Inspection on 21/11/07 for St Clements Nursing Home

This inspection was carried out on 21st November 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 02/05/07

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 Key Unannounced Inspection 21st November 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.V355019.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.V355019.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.V355019.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. 2nd May 2007 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 37 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 some pressure relieving equipment and a range St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 5 moving equipment to assist those persons who have restricted mobility. The current fee rates are discussed with each prospective person who is considering living in the home. The conditions of registration are currently under review following which a new registration certificate will be supplied by us. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know that the fieldwork visit would be carried out; this is to enable the inspector to obtain an accurate picture of the standards of the services provided. On the day of the visit, the home had 35 people living in the home, five of which were residential and the remainder nursing care. Two inspectors spent a long day at the home completing the fieldwork visit. The manager provided assistance. At the conclusion feedback was given to the manager. No Immediate Requirements were made but the home has been issued with an urgent letter in respect of poor care planning. To avoid further action being taken the home is required to make significant improvements in care plans and healthcare by 21st December 2007. Information was gathered from speaking with people who reside at the home and staff. Information had been gathered from a healthcare professional prior to the visit. This information was used as part of the inspection process. Care, health and safety and the arrangements for medications were inspected. Staff personnel files were checked and staff were observed whilst performing their duties. A partial tour of the premises was carried out. Two of the four care plans reviewed were case tracked. This involves obtaining information about individuals’ experiences of living at the home. This is done by meeting with or observing people, discussing their care needs with staff, looking at care plans and focussing on outcomes. Tracking peoples care needs and how the care is delivered helps us to understand the experiences of those people and the standard of care provision. Prior to the visit the home had completed the annual quality assurance assessment (AQAA) and returned it to us. The information within the document advised of what the home does well, improvements made during the last 12 months and what the home would like to further improve. This provided details that contribute to the inspection process and highlights areas that may be explored during the fieldwork visit. A number of people who live at the home were requested by the inspector to complete a questionnaire. These give personal opinions about the services provided and would be included in this report but none were returned. The inspectors spent time in both lounges carrying out an assessment about how staff and other people spend time with people who live in the home. It included how staff and others communicate with them, what they did and how it affects the daily lives of people. This is referred to in the body of the report as SOFI (short observational framework for inspection) in the section concerning daily life and social activities. The focus of inspections undertaken by us is based upon the outcomes for people who live in the home and their views about the services provided. This St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 7 process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and aspects of service provision that need further development. What the service does well: What has improved since the last inspection? Re-positioning charts are being well completed. This indicates that staff are taking positive action for people who have been identified as being at risk of developing pressure ulcers. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 8 All trained staff have undergone training in administration of medications to ensure that people receive their prescribed medications to promote their health. The meal menu has been reviewed and improved. It now consists of a four week rolling menu to ensure that a balance and varied diet is offered. The bedrooms have been re decorated and one has had new flooring laid. Peoples personal space is a pleasant area for them to spend time. The statement of purpose has been further developed and now provides prospective users of the service with detailed information to assist them in making a decision about the home. Some improvements were found in the activities provided but further work is need to ensure appropriate levels of recreation are provided. The home is currently exploring if people who live in the home can access local religious services and whether the clerical staff can visit the home. Some improvements have taken place but significant work needs to be carried out to bring care plans up to an acceptable standard. The majority of staff mandatory training has been completed to provide them with the knowledge and skills to carry out their roles effectively. Work has been commenced in converting two toilets into one on each of the upper floors to improve the access for people. On completion a bathroom on each floor will be refurbished. This will provide people with choices about the method of bathing without the need to transfer to another floor. What they could do better: Care plans require urgent attention so that staff are provided with comprehensive guidance about peoples personal and health needs and that personal preferences are incorporated to enhance their lives. This is considered to be an important factor of the standard of the services supplied. The home needs to ensure that it has met the recommended action made by the TVN (tissue viability nurse) in respect of purchasing of specialist equipment. Staff practices are failing to maintain peoples dignity and privacy. Action needs to be taken to eradicate poor practices. The variety and standard on the soft diet evening meals need to be improved. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 9 Activities and recreations need to be improved to ensure that all people receive physical and mental stimulus to enrich their lifestyles. The care staff rostered for the afternoon/evening shifts appeared to be inadequate. A review of staffing levels needs to be carried out that takes into account numbers, dependency levels, physical and mental stimulus of people and incorporation of staff breaks. The quality assurance system needs to be further developed with production of an annual report. Staff practices regarding failure to lock sluice room doors and the unsafe storage of control of substances hazardous to health (COSHH) products needs to cease to prevent people being harmed. 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.V355019.R01.S.doc Version 5.2 Page 10 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.V355019.R01.S.doc Version 5.2 Page 11 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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supplied with sufficient written details about the home for them to make an informed decision about moving into the home. Information is gathered and a pre-admission assessment is carried out to enable the home to demonstrate that it is able to meet the persons needs at the time of admission. EVIDENCE: The statement of purpose has been reviewed since the last inspection and now includes sufficient information for people to make a decision about the home. A copy of the service user guide is given to people and their representatives who display an interest in living at the home. It provides all the necessary details about the services the home provides and the standards of care people can expect to receive. A separate leaflet provides other information such as travel directions to the home, a list of external professionals who may be asked to visit and a sample meal menu. Both documents provide St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 12 comprehensive details about the home to assist people in making an informed decision about moving into the home. People admitted to the home are supplied with a contract of terms and conditions of residency. It clearly states the services that are not included in the fee rate, which will be agreed prior to admission. It includes details about a four week trial period to enable either party to assess the suitability of the placement. The document requires minor development to include details of the room occupied. The pre-admission assessment of the latest admission was reviewed. It contained detailed information about the individuals needs and what specialist equipment would be needed. The assessment was sufficiently in depth for senior staff to determine that the identified needs could be met. Senior staff will also carry out an assessment of people who have been admitted to hospital and whose needs have changed to ensure that the home can still meet the persons needs. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 13 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. Care plans fail to reflect the standards of care actually being delivered. Staff are failing to appropriately monitor peoples healthcare needs, this puts them at risk of deterioration of their health. The management of medications ensures that people receive their prescribed medications to promote their health and wellbeing. A number of staff practices fails to ensure that peoples dignity and self esteem are maintained. EVIDENCE: Four care plans were reviewed including the latest admission, two people who required pressure relief management and one who displayed difficult to manage behaviour. It was noted that work had been carried out regarding the layout of care plans. They were found to be indexed for ease of access to relevant sections and some additional sections had been introduced such as an assessment, night time arrangements and some effort had been made towards recording peoples background/life history. This information assists in providing staff with details about the persons preferences and needs. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 14 Repositioning charts were comprehensively completed and care staff record the type and amount of meals taken by all people. This forms part of the monitoring of peoples wellbeing. There were some improvements in the recordings since the last inspection but it was evident that significant further improvements were required to bring care plans up to an acceptable standard OTHERWISE WE WILL CONSIDER TAKING FURTHER ACTION. In practice staff were delivering good standards of care but this was not supported in the care plans. A moving and handling assessment stated that one to two nurses were required but failed to specify what assistance was needed. Some care plans failed to state the sling size to be used. Another stated the sling size but not in all of the relevant sections of the care plan. A care plan stated ‘ensure you place her feet on the footrest’. However, on two occasions staff were observed transferring people in wheelchairs without any footplates. This is considered to put the person at high risk of injuries to the lower limbs. The terminology of ‘bath as required’ fails to indicate that people are bathed when they wish to be and by which method such as shower or bath or time of day. Another stated, ‘nurse on pressure relieving mattress’ but fails to advise of which one. The home has a schedule for weekly bathing; this should cease and people should be asked about their preferences. Other terminology recorded in care plans was found to be generic such as ‘give medication as required’, and not specific to the individuals needs. Instances where complications may occur such as diabetes, care staff should be provided with written instructions about what they need to observe for. A file stated ‘ensure well balanced diet with enough roughage’ but there was no indication that kitchen staff had been advised of this. An entry stated, ‘give enough fluid’, how will care staff be advised of what is enough fluid? The assessment tool used for bedrails includes the terminology cot sides and had been repeatedly recorded by a nurse. Such practice fails to maintain peoples dignity. One file failed to have care plans for incontinence, pressure sore risk and confusion. A care plan was found difficult to read and understand the meaning of it such as ‘back from hospital need to encourage’. A file concerning difficult to manage behaviour states ‘keep away from her range but observe’, this is inadequate. Staff should record likely triggers, type of behaviour displayed and what staff need to do to diffuse the situation. A chart should also be introduced for recording of each incident to enable efficient monitoring to be carried out. Concerns were also raised about staff failure to monitor health needs. One care plan did not include weight records for a significant period of time and only one arm circumference measurement had been taken in September 2007, none since. Another file indicated that a weight loss had occurred over a St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 15 period of five months but there was no evidence of what action had been taken. There was consistent failure to record regular descriptions of pressure ulcers to enable staff to carry out any monitoring of them. The only descriptions found were carried out by TVN’s (tissue viability nurses). This is considered to be poor practice and must be addressed as a priority. A TVN report received by us dated 24th September 2007 provided details about individuals needs which were determined January 2007 of specialist equipment. A spot check was carried out and it was determined that the home had in some areas failed to supply specialist mattresses as recommended within the report. The home needs to determine with the TVN that the needs from the pre-dated report are still valid. Where shortfalls are identified, these need to be addressed. Staff are failing to adequately assess peoples needs and provide comprehensive written guidance for personal and healthcare needs that takes into account peoples personal preferences. Care plans are in need of urgent review. The recently appointed manager was aware of the shortfalls but the current management structure and available senior staff prevented him from dedicating time to resolving the problem. A comment was received about the standards of from a person living in the home, “I’ve got no complaints”. The management of medications was reviewed. Copies of prescriptions are kept so that staff can check that they receive the correct drugs from the pharmacy. Photographs are attached to each MAR (medication administration record) chart to minimise the risk of administration to the wrong person. Audits were carried out of the drugs of people whose care plans were seen. There was no audit trail for a boxed medication, the manager advised that this would be corrected the following day. It was noted that the recordings on a chart used by care staff for the application of two prescribed creams did not coincide with the recordings on the MAR chart. It is recommended that one chart per prescribed cream should be implemented to overcome the problem. The storage and recordings pertaining to controlled drugs were found to be satisfactory. Although staff were respectful when speaking to people living in the home, some of their practices were not satisfactory. Both inspectors observed bathroom 3 in use with the door open and a curtain pulled across the doorway. A nurse was observed talking to the person in the shower through the curtain and did not appear to note a problem with the curtain. This failed to ensure the persons privacy. People were transferred to dining positions and plastic bibs applied to protect their clothing at least 41 minutes before lunch was served. The standard of the evening meals in respect of soft diets were not acceptable because people were unable to enjoy differing tastes and textures because portions were not served individually. One member of staff was observed assisting a person with her lunch, she was standing beside the St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 16 person rather than sitting beside her. A further observation revealed a nurse carrying out a blood test and administering insulin in the main dining room in front of all the other occupants. This is viewed as poor practice and fails to respect peoples dignity and privacy. These shortfalls need to be addressed as a matter of priority. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts are being made within the limited resources in providing physical and mental stimulus to enhance the quality of peoples lifestyles. Although a balanced and nutritious diet is offered the standard of evening soft meals fails to ensure a varied diet is provided or that meals are served to an acceptable standard. EVIDENCE: Since the last inspection some improvements were noted regarding activities. Although there was no pre-planned activities programme the manager advised that this is currently being developed. This will enable people to have advanced notice and to give visitors notice for them to consider participating. The activities organiser works three hours a day Monday to Friday. The inhouse activities included reminiscing, games and gentle exercises. Some outings had taken place such as a visit to the Sealife Centre, the rag market and a social club. The home is currently arranging greater access to the local church and church clerics are being arranged to visit the home. Entertainers regularly come into the home for additional recreation. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 18 Each person living in the home has a dedicated record of what activities they have participated in. A good proportion of people who have limited or no communication skills and require one to one involvement for activities. The recordings indicate that for some this contact is infrequent thus limited time is permitted for these people. Taking into account the number and dependency levels of people in the home the hours allocated for activities may be inadequate to meet peoples preferences and aspirations. Regular meetings are held where people who live in the home and their representatives are invited to attend. The meetings involve discussions about the day to day running of the home so that people can influence the way in which the home is managed and the way that they wish to live. SOFI (short observational framework for inspection) was carried out concurrently by each inspector in the lounges of the upper floors. The outcomes differed for each floor. The ground floor results were fairly positive. There were some good interactions such as carers saying goodbye to people as they were going off duty another was doing peoples nails and hand massages. Another member of staff sat next to a person to chat with him/her. A person living in the home was given a large colouring book. The results on the first floor were less positive. A member of staff spent some time chatting with a person who was celebrating his birthday. During the majority of the time there was only one nurse in the room. There was Christmas music playing but there was little response to this. Some staff entered the lounge to carry out tasks but there were little interactions with people as they walked past them. There appeared to be lack of engagement and staff failed to use opportunities to talk as they carried out their roles. A four week photocopy of the rolling meal menu was supplied. People can order eggs fours days per week as part of the breakfast menu. Lunch is the main meal of the day and offers two choices for the main course every day except Wednesdays. Soup, a light cooked meal, assorted sandwiches, fresh fruit and a desert is offered for each evening meal. The menu indicates that a balanced and nutritional diet is offered. The cook advised that ten people prefer to have rice with their main meal; a large pot of rice had been prepared. As discussed previously people are prepared and seated at dining tables too far in advance of the meals being served. It was noted during lunchtime that meals were served with plate guards fitted to assist people in maintaining their independence. People who required assistance to eat their meals were being provided with help but in one instance the carer was standing to do this. Staff should sit beside the person to provide effective assistance whilst maintaining the persons dignity. A concern noted in respect of the evening meals was brought to the managers attention. For people who need a soft diet the evening meal consists of mashed potato with a sauce poured over it. The kitchen assistant confirmed that mashed potato is served every evening and that the sauce may vary between spaghetti, beans, tuna, salmon or cheese. The appearance of the meal and serving of potato on a St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 19 daily basis is unacceptable and lacks variation. Meal portions need to be served separately to permit the individual to experience different tastes and textures. Peoples individual tastes and dignity should be maintained at all times. It was noted that staff commenced serving the meal at 5.15pm; people had been prepared for the meal well in advance. A comment was made by a person who lives in the home, “Start meals at 5.10pm, too early, if they can get away with it”. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. People are aware of how to make a complaint and the home takes appropriate action when shortfalls are identified. Arrangements are in place to protect people who live in the home from risks of abuse. EVIDENCE: The written complaints procedure was noted to be satisfactory and a copy was on display in every bedroom. No complaints had been received from people who live in the home or their representatives and CSCI had not been made aware of any since the last inspection. A concern but not a complaint, had been raised by relatives and this had been dealt with quickly and effectively. The policy regarding adult protection was found to contain sufficient information to give staff guidance about what action they should take if abuse is suspected. A few staff had not received training in adult protection to give them the knowledge and skills to carry out their roles effectively. The home needs to complete the rolling programme of staff training to rectify the problem. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 21 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, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a comfortable environment but staff fail to ensure that people are protected from risks of injuries and infections. Work is currently being carried out to provide sufficient assisted bathing facilities to cater for the number and needs of people living in the home. EVIDENCE: The home has a lounge and separate dining room situated on the ground floor. A lounge/dining room is located on the first floor. It was noted that the main dining room appeared sparse and unwelcoming due to the lack of soft furnishings. The room contained five tables; this indicates that there may not enough for people to sit at comfortably and for staff to provide assistance. A nurses station is located in each lounge; this assists in observing and socialising with people. The slope and layout of the garden severely restricts St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 22 access by people living in the home. The manager advised that there are plans to carry out work to improve the access. The sluice room was unlocked and control of substances hazardous to health (COSHH) products had been stored in a bucket and a clinical waste bag was on the floor and not in the designated holder. Access of these items put people at risk of accidents. The entry to the sluice room situated on the first floor was found not to be secure. A mop was found in a bucket of used water, which again created a health hazard. Mops should be stored inverted to permit the mop head to dry out. Also a bathroom contained COSHH products in a bucket thus posing a further hazard. As discussed the practice of using curtain screening for bathrooms needs to cease. A mechanical system for disposal of bedpans is available only on the first floor; which means that staff have to transport items between floors. It is recommended that mechanical disposal systems be installed on each floor. The only bathrooms in use were a walk-in shower on the ground floor and an assisted bathroom situated on the first floor. A bathroom on each floor was not being used. The lack of assisted bathing facilities restricts choices and availability to meet peoples needs. At the time of the fieldwork visit work was commencing to convert two toilets on each floor into one room to improve access. Further work planned to be carried out is to upgrade the ground floor bathroom and to create a walk-in shower on the first floor. This will provide people who reside on each floor with choices without the need to access a different floor to meet their needs and preferences. Bars of soap were noted to have been left in bathrooms; this practice should cease. Some hand towel bins did not have lids; this poses a risk of infection. Incontinence products were not appropriately stored in bathrooms and toilets to prevent infection. They need to be stored in their original packaging or a lidded container. The bedrooms were viewed of people whose care plans were seen and a sample from the list supplied for the TVN (tissue viability nurse). They appeared to be tidy, clean and personalised. The occupant of the sole room situated in the basement of the premises has to access bathing facilities on one of the upper floors. The domestic style bathroom is not suitable for his/her needs and was being used as a storage room. Comments made by people were, “I’ve had a new floor down” “The shower doesn’t drain away properly” The kitchen looked tidy and hygienic. The home was found to be clean and fresh with no offensive odours. St Clements Nursing Home DS0000024892.V355019.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. There is a need to demonstrate that adequate staff levels are ensured to meet the specialist and social needs of the people living in the home. Recruitment practices are robust thus protecting people from risks of harm. Most staff have received the necessary training to provide them with the knowledge and skills to meet peoples personal and specialist needs. EVIDENCE: Recent staffing rotas were reviewed. There appeared to be adequate numbers of trained staff for each shift. Concerns were raised about the adequacy of the number of carers on duty during the afternoon/evening shifts. The manager stated that a total of five were sufficient but sometimes there were only four on duty. This indicates that staffing levels are not consistent to enable them to meet peoples needs. The SOFI (short observational framework for inspection) timescale identified lack of staff availability to socialise with people on the first floor. Staff advised that their ability to bathe people with current staffing levels was difficult. The numbers and high dependency levels of people on the first floor indicated that more staff may be required. The home is required to carry out a staffing review that takes into account the numbers, dependency levels, lack physical and mental stimulus of people, staff breaks and their ability to meet peoples needs and preferences. Upon completion of the review a copy is to be sent to us for review and agreement. The manager St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 24 advised that the home uses only one agency to cover gaps; this is to promote consistency of care for the benefit of those people living in the home. All ancillary work such as housekeeping, kitchen work, administration and maintenance is supplied by dedicated staff. This ensures that care staff can carry out their role. A comment received was, “I get on OK with the staff”. Some staff files were checked and they suggested that all appropriate checks are carried out and two written satisfactory references are obtained before a position is confirmed. Ongoing follow up checks should also be carried out such as PIN checks of nurses eligibility to work. Newly appointed carers are expected to undertake a formal induction programme as well as the homes own short one. 50 of carers currently employed have successfully completed NVQ level 2 training and a further five were undertaking the course. Some carers have also completed NVQ level 3 and one was being encouraged to complete level 4. This indicates that those staff who display abilities are supported in enhancing their skills over and above the minimum required. It was noted that a few gaps persist in staff training such as moving and handling, fire safety, adult protection and food hygiene. Approximately 60 of staff have completed training in dementia awareness. To ensure that all care staff possess the knowledge and skills to work effectively the training programme needs to be completed. Other courses have been attended such as medications, first aid, incontinence, risk assessment management, falls prevention awareness, wound care and coronary heart disease. This suggests that senior staff take a proactive approach towards staff ability to meet peoples specialist needs. St Clements Nursing Home DS0000024892.V355019.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, 32, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is striving to improve the services provided for people living in the home. A formal annual quality assurance system needs to be established to demonstrate a consistently improving service. Failure to lock doors and store COSHH products appropriately fails to protect people from risks of harm or injury. EVIDENCE: The manager was appointed from internal staff three weeks prior to the fieldwork visit. This has resulted in a deputy manager vacancy. The manager was working along side his colleagues and this resulted in lack of time for him to address the serious shortfalls identified. There was an urgent need for the manager to be allowed time to address the poor care plans, which would be St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 26 time consuming to complete. Also, the lack of deputy manager placed the full responsibility of out of the hours on call service on the manager. It was evident that he was not receiving the support he needed to carry out his role. To partially compensate the manager advised that he was working excessive hours in the home. The manager displayed optimism in the appointment of a deputy manager and a trained nurse. It is recommended that the manager submits an application to us for registration. Two staff were interviewed, only one was asked about management support. She said that the manager is supportive and approachable. Regular staff meetings were being held and the minutes were available for staff to refer to. The agenda items suggest that improvements in staff practices form the majority of the topics covered. Staff are being urged to work effectively as a team in delivering appropriate standards of care. The manager holds monthly management meetings with the responsible individual and a report is compiled. The topics cover all aspects of the services and where shortfalls are identified a date for addressing them is incorporated. Relatives are asked to complete a questionnaire regarding their opinions on the services provided for their respective relative. The home needs to incorporate these and the management reviews into an annual report, which can be provided to such agencies as adults and communities directorate or us on request. This will enable senior staff to demonstrate that the home makes continual improvements for the benefit of people who live in the home. The arrangements for the safe storage and transactions of peoples personal monies were found to be robust. This protects people from risks of financial abuse. The accident records were satisfactory and there was evidence of further action being taken when necessary. All relevant checks and servicing of equipment are carried out to ensure that they are fit for purpose. The fire alarm and emergency lighting systems are regularly checked and the findings recorded to protect people from risks of harm in the event of an emergency situation. Fire drills are carried out and the names of staff who have participated are recorded to ensure that all staff are captured during a twelve month period. The failure of staff to lock sluice room doors and safely store control of substances hazardous to health (COSHH) products requires prompt attention to prevent people from risks of harm. The staff practice of using wheelchairs without footplates needs to cease to prevent injuries from occurring. The manager advised that all wheelchairs are currently being reviewed by the appropriate agency. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 2 2 x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 x x 2 St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15(1)(2) (a-d) Requirement Care plans must include: Identification of all illnesses, assessments and care planning of them that provides staff with clear and comprehensive guidance. They must include staff guidance about what to observe for when complications may occur as a result of a specific illness such as diabetes. The use of generic terminology must cease; staff must record how care should be delivered that is appropriate to individuals needs. Carers must be advised of what is an acceptable fluid intake. Assessments concerning bedrails must include comprehensive information and not rely only on ticks. The terminology of ‘cot sides must cease as this fails to maintain peoples dignity. Moving and handling St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 29 Timescale for action 21/12/07 assessments and guidance must be accurate and provide appropriate staff guidance and include sling sizes to be used. Care plans must be legible to enable people to understand them. They must include information about peoples personal preferences and how they will be met. The practice of a schedule of weekly bathing must cease. People must be consulted about bathing, when and by which method. Kitchen staff must be advised about dietary advice for people. 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 residents must be recorded and include details of how upper arm circumferences are carried out. Care plans regarding difficult to manage behaviour must include likely triggers and a description of the type of behaviour displayed. Staff must demonstrate in care planning that the health and welfare of people is being promoted. Timescale of 30/06/07 has not been met therefore this must be St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 30 treated as a matter of priority. 2. OP8 12(1)(a) Peoples weights must be regularly carried out and where weight loss is identified appropriate action taken. Consistent failure to record the description of pressure ulcers prevents staff from being able to monitor them. A review needs to be carried out in conjunction with the TVN (tissue viability nurse) regarding the current needs of people to ensure that sufficient pressure relieving equipment is in place. The practice of staff using wheelchairs without foot rests must cease. This is to prevent accidents resulting in lower limb injuries. These actions are required to ensure that peoples’ healthcare needs are assessed and met. 3. OP10 12(4)(a) The numerous inappropriate staff 21/12/07 practices observed must cease. This is required to maintain peoples dignity, privacy and self esteem. 4. OP12 16(2)(m) (n) A programme of activities must be developed, which takes into account peoples aspirations that gives them prior notice to enable them to make choices about participating. There must be sufficient resources made available to provide adequate mental and physical stimulation of all people living in the home. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 31 21/12/07 31/12/07 5. OP15 16(2)(i) The evening meals for people receiving a soft diet must vary to ensure that a balanced and nutritious diet is provided. The practice of serving separate portions must be commenced to provide people with the ability to experience individual tastes and food textures. The commenced programme of supplying sufficient assisted bathing facilities must be completed. This is required to give people choices about the method of bathing without the need to access a different floor to achieve this. A staffing review must be carried out. It must take into account numbers and dependency levels of people, their physical and mental stimulus and demonstrates how staff breaks will be managed whilst meeting peoples’ needs. Upon completion a copy of the review must be forwarded to us for review and agreement. 21/12/07 6. OP21 23(2)(j) 10/03/08 7. OP27 18(1)(a) 18/01/08 8. OP30 18(1) The commenced programme of ensuring that all staff receive training in Fire Safety, Moving and Handling, Food Hygiene and Dementia Care must be completed to provide them with the knowledge and skills to carry out their roles effectively in meeting residents needs. The commenced quality assurance system must be completed with production of an annual report. DS0000024892.V355019.R01.S.doc 29/02/08 9. OP33 24 31/03/08 St Clements Nursing Home Version 5.2 Page 32 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, 28/02/07 and 31/08/07 have not been met. This must be treated as a matter of priority due to consistent failure to meet timescales. 10. OP38 13(4)a-c Sluice rooms must be kept locked at all times when not occupied. All control of substances hazardous to health (COSHH) products must be stored safely. These are required to prevent people from risks of accidents and resultant ill health. 21/12/07 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. It is recommended that contracts of terms of residency be further developed to include details of the room occupied. It is recommended that separate charts are used for care staff to use regarding the prescribing of more that one cream for a person. DS0000024892.V355019.R01.S.doc Version 5.2 Page 33 2. 3. OP2 OP9 St Clements Nursing Home 4. OP16 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. It is recommended that the dining room should be made more homely and inviting for people living in the home. 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 that a mechanical sluicing system be installed on the upper floor to assist in appropriate transportation of waste products for disposal to prevent risks of infections from developing. 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. 5. 6. OP20 OP20 7. OP26 8. OP29 9. OP31 It is recommended that the manager makes an application to us for registration. St Clements Nursing Home DS0000024892.V355019.R01.S.doc Version 5.2 Page 34 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. 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