs or sizes of the wound or ulcer. This is required to ensure that the progress of the wound or ulcer can be assessed and appropriate changes made to the treatment given by staff. The wound care plans did not clearly detail the dressing or treatment currently being used. It could not be confirmed therefore if these were appropriate. The care plans seen confirmed that people living at the home have access to a range of health care professionals. This included input from district nurses, GP’s, Social workers & palliative care specialists. During a tour of the building it was noted that a number of people’s toothbrushes were dry and the top of the toothpaste was hard. This leads the inspector to believe that people had not been supported by staff to clean their teeth or dentures. Service users who were able to express a view were very positive about the care they received. Staff interactions with service users were noted to be very warm, professional and respectful. Interventions were observed to be ‘unhurried’. Staff were heard explaining interventions to service users before St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 14 carrying out. Service users appeared relaxed and comfortable throughout the day. The home’s procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. As the MAR are pre-printed there are occasions when the GP may change the dose required in between the new MAR starting. In these cases staff should rewrite the prescription in full on the chart to reduce the risk of the incorrect dose being given. This was not seen to be the case on this inspection. Some creams in use, seen in service user bedrooms, had not been marked with an expiry date nor had the MAR chart been signed to confirm that the creams had been applied as per the Prescription. Some creams and lotions seen in bedrooms did not relate to the individual to whom they had been prescribed. Two individuals living at the home required insulin to control their diabetes. Insulin once opened should be stored at room temperature. The opened insulin for these individuals was found to be stored in the fridge. This would make administration uncomfortable. Once opened insulin has a shelf life of six weeks and should be discarded after this time. The insulin for both these individuals had been opened in excess of this six-week timescale. The fridge temperatures had been recorded on a daily basis by staff. The documented fridge temperatures were found to be high ranging from 7 degrees centigrade to 10 degrees over a period of two weeks. Despite documenting these high temperatures staff had not taken any action to reduce the temperature. Storing medication at the incorrect temperature may reduce its effectiveness. The medical room was found to be cluttered and overstocked including wound dressings for people who no longer resided at the home. A large amount of stock was found to be out of date. This included blood bottles which expired as far back as June 2007, suction catheters which expired in 2005 and giving sets used for administering subcutaneous fluids in January 2008. Staff need to complete an audit of the treatment room and ensure that all out of date stock is removed and ensure that a system of stock rotation is put in place to ensure that out of date stock is continually removed. Oxygen is stored in the treatment room. No signage was in place on the door to reflect this. St Benedict`s Nursing & Residential Home DS0000003287.V364823.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, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Choice and preferences are not always considered by staff and these are detailed in the care plans. Choice is available at some times with regard to meals although this needs to considered at all times. Meals and mealtimes are a pleasant experience for people living at the home. Activity provision is currently limited although this may improve in the near future EVIDENCE: Lunch was reviewed on the day of the inspection. The lunch consisted of pork chops, mashed potatoes stuffing, apple sauce, cabbage carrots and gravy. There was no choice available although staff stated that they did inform people living at the home what was on the menu on the previous day and alternatives could be arranged if necessary. This was confirmed as one lady at the home had fish fingers as an alternative to the pork chops. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 16 Two people were spoken to prior to lunch stated that the food was of a good standard and that they enjoyed the meals. One of these people stated that he did not like pork chops although it was observed that these were given. The individual stated to the staff that he did not like the chops however no alternative was offered. The inspector raised this issue with the staff who stated that the individual had never expressed a dislike to pork chops and had indeed eaten them on previous occasions. Despite this staff should consider that individuals might change their minds and ensure that choices are actively offered and available at all times. During the serving of the meal staff were observed offering people choices about the type and amount of vegetables that they would like and if they would like gravy and/or applesauce. A soft diet was available for those people who required it due to difficulties in chewing or swallowing. Interaction between individuals and staff were seen to positive and appropriate particularly for those people who required staff assistance. The meal was nicely presented and smelt appealing. The tables were nicely set and the lunchtime experience was pleasant. Staff should consider making condiments such as salt and pepper available on the tables. It was noted that all people who ate lunch were wearing aprons to protect their clothes. This gave a rather institutional feel to the meal and staff should consider how this impacts on people’s dignity and self esteem. A more person centred approach should be used. The chef spoke to the inspector during the visits and confirmed that all the food was homemade including puddings and cakes. The chef confirmed that she was aware of people likes and dislikes and any specialist diets required. The chef stated that she liked to use fresh local products when ever possible. There is currently no activities organiser employed by the home although one has been recruited and is due to start work in the very near future. Due to this in house activities have been limited over the last few months. Two activities had been arranged and this included a visit by some birds of prey on the day of the inspection visit. Additionally a clothes sale had been organised fort he 24/05/08. People living at the home stated that they appreciated the care and support afforded to them by the staff at the home. Comments included “the staff here are marvellous and they work so hard” As previously stated however the care planning process needs to be developed to ensure that a person centred approach is adopted by all staff. This will ensure that care and support is delivered in a way that they would prefer and taking into account their individual wants and wishes. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 17 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It could not be confirmed that all staff have received training in the prevention of abuse and are aware of what action to take if they suspect abuse is occurring within the home. Staff recruitment is not robust on all occasions EVIDENCE: The home had a complaints procedure, which was available to service users, staff, and visitors. It forms part of the Service User Guide and is detailed in the Statement of Purpose. Service users who were able and staff spoken with informed the inspectors that they would not hesitate in raising concerns if they had any. No complaints had been received by the home since the last inspection. We have received two concerns relating to the home since the last inspection. These related to the number of people at the home who have pressure damage St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 18 and to an individual who had been involved in two incidents whilst using a hoist. These concerns have been reviewed as part of this inspection visit. Three staff were spoken to during the visits and asked what they would do if they suspected abuse was occurring at the home or if they saw another staff member acting inappropriately. Two of the staff gave clear answers whilst the remaining staff member was unsure what she would do. The staff training records did not clearly demonstrate that all staff have received training in abuse awareness. Staff recruitment files were viewed during the inspection. It could not be confirmed that staff recruitment is robust in all areas (see section “staffing”) this may put people living at the home at risk. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some parts of the building are looking tired and worn but it is understood that this will be rectified once the new building has been completed. There has been an increase in the number of adjustable beds although not all people with nursing needs have this equipment. People are able to individualise their private rooms. People are able to have access to a garden although this is currently restricted due to construction of a new building. The cleanliness of the home was good. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 20 EVIDENCE: A new building is in the process of being developed at the site of the home. This will be completely separate registration from the existing service with it’s own manager although the two homes will be linked via one corridor. Services such as the laundry and kitchens will be shard by both the homes and as such will be upgraded in the near future. The new service will provide dementia care. A tour of the building was conducted during the inspection. There are a range of communal areas including 2 large lounges, two dinning room. This space complies with the requirements of 4.1sq m per service users. The furnishings and decoration are all homely and varied although tired looking in parts. Although some of the bedrooms in the existing service have been redecorated and modernised the owner of the home stated additional refurbishment will occur once the “dirty” work form the new building is completed including the link corridor. There is a range of specialist equipment including air mattresses and cushions used to help in the prevention of pressure sores. People who are frail and nursed in bed for long period s should be provided with an adjustable bed to reduce the risk of back injury to staff. The home does not currently provide all people with nursing needs with this equipment. The number available has increased since the last inspection however. The home does prove access to outdoor space in the form of a garden and patio area. The access to this space is currently limited due to the building works that are being completed. Parking is also restricted at this time. The home was clean and tidy on the day of the inspection with the exception of the drug room as discussed earlier in this report. The AQAA sent to us following this site visit confirms that all necessary maintenance is completed. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment is not robust It could not be confirmed that all staff have undertaken all necessary training in order to meet the needs of the people living at the home. EVIDENCE: The duty rotas were examined. These showed that a registered nurse is on duty for a twenty-four hour period. In addition to this 7 care assistants are available from 08:00 until 12:00hrs. 3 or 4 care assistants are on duty from 12: 00 until 17:00 hrs. Rising again to 4or 5 care assistants between 17:00hrs and 21:00hrs In addition ancillary staff are available to cover the kitchen, laundry and cleaning. Four staff recruitment files were viewed. Of these four two did not have the required two written references. The staff files viewed did not contain St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 22 references from the staff member’s last employer. Only one of the staff files contained any identification as stated in the Care Home Regulations. All the staff files however contained enhanced Criminal Record Bureau checks. The homes management should consider reviewing the current application form as this currently requests information with regard to the individual’s age, marital status and ages and number of children. This does not comply with equal opportunities guidance. A new induction programme has recently been introduced to the home. This induction programme now meets the skills for care good practise guidelines Staff training records were viewed. No training matrix is available. Currently training is recorded in a book. This states when training was held and who attended. It is difficult to ascertain easily therefore how the management know which staff are due for updating or refresher training in order to plan the training required for staff. The information received from the home states that there are currently 32 care and nursing staff employed at the home. The records viewed showed that only 23 staff have undertaken training in moving and handling, 4 staff have attended health and safety training and 8 staff infection control in the last 12 months. Abuse training was conducted in May and June 2007, which covered all staff. It cannot be confirmed that new staff commencing employment between June 2007 and the new induction programme (which covers abuse awareness) being introduced have received abuse training. It cannot be confirmed if all staff have received fire awareness training. The staff training book confirmed that 2 of the Registered Nurse’s (RGNS) have undertaken Venapuncture training on the 07/03/07 and 2 RGN’S syringe driver training It is required that the management at the home review the training that has been provided and consider developing a training matrix to ensure that all staff have the appropriate skills and competencies to fulfil their role. The homes AQAA states that 18 staff have an NVQ level 2 or above and an additional three staff are working towards this qualification. This is above the expected 50 . St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 23 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, 32, 33, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and safety of the people living at the home may be compromised by the lack of robust audits and checks A system of staff supervision and appraisal has been implemented. The home is breaching the care home regulations in that the home manager is not yet registered with us. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 24 EVIDENCE: In September 2007 the previous home manager retired. This manager had been at the home for a considerable period of time and had in-depth knowledge of service. Following the retirement of the previous manager one of the senior nurse has been recruited to this role. This is the first managerial role that this individual has undertaken and as such is having to work extremely hard to develop the necessary skills to run the service. In addition due to other senior staff leaving there has been no deputy manager for some time. Despite a “stressful” start the manager now feels that she is developing within her role and is enthusiastic to make the necessary changes to improve the care and support afforded to people living at the home and to the staff team. The new manager has yet to registered with us, the CSCI, despite being in post for over six months. Managers are required under the Care Home Regulations to be registered with us to ensure their suitability for the role. An application, therefore, needs to be forwarded to us without delay to ensure that no additional action is taken. Since taking on her role, the manager, has implemented a system of staff supervision and appraisal. Staff spoken to during the inspection stated they found this system beneficial and worthwhile. Concerns were expressed to us from the community nurse with regard to one individual living at the home. The concerns related to two separate incidents, which the individual was involved in while using a hoist at the home. These concerns were investigated during the inspection. Accident records showed that the two incidents had occurred and that the individual had fallen from the hoist on one occasion. As previously stated in this report the care plan had not been evaluated or changed to reflect this fall and so therefore it could not be confirmed that staff were taking appropriate action to ensure that this accident was not repeated. The accident form for the second incident is not clear. It would appear that the hoist “fell over”. This may have been due to a fault on the hoist. Accident forms are not currently audited so it cannot be confirmed if the management were aware of this incident and the potential risk to individuals living at the home. On discussion with the manager and the owner of the home it was evident that neither had been informed of this occurrence. It cannot be confirmed if the hoist was still in use at the home. This was raised with the manager on the day of the inspection and a request made that they review this incident without delay to safeguard people living at the home. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 25 The home has an environmental risk assessment however this was dated 2001. This document requires updating to ensure that the information it contains remains relevant and that the environment remains safe for people living at the home, staff and visitors. The manage needs to develop a system of auditing and quality assurance to ensure that the home provides a good service to the people living at the home. The AQAA information sent to us states that the ongoing maintenance of equipment is completed. On the day of the inspection however the hot water at the home was not within safe limits and could poise a risk of scalding. This needs to be reviewed by the home. The home has a range of policies and procedures all of which were reviewed and update in May 2008. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 26 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 1 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X X 3 X 1 St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 27 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 OP29 Regulation 19 (1) (b) Schedule 2 Requirement Timescale for action 30/07/08 2 OP1 4 5 12 (1) (a) 13 (5) 3 OP38 4 OP9 13 (2) 13 (4) (c) Systems for staff recruitment need to be robust and include two written references (one should be from the last employer.) and identification including a recent photograph. It is required that up to date 30/07/08 information is available in the form of statement of purpose and service user guide. It is required that the 19/07/08 management investigate the concerns relating to the incidents involving the hoists and any necessary remedial action is taken to ensure the safety of the people living at the home. It is required that all date 19/07/08 expired medical equipment is removed form the home and a system is developed to ensure that a system of stock rotation and checking is implemented St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 28 5 OP9 13 (2) 6 OP8 12 (3) It is required that all prescribed creams and lotions are marked with a date of opening and that these creams are administered only for the individual to whom they are prescribed. The person applying the cream should sign the Medication Administration Record It is required that the manager ensures that all aspects of service users’ personal hygiene and health needs are met. This is to include oral hygiene and pressure area care. It is required that a plan of care is developed for all people who have wounds or pressure ulcers. The plan of care should give clear details of the size, treatment and progress of the wound or ulcer. Consideration should be given to the introduction of photographs and of wound measurements and/or tracings. It is required that all staff receives training in • Moving and handling • Abuse awareness • Fire safety Staff who handle or prepare food should also receive food hygiene training. It is required that people living at the home have the opportunity to exercise choice in relation to all aspects of their lives including routines of personal living and dietary likes and dislikes. These choices should be documented in the plan of care. 30/07/08 30/07/08 7 OP7 12 (1) (a) 19/07/08 8 OP30 18 (1) (a) 30/08/08 9 OP12 12 (2) 30/07/08 St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 29 10 OP7 15 (2) It is required that the service user plans are reviewed to ensure that the plans adequately reflect the current care needs of the individual and provide clear guidance to staff including weights, nutritional and fall risk assessments. You must make application to register any person appointed to manage the home to comply with Section 11(1) of the Care Standards Act 2000. It is required that insulin is stored within the manufacturer’s guidelines and at the correct temperatures. 30/07/08 11 OP31 8 (1) 9(1) 30/07/08 12 OP9 13 (2) 30/07/08 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 It is recommended that the service user or their nominated representative are involved in the development and review of their plans of care. The service user plans need to be continued to be developed to reflect the current needs of the service user and give clear instructions to staff on how to deliver the care required. It is recommended that consideration is given to developing the range of activities. This may require the activities organiser accessing some additional training. 2. OP12 St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 30 3. OP33 The registered person shall establish and maintain systems for evaluating the quality of the services provided at the care home. This refers to the introduction of a quality assurance system that includes quality audits and risk assessments. 4 OP24 5 6 7 8 9 OP2 OP19 OP30 OP9 OP29 It is recommended that the purchasing of adjustable beds continue. A risk assessment should be completed to ensure that the current beds are made available to those assessed as being at high risk It is recommended that the contract (terms and conditions) issued to people details the room to be occupied and the items covered in the fees paid. It is recommended that the home environmental risk assessment is reviewed to ensure it remains up to date and relevant. It is recommended that a training matrix is developed in order that staff training can be identified and organised. It is recommended that the drug fridge temperatures are reviewed to ensure that drugs requiring refrigeration are stored at the correct temperatures The management should consider reviewing the home’s current application form to ensure it meets equal opportunities guidance. St Benedict`s Nursing & Residential Home DS0000003287.V364823.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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