Inspection on 02/05/07 for St Clements Nursing Home

This inspection was carried out on 2nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

St Clements Nursing Home 08/05/09

St Clements Nursing Home 17/11/08

St Clements Nursing Home 29/04/08

St Clements Nursing Home 21/11/07

St Clements Nursing Home 07/11/06

St Clements Nursing Home 24/05/06

St Clements Nursing Home 27/01/06

St Clements Nursing Home 09/08/05

St Clements Nursing Home 20/10/04

St Clements Nursing Home 23/04/04

St Clements Nursing Home 24/11/03

St Clements Nursing Home 19/08/03

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Clements Nursing Home 8 Stanley Road Nechells Birmingham West Midlands B7 5QS Lead Inspector Kath Strong Unannounced Inspection 2nd May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Clements Nursing Home DS0000024892.V335202.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 Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Clements Nursing Home Address 8 Stanley Road Nechells Birmingham West Midlands B7 5QS 0121 327 3136 0121 328 1461 stclements@bmlhealthcare.co.uk 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) Noblefield Limited vacant post Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (37) of places St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate a total of 37 service users, categories DE(E) and OP. Accommodation may be provided for up to 37 service users who require nursing care, categories DE(E) and OP. Accommodation may be provided for up to 10 service users who require personal care, categories DE(E) and OP. Minimum staffing levels must be maintained at two nurses plus six carers during the morning shift and two nurses plus five carers during the afternoon shift when there are 36 service users requiring nursing care. In addition to the above minimum staffing levels there is one nurse and three carers overnight plus a second nurse who remains on duty until 10pm when there are 30 service users in the home requiring nursing care. The care managers hours and ancilliary staff should be provided in addition to the care staff. 7th November 2006 5. 6. Date of last inspection Brief Description of the Service: St Clements is a purpose built three-storey home situated in a built up residential area of Birmingham. The home provides accommodation to thirtyseven elderly residents in 27 nursing beds and 10 residential beds. There are twenty-five single bedrooms and six double rooms, one of which is located on the lower ground floor and all have en-suite facilities consisting of a toilet and wash hand basin. Access to the home is gained by the lower ground floor and a passenger lift gives access to the ground and first floors. There is limited covered parking on the lower ground floor to the front of the property. There is a small garden with steep elevations that is accessed from the ground floor. Communal facilities consist of a large lounge on the ground and first floor. There is also a dining room situated on the ground floor that is adjacent to the kitchen, which provides all the meals. Residents are able to have meals on either of the upper floors or in their own room. A laundry facility is situated on the lower ground floor, where washing of resident’s personal clothing is undertaken. There are bathing facilities on each floor; however, some of these are not suitable for the client group resulting in insufficient assisted bathing facilities. The home has a range of pressure relieving equipment and moving St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 5 equipment to assist those persons who have restricted mobility. The current fee rates were not available, the following are the rates for the previous year £333.00 for shared rooms and £363.00 for single rooms per week for nursing care and there may an additional fee paid by the Primary Care Trust of £45.00, £85.00 or £134.00 per week depending on the estimated level of nursing car needs. Residential fees are £305 for a shared room or £336.00 for a single bedroom. A charge of £5.00 per week is also made for those persons requiring continence products. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork visit was carried out by two inspectors over a period of a long day. The manager was on annual leave, the deputy manager provided assistance throughout. There were 31 people living at the home on the day of the visit, one of which was in hospital. Information was gathered from speaking with residents and staff. Care, health and safety and the arrangements for medications were inspected. Staff personal files were checked and staff were observed whilst performing their duties. A partial tour of the premises was carried out. Due to some residents having dementia it was not always possible to have a meaningful conversation with them. At the conclusion verbal feedback was given to the deputy manager. All Immediate Requirements from the previous inspection had been met and none were made from this inspection. What the service does well: What has improved since the last inspection? A manager was appointed six months ago and the deputy manager four months later. They have developed a good working relationship and have identified the improvements needed and have commenced work towards these to promote good standards of care for residents. Care staff were noted to be more motivated and had requested to be allocated specific responsibilities in assisting management in achieving an effective workforce that actively contributes to the day to day running of the home. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 7 There was a significant reduction in the number of residents who had pressure ulcers. Specialist equipment has been purchased to assist in the process of promoting residents health. The deputy manager works along side carers to observe standards of care and to give guidance as required. The staff room has been redecorated to improve their welfare facilities. The newly appointed maintenance operative appears to be professional and displayed good ‘people skills’ to make a positive impression on people such as relatives that he comes into contact with. A temporarily employed maintenance operative is continuing to undertake redecorating of the home to make it a pleasing environment for residents to live in. A room has been created for use by the hairdresser and chiropodist to provide a discreet location for these procedures. A resident who was being transferred with the use of a hoist has been encouraged and guided by the deputy manager in progressing to walking a short distance. Such practices enhance the persons independence and confidence in themselves. Although there are still gaps in staff training improvements were noted and the manager has arranged further courses that staff require for them to meet the specific needs of residents. Some improvements were noted in care planning but significant improvements are required to ensure that the home identifies and meets all individuals needs. What they could do better: Care planning needs to drastically improve in identifying physical and mental health illnesses. Assessing them and developing care plans that give staff clear and comprehensive guidance of the care needs and personal preferences need to be incorporated in them. Regular reviews need to be consistent and formal reviews carried out with the respective resident and/or relatives invited to attend, participate and agree the care plan. This process is essential in promoting health and making required changes to care plans and delivery of care when other conditions develop. The home needs to acquire specialist equipment that is on the premises for use immediately when it is assessed as being needed. Staffing levels must be sufficient to meet the needs of the client group taking into account the number of residents, dependency levels and dementia needs. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 8 This is vital in ensuring that acceptable levels of care are being delivered and prevention of overloading of staff duties. Provision of activities was found to be inadequate in providing a good level of recreation and stimulus to enhance the quality of residents life. An activities programme needs to be developed, which takes into account residents preferences and expectations, allocated hours and resources. This should be backed up with records that are informative and can be used as a tool to judge individuals preferences. The home needs to develop a system for those people who have communication difficulties and for those who for medical reasons remain in their bedrooms. An assessment of usage of terminology needs to be carried out and of interaction between residents and staff in ensuring that each party can understand the other. There must be a communication system in place to ensure that all requests made and interactions with residents are clearly understood and their dignity is maintained. Consideration needs to be given to implementing a system whereby residents are assisted in recognising communal rooms and their bedrooms The lack of suited bedroom door locks has remained an outstanding requirement for a long period of time and needs addressing. The pockets of mal odour need to be eradicated to provide a fresh and pleasing environment for residents to live in. The already commenced arrangements for carrying out formal staff supervisions at least six times a year needs to be implemented and ongoing. This is a means of assessing staff competence, providing guidance and identifying training needs to ensure that residents receive the correct care that they are entitled to. 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 Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose does not provide prospective residents or professionals with sufficient written details for them to make an informed decision about living at the home. Pre-admission assessments are carried out and information gathered to determine that the home is able to meet the individuals needs. EVIDENCE: A copy of the statement of purpose was reviewed. The document was dated May 2007. Further development is required including room sizes and that when regular reviews of care plans are carried out that the resident and/or relative will be invited to attend and agree the final document. The inspector was supplied with a copy of the service user guide dated January 2005, which was found to be informative. Information was given that new residents are supplied with a welcome pack, which includes the service user St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 11 guide, a welcome note, details about routines in the home, the room allocated and the fee rate and what is not included in this. Either the manager or the deputy manager carries out pre-admission assessments prior to a placement being offered. This ensures that the home is able to meet the identified needs at the point of admission. The deputy manager advised that residents who have been in hospital undergo another assessment before being accepted back into the home to ensure that the home can meet the needs. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff practices and care planning were not adequate in ensuring that residents receive appropriate standards of care to meet their healthcare and personal needs. Generally the arrangements for administration of medications were good but staff need to ensure those who self medicate are fit to do so to confirm that residents safety is being maintained. Observations indicated that staff conduct ensures that residents privacy and dignity is not being maintained. EVIDENCE: Key UI 02/05/07 The home has made good and steady progress regarding ten persons who were identified as suffering with pressure ulcers. Due to correct procedures and purchasing of pressure relieving equipment as suggested by external professionals, it was found that only two residents had remaining pressure ulcers. This indicates improvements in care and that the advice provided has St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 13 been actioned for the benefit of the current residents. Purchasing of pressure relieving equipment needs to continue to ensure adequate amounts are available when it is needed. Six care plans were checked, two of which were case tracked since admission to the current date to determine that all needs had been identified and addressed. Each resident has there own tailored care plan. This identifies the assessments carried out and how care needs to be delivered by staff to promote the health and well being of each person living at the home. The deputy advised that care plans were in the process of being re-written. It was noted that three of the six files had been re-written. Staff had commenced recording residents life history, background and personal preferences to enable staff to provide care that is appropriate to the receiver. Some files contained good information about a persons strengths and weaknesses. Although some improvements were found significant improvements are required to confirm that conditions are identified and assessed and that staff are given comprehensive written guidance on how to deliver care. The shortfalls included: • Failure to develop toileting regimes to suit the persons requirements • Some assessments were not being reviewed monthly as stated in the statement of purpose • Regular formal reviews were not being carried out and there was little indication of the respective resident and/or relative being invited to participate and agree the care plan • Infrequent descriptions of wounds resulted in ineffective monitoring being carried out • There were improvements seen in the documentation of peoples preferences but these were not being transferred into the care plans to confirm that residents received their care how and when they want it • The document for assessment of bed rails contains inappropriate terminology, ‘Cot sides’, which staff had also handwritten. This indicates a lack of respect for peoples dignity. Staff had recorded ticks on the tool and very scant other information to evidence that the assessment had been comprehensive • There was no risk assessment or care plan for the resident who experiences difficulty in swallowing • A resident had signed a disclaimer 2003 regarding the continued use of the wheelchair lap strap. There was no evidence in the file that a specialist had been requested to assess the resident and provide an appropriate lap strap. The home should have a risk assessment in place that is regularly reviewed and written individual protocols for correct use of the lap strap to give staff adequate guidance in safe usage of it • Information in one file advised that an MRI scan had been arranged for a resident but there was no care plan to give information about why it was required or which area of the person would be scanned • The file of a person who was receiving respite care did not contain any St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 14 • • • • • • • • assessments or care plans A circumference measurement of a resident who could not be weighed did not provide any information about which part of the body had been measured Files lacked detailed care plans in respect of dementia care and information about difficult to manage behaviour did not include likely triggers or the type of behaviour displayed Lack of short term care plans for conditions such as chest or urinary tract infections. A resident had been diagnosed with a urinary tract infection and was later transferred to hospital did not have a care plan in place A form used regarding bereavement included ‘No resuscitation’ Staff must ensure that the decision has been made by an person who is capable of making decisions or their relatives whilst gaining the GP or other medical professional approval of the arrangements. All parties must confirm this in writing to ensure that the legal process has been followed An inspector found a re-positioning chart at 3.15pm that had two entries the latest at 10am. Staff must carry out instructions as per the care plan and make recordings of their actions upon completion of the task Staff need to improve their practices regarding use of wheelchairs. One resident was observed to be sat in an poor position and another did not have footplates. Staff need to ensure that the equipment is used correctly and that assessments have been carried out for those persons who may benefit from lap straps and other specialist equipment A resident was resting on the bed but the bedrail was on top of the wardrobe putting the person at risk of injury Staff use inappropriate terminology when talking about residents who require assistance with meals. Referring to them as, “Feeders” is not acceptable and does not promote residents dignity. The home needs to demonstrate that all physical and mental health conditions are being identified, assessed and appropriate care plans developed with clear guidance for staff, which ensures that the care residents receive tailored care that incorporates their personal preferences. One resident said, “I really like the home, staff are good”. Another reported, “Pull cords are not in peoples reach, position chart is not always completed at the time when care has been given”. The whole process for administration of medications was reviewed and audits carried out of those whose care plans have been seen. An inspector was supplied with a copy of the tool the deputy manager uses for his audits, which are carried out monthly in conjunction with the pharmacist. All aspects of the arrangements were found to be good with one exception. The resident who St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 15 was receiving respite care was noted to be self medicating but had not been assessed as being safe to do so. This was discussed with the deputy manager during the inspection, the home needs to assess the safety of any residents who wish to self medicate. One inspector spent a considerable amount of time with residents and staff. Residents were treated with respect and the preferred term of address was being used. Residents were well presented and staff spent time socialising with them. Personal care was delivered in a bathroom or the residents own room. Staff practices ensure that residents privacy and dignity are being maintained. However, as mentioned above staff may use inappropriate language when referring to assistance needed by residents. A trained nurse was noted to be having difficulties in talking with a resident and enlisted the help of a carer. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not supply sufficient social activities to enhance the quality of life of residents. Residents are not being consulted and given choices about how they wish to live. A wholesome and varied diet is offered and specialist dietary needs are catered for. EVIDENCE: An inspector looked at records in respect of activities, observed practice, reviewed available resources, talked to residents and had a discussion with the activities organiser who work three hours per day Monday to Friday. Since the last inspection a storage room has been converted to a hairdressing room to enable residents appropriate privacy. The file containing information about which residents had participated in activities provided limited information regarding what was offered and if they had enjoyed the activity. There was evidence of one to one conversations, playing dominoes, skittles and birthday celebrations. There was a good deal of emphasis on hair and nail care, which forms part of necessary personal care rather than an activity. Internal activities appear to be ad hoc due to availability of the activities organiser and care staff in providing assistance. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 17 The activities organiser has attended training for the role she carries out and also advised that she was planning some trips but that funding is restrictive resulting in difficulties in providing specialist transport and limiting outings. Senior staff were helping with fund raising to pay for outings. Some residents are assisted to go out to do some shopping. Advice was given that those residents who are unable to communicate, the activities organiser encourages them to touch/feel objects and to listen to the birds outside. The narrow garden surrounds the home on three sides and is on a deep slope, this causes restrictions on people living at the home, some residents said they enjoy sitting in a garden. Access from the home to the garden is difficult for people who are wheelchair users. Some emphasis is required in ensuring that residents are able to access the community. Residents are not being provided with sufficient physical or mental stimulus to enhance the quality of their lifestyles. A programme needs to be developed that takes into account residents preferences and expectations. The lack of resources and available staff need to be reviewed. Outings should be considered as an important aspect of the service, especially with the restrictions imposed on resident’s access to the garden. A copy of the four week rolling menu was supplied, it indicated that a balanced and nutritious diet is offered and choices given at each meal. Special diets were being catered for. The main meal of the day is served at lunchtime and a light meal or cold foods are served during evening meals. The serving of lunch was observed. Meals were served with additional equipment to encourage residents in maintaining their independence. The quality and presentation of the meals were acceptable. The room contained 14 people and two staff, five people required assistance. Staff provided assistance where required but were unable to do this in a timely manner due to lack of available staff. Food was left in front of people whilst staff assited others, which resulted in meals going cold before assitance could be offered. Consideration needs to be given to the number of staff required to match the number and dependency levels of residents and a review carried out of mealtimes. Mealtimes should be a positive experience for people living at the home. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives are confident that their views will be listened to and acted on and any complaints dealt with effectively. Lack of staff training in adult protection fails to protect residents from the risk of abuse. EVIDENCE: The written complaints procedure on display was found to contain adequate information to give guidance on how to make a complaint and how complainants would be dealt with. The home has not received any complaints since the previous inspection six months ago. The Commission had received a complaint January of this year. The concerns raised were regarding management practices. An investigation was carried out by CSCI as part of a random visit 22/01/07 and there was no evidence found to substantiate the allegations, therefore the Regulations had not been breached. The adult protection policy had been re-written since the last inspection. It was considered to be much improved and contained all the relevant information. A recommendation was made to the deputy manager that the wording of the section concerning disciplining needs to be clear. No disciplinary action would be taken until the Adult Protection Team are satisfied that such action would not hinder the investigation process. There was a Whistle Blowing policy in place and a policy regarding restraint had recently been developed and introduced. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 19 The Commission had been advised by senior staff during March of an allegation made by two staff concerning another member of staff. The home has followed the correct procedure at each stage of the incident, which was still being investigated by the Adult Protection Team of Adults and Communities Directorate. Although staff talked with demonstrated that they would take appropriate action in the event of suspected abuse some staff have not received training in this aspect of their role. This puts residents at risk of abuse. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers comfortable accommodation. Choices of communal areas are restricted to internal as the garden offers little scope. The assisted bathing facilities are not adequate to meet the needs of residents. EVIDENCE: There is a large lounge situated on the ground floor and a separate dining room. The first floor includes a lounge/dining room to enable people to have a choice about where they wish to sit and have meals. Meals are served on the first floor from a hot trolley to ensure that food is served at an acceptable temperature. The communal rooms are quite well appointed and resident were seated in comfortable chairs. The steeply sloping garden puts restrictions on residents choice of sitting outside during warm weather. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 21 There was an ongoing improvement in the décor of the premises, work needs to continue to bring the home up to an acceptable and pleasing standard for residents to live in. The ground floor houses assisted bathing with residents having a choice of bath or shower. Residents who live on the first floor do not have the privilege of choices of bathing. There is only one bathroom containing an assisted bath so if a shower is preferred the resident needs to travel to the ground floor. This detracts from residents dignity. An inspector was advised that there were plans to convert a bathroom into a shower room to overcome the problem. The basement contains offices and utility rooms such as kitchen and laundry. There is one shared bedroom, which has recently been converted to a single and a basic bathroom. Residents would need to access another floor for bathing facilities because the bathroom continues to be used as a storage room Storage of clean bed linen in bathrooms should be avoided to ensure that it is absolutely dry when used in bedrooms. The space in communal toilets is small and do not permit assistance, residents visit their en-suite toilet for purposes of assistance and privacy. Staff spoke of the difficulties they experience when personal care is required. The adaptations and equipment was found to be sufficient to meet the needs of the current client group but no reserves were available to provide appropriate specialist equipment for others who may develop a need. There is a call system and a shaft lift for access to each floor. The shaft lift is not large enough to accommodate a stretcher when a resident requires transfer to hospital. There was no evidence of signage that would help residents who suffer from dementia in accessing various communal rooms or their bedrooms. The home has 20 single bedrooms and eight shared rooms. The bedrooms were visited of those persons whose care plans were viewed. Rooms were noted to be tidy and generally clean. All bedrooms have en-suite facilities consisting of a toilet and wash hand basin. The amount of space in the toilet is restrictive when the assistance of two persons is required. Bedroom door locks are not safe to be used because the locks cannot be overridden in the event of an emergency. The need for suited locks has been brought to the attention of the responsible individual who has advised that locks would be fitted if requested. This is not adequate because the facility needs to be available to residents at the time of admission, it does not ensure residents rights to privacy when they want it. Several bedroom doors were open and did not fit properly into the rebate. This requires some attention to promote residents access to privacy. The home has recently employed a maintenance operative who appeared to be professional and had commenced work on the outstanding repairs needed throughout the home. A further person who has been employed on a temporary basis was noted to be continuing to refresh the paintwork within the premises. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 22 All communal rooms, bedrooms, kitchen and laundry rooms were found to be tidy and generally clean. There were some pockets of mal odour noticed that need eradicating. The permitted space in the laundry room prevents the home from installing individual residents laundry baskets that are large enough to hold clothing. The laundry door was propped open, this poses a health and safety risk and this practice should be reviewed. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate to ensure that residents needs are being met. Recruitment practices are not robust and fail to ensure that residents are protected from harm. Some staff training is needed to ensure that they are supplied with the knowledge and skills to carry out their designated roles. EVIDENCE: The home had 31 residents at the time of the visit, one of these was in hospital. Examination of the staffing rota indicated that the number of carers were adequate to meet the needs of the current client group. The number of carers for morning shifts was five, between four and five for the afternoon/evening shifts and two or three for night duty. Separate ancillary staff are employed to enable care staff to perform their designated roles. All carers have successfully completed the NVQ level 2 training, four of which have level 3 and two of them are carrying on in undertaking level 4. This exceeds the required minimum of at least 50 of the workforce having completed NVQ level 2 or equivalent. Four staff personnel files were checked. Each one had completed the required police checks before commencing employment. A carer who commenced St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 24 employment late March of this year did so without two written references being obtained. He had started work based on one verbal reference, which was later confirmed in writing but there was no evidence of a second reference. Such practices puts residents at risk by failing to determine the integrity of staff. When care staff commence employment they spend time shadowing another carer whilst undertaking the homes own induction programme. Upon completion they are required to complete the ‘Skills for Care’ induction programme to provide them with the knowledge and skills to carry out their roles effectively. Review of the training file revealed steady improvements had been made towards staff training. However, some gaps were still evident. These included, Fire Safety, Moving and Handling, Abuse, Challenging Behaviour, Dementia Awareness, Health and Safety and Infection Control. The deputy manager said that he was aware of the need for further training and this was being organised. Training that enables staff to deliver an acceptable service was ongoing such as conflict management, customer care skills and medications for trained staff. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recently established management structure has a clear vision on how the home needs to progress and has commenced the work. The staff recruitment processes are not robust and puts residents at risk of harm. An appropriate quality assurance programme needs to be implemented to confirm that the home is making ongoing improvements fro the benefit of residents. Staff formal supervision arrangements need to be completed to provide staff with the knowledge and skills to carry out their roles effectively. EVIDENCE: The manager was not on duty during the inspection. She was appointed to the post six months previously and she is supported by the deputy manager who was appointed two months ago. During previous conversations with the manager and deputy manager they both acknowledge that significant St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 26 improvements need to be carried out and work had commenced towards this. The deputy manager stated that there is a good working relationship between him and the manager and that staff have a clearer knowledge of their roles and responsibilities. He also works along side staff and leads by example in ensuring that standards of care are improving. Care staff are motivated and reported to an inspector that the recent changes made are for the better. The deputy manager advised that no work has been commenced concerning quality assurance, therefore it was not possible to assess this aspect of the services. Efforts are directed towards improving the standards of care. The responsible individual carries out unannounced monthly inspections and gives a written report to the manager. He is requested to send copies of these to CSCI in order to assist in the monitoring process of the home. The arrangements for the safekeeping and financial transactions of residents personal monies are robust, this prevents financial abuse of residents. The deputy manager advised that he had carried out the first formal staff supervision the previous day. He stated that once senior staff are competent the system will be cascaded with the grades of senior staff so that supervisions are delegated appropriately. Residents care plans are held at the nurses station in the lounge areas of the ground and first floors. They are accessible by mobile residents and visitors, this raises concerns about maintaining confidentiality. An appropriate safe storage system should be acquired. The arrangements for storage of records concerning health and safety were fragmented resulting in difficulty in accessing relevant information. The home should review the arrangements of storage of health and safety information. The accident records are being maintained, a new system for these was being implemented, however only a few recent ones were available for inspection. All relevant checks and servicing of equipment are being carried out to ensure that they are fit for purpose. The emergency fire alarm and emergency lighting systems were being regularly checked and the findings recorded to protect residents from harm in the event of an emergency situation. Further regular checks were being re-introduced by the new maintenance operative. Fire drills had been completed and names of staff who have participated were recorded to ensure that all staff are captured. The testing of hot water outlets that residents come into contact with had not been tested recently due to the departure of the previous maintenance operative, assurance was given that testing would be re-introduced. The fire risk assessments was noted to be in need of further development to ensure that all aspects have been considered. When work on hot water testing and the fire safety risk assessment completed the arrangements may protect residents and others from risk of injury. St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 27 St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 28 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 2 2 2 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement Timescale for action 15/07/07 2. OP7 OP8 15(1)(2) a-d The statement of purpose must include room sizes and information about how and when formal reviews of care plans are to be carried out. This will ensure that prospective residents and professionals are provided with accurate and comprehensive information about the home. 30/06/07 Care plans must include: • Identification of illnesses, assessments and care planning of them that provides staff with clear and comprehensive guidance • Monthly reviews must be consistent • Regular formal reviews must be introduced with the resident and/or relatives invited to participate and agree the them and all changes must be fully recorded • Appropriate terminology must be ensured in tools used, staff recordings and speech DS0000024892.V335202.R01.S.doc Version 5.2 St Clements Nursing Home Page 30 • • • • • • • • • • • St Clements Nursing Home Assessments concerning bedrails must include comprehensive information and not rely only on ticks Short term care plans must be developed for illnesses such as chest or urinary tract infections The documented personal preferences must be incorporated into care plans and adhered to Toileting regimes must be explicit and appropriate to the respective resident The home must ensure that it follows legal requirements when formulating resuscitation decisions A care plan and risk assessment must be carried out for the resident who experiences difficulties in swallowing Records must be kept in the current care plan to be sufficient to identify trends such as weight loss and what action is required Residents admitted for respite care must have risk assessments and care plans developed within an acceptable timescale Where a health investigation is to be carried out a care plan must be developed A review must be carried out of the use of wheelchair lap straps, assessments carried out, risk assessments and individual protocols developed for their correct use Monthly weights of Version 5.2 Page 31 DS0000024892.V335202.R01.S.doc • • residents must be carried out Recordings must be clear as to which area of the body is measured when it is used to replace weighing a resident Care plans regarding difficult to manage behaviour must include likely triggers and a description of the type of behaviour displayed. 3. OP9 13(2) 4. OP10 12(4)a 5. OP10 16(2)m n 6. OP18 13(6) 7. OP21 2392)j Staff must demonstrate that the health and welfare of residents is being promoted. Residents who wish to self medicate must receive an assessment, risk assessment and regular auditing of the procedure to ensure that they are taking medications as prescribed. Residents must be treated with dignity and respect within all aspects of the services provided to ensure their self esteem is not compromised. A programme of activities must be developed that takes into account individuals preferences and expectations. Records maintained must be comprehensive, which may be used as a monitoring tool. Regular outings must be offered and carried out. These are essential in providing appropriate residents with stimulus to enhance the quality of their lives. The commenced programme of staff training in respect of adult protection must be completed to ensure that residents are protected from harm. Residents must be given choices about how they wish to bathe DS0000024892.V335202.R01.S.doc 31/05/07 31/05/07 15/07/07 31/07/07 31/08/07 Page 32 St Clements Nursing Home Version 5.2 that is within a convenient location to ensure that their preferences are acted upon. Timescale of 30/10/06 and 28/02/07 have not been met. The home must have sufficient specialist equipment available to be used immediately when it is identified as being required to ensure that preventative measures are taken to promote the health of residents. Residents must be assessed as being fit to have their own bedroom door key at the point of admission to ensure their rights regarding privacy are protected. This remains an outstanding requirement from numerous inspections. The homes hygiene levels should be such that eradicates an mal odour and provide a fresh and pleasant environment for residents to live in. 8. OP22 23(2)n 31/07/07 9. OP24 12(4)a 31/08/07 10. OP26 16(2)j 31/05/07 11. OP27 18(1)a 12. OP29 19(1)a-c Timescales of 30/06/06, 31/10/06 and 31/12/06 have not been met. Sufficient staff must be allocated 15/06/07 to meet the needs of residents. A review must be carried out of staffing requirements that takes into account the numbers, dependency levels of residents and their needs regarding dementia care. Upon completion a copy of the report must be forwarded CSCI and advise provided regarding timescales for addressing shortfalls. Adequate staffing must be ensure at all times to enable staff to appropriately meet residents needs. Staff must not commence 31/05/07 DS0000024892.V335202.R01.S.doc Version 5.2 Page 33 St Clements Nursing Home 13. OP30 18(1)a 14. OP33 24 employment without the home obtaining two written satisfactory references beforehand. This is essential in protecting residents from risks of harm. The commenced programme of 31/08/07 ensuring that all staff receive training in Fire Safety, Moving and Handling, Health and Safety, Infection Control, and Dementia Care must be completed to provide them with the knowledge and skills to carry out their roles effectively in meeting residents needs. A quality assurance system must 31/08/07 be developed and implemented, ensuring that stakeholder’s views are obtained and an annual development plan is drawn up as per Standard 33.1 to 33.10 inclusive. The home must demonstrate that it is constantly striving in making continuous improvements for the benefit of residents. Timescale of 30/10/04, 30/09/06 and 28/02/07 have not been met. The commenced process of 31/07/07 carrying out all staff formal supervisions at least six times a year and records retained in the home must be fully implemented. Staff competency needs to be regularly tested to ensure that residents rights are promoted in that they receive appropriate standards of care. The Fire safety risk assessment 15/06/07 must be further developed in order that appropriate procedures are followed in the event of an emergency and safeguarding residents. 15. OP36 18(2) 16. OP38 13(4)a-c St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 34 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 OP1 Good Practice Recommendations It is recommended that the service user guide be produced in large print and/or audiocassette for the benefit of those persons who are partially sighted. Not assessed during this visit. It is recommended that the arrangements for assiting people at meal time is reviewed to promote peoples enjoyment. It is recommended that all residents be informed in writing of their right to access records and provide information regarding advocacy schemes. No evidence found that this has been addressed. It is recommended that the complaints procedure be produced in large print and/or audiocassette for the benefit of those persons who are partially sighted. Not assessed during this visit. It is recommended that the adult protection written policy be adjusted to make clear that internal disciplinary procedures must not be carried out until the Adult Protection team advise that to do so would not hamper the investigation. It is recommended that the home introduces a signage system for the benefit of persons suffering from dementia are assisted to identify communal rooms and their own bedroom. It is recommended as being good practice for the home to carry out ongoing CRB checks for those staff that have been employed in excess of three years. No evidence found that this has been addressed. Not assessed during this visit. It is recommended that residents care plans are made secure in order to maintain residents rights of confidentiality. DS0000024892.V335202.R01.S.doc Version 5.2 Page 35 2. 3. OP15 OP14 4. OP16 5. OP18 6. OP20 7. OP29 8. OP37 St Clements Nursing Home Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 St Clements Nursing Home DS0000024892.V335202.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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