Inspection on 27/01/06 for St Clements Nursing Home

This inspection was carried out on 27th January 2006.

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 02/05/07

St Clements Nursing Home 07/11/06

St Clements Nursing Home 24/05/06

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

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Inspirations

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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 Ann Farrell Unannounced Inspection 27th January 2006 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.V281130.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 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 1464 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 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.V281130.R01.S.doc Version 5.1 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. 20th October 2004 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 in Birmingham. The home provides accommodation for up to 37 residents who require nursing care or residential care in twenty-five single bedrooms and six double rooms, which 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 floor. There is limited parking on the lower ground floor to the front of the property, which is covered. 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 on the ground floor that is adjacent to the kitchen, which provides all the meals. A laundry and staff facilities are situated on the lower ground floor. There are bathing facilities on each floor; however, some of them are not suitable for the client group. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted on an unannounced basis in conjunction with the investigation of a complaint over a full day commencing at 9.30am on 27th January 2006. This is the second statutory inspection for the year 2005-2006 and it is recommended that this report be read in conjunction with the previous report. The acting manager arrived approximately half an hour after the arrival of the inspector and was present for the duration of the inspection. During the inspection process a of sample residents files and case tracking was undertaken in addition to inspection of other documentation in relation to the management of the home. The acting manager, five members of staff and approximately four residents were spoken to during the course of the inspection. A number of residents were unable to communicate verbally. What the service does well: What has improved since the last inspection? The home has acquired a supply of new mattresses following an audit by the tissue viability nurse. Care plans with information of how resident needs should be met are more accessible to staff. There is a choice of areas for residents to take their meals now. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 6 What they could do better: Effective management systems need to be implemented to ensure the efficient running of the home. Action needs to be taken to improve communication systems and ensure all staff are following the same procedures, care practices etc. Systems of staff support need to be implemented to ensure staff feel valued and any issues are addressed. The care planning process needs to be further enhanced to ensure all aspects of residents needs are addressed and the manager must introduce systems to ensure they are implemented in a consistent manner by staff. Physical restraint is not used unless there is no other practicable method of securing the welfare of residents. If there is a need to use restraint it must be in line with recognised guidance. Suitable arrangements must be in place for all residents to have regular checks from health professionals and records of the checks must be retained in the home. A considerable amount of staff training is required to ensure staff have the appropriate skills and knowledge to care for the client group. Aspects relating to residents’ privacy and dignity needs to be further enhanced to ensure residents’ dignity is maintained. Suitable systems need to be put in place for regular staff supervision and consultation with residents. Infection control systems need to be enhanced to reduce the risk of cross infection. The recruitment procedure needs to be more robust and all documents must be in date to ensure residents are safeguarded. Re-decoration of the home needs to be continued with a programme of replacement of furniture on order to enhance the environment for residents. Urgent action is taken to ensure hot water temperatures are within normal ranges to reduce the risk of scalding to residents. Some residents also require specialised seating to meet their needs and this needs to be addressed following advice from a qualified professional. The bathing facilities need to be updated and enhanced to meet resident’s needs, as there is not enough suitable assisted bathing facilities in the home. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 7 The home must develop a quality assurance system to measure its success, which must include seeking views from various stakeholders and drawing up an annual development plan. The arrangements for handling resident’s personal monies and valuables needs to be reviewed with records in the home clearly indicating the arrangements in place for holding residents money and valuables. The arrangements for social activities be reviewed to ensure they are continued in the absence of the activities co-ordinator. 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. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 Information is available for prospective residents wishing to enter the home, but it requires enhancing. The assessment process needs to be developed further to ensure all resident’s needs are identified when being admitted to the home. EVIDENCE: The home generally admits residents for long-term care and information is available to provide information about the home. This was not assessed. A member of senior staff undertakes an assessment prior to a resident being admitted to the home. On inspection it was noted that some assessments provided good detail. Following admission staff complete an admission sheet, risk assessments are undertaken in respect of nutrition, tissue viability, falls manual handling etc. On inspection it was noted that all areas had not been completed, there was no evidence of a continence assessment or mental health assessment where relevant. Also there was no evidence that the resident or relatives were involved in the assessment process. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 10 The home is registered to care for residents with dementia and there are currently a number of residents who suffer with confusion/dementia. On discussion with staff they felt that they needed training in this area as they were experiencing more problems with challenging behaviour. At previous inspections a requirement has been made for staff to undertake training in respect of dementia and handling behaviour that challenges and this remains outstanding. Decoration of the home has been undertaken and each floor is a different colour, but there is a lack of signage. It is recommended that this area be reviewed and advice taken where necessary. At the last inspection the home were due to receive some new mattresses to assist in respect of pressure relief and it was advised that a review of bed safety rails be undertaken when they were in place. However, it appears that this has not occurred and some of the bed safety rails are not sufficiently high enough for safety purposes; it was noted that one set of rails was at the same level as the mattress. A full audit will need to be undertaken and action taken to replace bed safety rails where necessary. During inspection it became apparent that turn charts for residents were not completed, nurses lacked knowledge about the use of re-usable syringes for PEG feeds and staff were using inappropriate handling techniques despite having recent training. On talking to a member of staff she stated they had hoists and wheelchairs for moving and handling residents, but no reference was made to the use of sliding sheets suggesting they are not used when moving residents in bed. The manager must ensure there are systems in place to monitor practice ensuring that all residents’ needs are met in a consistent and appropriate manner. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 There are systems in place to meet resident’s health needs, but the lack of comprehensive records and follow up cannot guarantee that all residents needs are met or that consistency of care is provided. The management of medication was satisfactory. EVIDENCE: Nurses draw up a care plan for each resident following admission to the home outlining how the resident’s needs are to be met by staff. On inspection of a sample of records there was noted to be some improvements and a night plan of care is available, but there were still some areas where the information was vague, some areas of care not been included in the plan and they had not been updated when health professionals visited and gave instructions. The record of review stated, “care plan remains appropriate” despite the fact that the practice had changed. There was no evidence that the resident or their representative had been involved in the process. Nutritional assessments are undertaken, but it was noted that where a risk had been identified there was no evidence of any action taken. Some residents were of low body weight and there was no record of BMI. When discussed with the manager he stated that these residents were having nutritional St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 12 supplements, but this was not in the care plans. On discussion with staff it was apparent that the residents were not actually receiving any nutritional supplements. At inspection there was no evidence of any oral care for a resident with a PEG feed and it was not included in the care plan. Records of bathing were available, but in one instance there were two records for one resident with varying details. One suggested that they had not received a bath for three months. On discussion with staff it was stated that communication is poor, there are times when they find out things by “word of mouth” and they receive conflicting instructions. The manager must set up systems to ensure care plans are comprehensive, all staff are aware of them and all interventions required are implemented to meet residents needs in a consistent manner. The majority of residents are registered with a local G.P. who visits the home regularly each week. At the previous inspection it was stated that residents would receive regular health checks, but it could not be confirmed that this was occurring at present or if residents were having regular visits from health professionals such as the chiropodist, dentist etc. The manager will need to follow this area up. Aspects in relation to residents dignity need to be enhanced as it was noted that catheter bags were on show, ladies dresses were riding up exposing there legs, and many residents did not have socks, slippers or stockings on. It was also noted that some residents were slipping out of the chairs. The manger will need to ensure an all residents have suitable seating. An assessment should be undertaken by an occupational therapist where required. An inspection of the medication was undertaken and the majority of audits were satisfactory. An air conditioning unit has been provided to maintain the temperature of the room at an appropriate level. Areas that need attention include: • Some creams had not been dated when opened and others had been open in excess of one month. Creams must be dated when opened and discarded after one month due to the risk of bacterial contamination. • Morning medication had been administered and left on the bed table of one resident. • Dressing etc were stored on the floor in the medication room. • Two members of staff had not countersigned details hand written medication details. • There was no record of some of the drugs destroyed by staff and the container for destroyed medication was not stored in a locked cupboard. • The trolley was not secured to the wall. • Single use syringes were being re-used. • There was no evidence of consent for flu vaccinations. • The flooring in the medication room was damaged. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 Arrangements for activities need to be reviewed to ensure there is some continuation when the activities co-ordinator is not in the home. The dietary needs of residents are fairly well catered for and choices are available. EVIDENCE: Since the last inspection arrangements have been made to enable residents on the first floor to have their meals on the first floor if they wish. This means that the dining room is not so cramped at meal times and staff were able to sit with residents when feeding them. Many of the residents had blue aprons put around their necks to protect their clothing at meal times, which was not always successful and lacked dignity. It was recommended that a suitable alternative be found. There is a four-week rotating menu with a choice. On discussion with residents they stated they enjoyed the meals. However, it appears fresh vegetables are generally not used. On discussion with a member of staff she gave examples of other areas where residents received a choice e.g. going to bed, clothing and if they wish to have a rest on their bed in the afternoon. However, it was unclear if residents were given a choice about the time to get up. This area needs to be explored with residents and their preferences recorded in their care plan. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 14 There is an activity co-ordinator employed by the home, but she did not attend on the day of inspection. During the course of the inspection staff were noted to be sitting talking with each other and another was watching television. The arrangements for social activities should be reviewed to ensure that they continue when the activities co-ordinator is not in the home. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Practices and the knowledge of staff in this area need to be developed and improved to ensure residents are adequately protected. EVIDENCE: A complaint was investigated at the time of inspection as an allegation was made about residents being left in the basement unsupervised. On arrival the residents who reside in the basement were in the dining room having breakfast and they were in the lounge during the course of the inspection. However, it was noted that one of the resident was left sitting in the wheelchair during the day, which was situated up against a table top prevent her from sliding out of the chair. On inspection of records it was noted that this was practice as she kept sliding out of the chair. This is a form of restraint. The manager was advised that this is not appropriate practice and action must be taken to provide suitable seating or staffing levels must be increased to ensure the resident is supervised at all times. In addition, staff require training in aspects of restraint and adult protection. This remains outstanding from previous inspections. On discussion with a resident it was stated that another resident pushed her to the floor. This was confirmed on inspection of records and constitutes a form of abuse. This incident was not reported to the social worker or the Commission as required. The manager must ensure that if any further incidents occur the relevant authorities are informed. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 The environment is generally safe although a number of outstanding requirements mean that the comfort of some residents could not be ensured. Further decoration, replacement of furniture and bathing facilities is required to enhance the homeliness and suitability of the environment to meet resident’s needs. EVIDENCE: St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 17 The home is a modern three-storey building and is generally cleaned to a satisfactory standard. There was a slight odour in some isolated areas of the home. There is limited parking to the front of the building with a small garden within the grounds. There is a large lounge on the ground and first floor, where the majority of residents reside. A dining room is situated on the ground floor, but this is not adequate in size to accommodate all the residents comfortably. Since the last inspection arrangements for meals have changed and residents on the first floor may remain in the lounge to have their meals. However, this had lead to issues in respect of the carpet as it was stained from food debris. The lounges are adequately furnished, but some of the seating is not appropriate for some of the residents. An audit must be undertaken and specialist advice sought in respect of appropriate seating for residents. All bedrooms have an en-suite facility that includes toilet, wash hand basin and call bell. It was noted that the wires of the call bell in one room were exposed. There are communal bathrooms on each floor where residents rooms are situated, but there are only two in the home that are suitable as assisted bathing facilities, which is not sufficient for the number of residents. In addition, some tiles are damaged or missing in the shower room with the flat floor shower. Toilets are strategically placed through the home. All bedrooms are provided with basic furnishings some of which is damaged. It was stated that the organisation are in the process of replacing bedroom furniture. A number of bedrooms do not have lockable facilities or suitable locks to doors for residents who wish to lock their door for privacy. Rooms are individually and naturally ventilated and windows are provided with restrainers for safety and security reasons. Lighting appeared adequate, but some residents did not have any bedside lights. Radiators are of the low surface temperature type. Although work has been undertaken on the hot water system in the past to ensure safe water temperatures there are still problems and at the time of inspection it was noted that it was very hot in some areas and cool in other areas. There was no record of hot water temperatures at the time of inspection. This needs to be followed urgently due to the risk of scalding to residents. Also some of the doors were propped open, some did not have closures in place, intumescent strips were damaged in areas, which may increase the risk of fire and some of the extractor fans were not working Laundry facilities are situated on the lower ground floor, but are rather cramped. Sine the last inspection the cupboards have been replaced and a new washing machine had been provided. The existing washing machine was leaking at the time of visiting and cardboard had been placed on the floor. This is a health and safety hazard and it was stated that arrangements had been made for it to be repaired. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 18 Arrangements in respect of infection control were not satisfactory e.g. toiletries in rooms occupied by two residents were not labelled, there was only one washing bowl suggesting that it was used for both residents, a clinical waste bag in the room of a resident with MRSA was on the floor rather than in a suitable bin, the linen on a bed that had been made was soiled and staff were seen walking around with gloves on. On discussion with staff it was stated they are provided with one uniform and it was noted that some of the staff required clean uniforms, as they were “grubby”. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 There were adequate staffing levels at the time of inspection. The recruitment procedure needs to be more robust to ensure residents safety. Staff induction training needs to be updated in line with standards and further training in respect of NVQ is required. EVIDENCE: Staffing rotas indicated that there were two nurses and six carers on duty during the morning, one nurse and five carers on duty during the evening, one nurse and three carers overnight. The rota indicated that the manager works 9am to 5pm daily Monday to Friday. In addition, there are catering, domestic, laundry, administration staff and handy man who support the care staff. A small number of staff files for newly appointed staff were examined and they were not satisfactory e.g. two written references for one member of staff contained exactly the same wording, which the manager was not aware of, there was not adequate proof of identity in all cases and the visa/work permit for one member of staff expired in January. The manager will need to ensure a robust recruitment procedure in future and ensure these areas are followed up. The home has an induction programme, however it does not meet the new Skills for Care Common Induction Standards as some areas are not addressed e.g. equal opportunities, infection control, abuse etc. The manager will need to review the induction training and ensure it meets the standards. Records indicate that five staff currently holds an NVQ level 2 certificate, three staff are working towards it and one member of staff is working to wards NVQ level 3. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36, 38 The current management arrangements are not adequate to ensure the home is well run to meet residents needs. Strong leadership and organisational skills are required to ensure management systems are implemented and monitored to meet the needs of residents. EVIDENCE: Currently the deputy manager is acting up and he has applied to the Commission for registration as the manager. He is responsible for the establishment. On arrival at 9.30 am the manger was not on duty and staff were not aware when or if he would be on duty that day. The inspector was told to look at the duty rota. On discussion it appears that staff are generally not aware of the times he will be in the home and this is not the first time he has been late arriving on duty. These arrangements are not satisfactory for the effective management of the home. On discussion with residents they stated he was nice, but they did not see much of him. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 21 On discussion with a number of staff they stated there was a lack of communication in the home, they heard things by word of mouth, received conflicting instructions and they did not feel supported by the nursing staff. There had been a staff meeting prior to the inspection and records indicated that staff felt the standard of care had fallen and they were requesting a meeting with the area manager. The acting manager stated he was not aware of the reason for this request and no arrangements had been made for a meeting to date. The acting manager stated he had undertaken group supervision with staff and records indicated that it did not meet the areas outlined in the standards. It appears from discussion with the acting manger that he has not had any training in providing supervision to staff. This will need to be addressed in order that he has the appropriate skills to undertake the process. The home holds monies on behalf of residents and on discussion with the manger he stated that they receive money from the organisation. However, he was not aware of the arrangements for the money held on behalf of residents by the organisation. On inspection of the monies in the home there was no record for one resident. Records for other residents indicated that two signatures and receipts were not available for all transactions. Where money is held on behalf of residents it must be in a separate account and there must be records available for inspection of the amounts held. Maintenance files were inspected and it was found that the testing of portable electrical appliances had been undertaken by the maintenance operative, but there was no evidence to indicate that he is qualified to undertake the testing. The following areas were outstanding: • • • • Asbestos testing. Servicing of pressure relieving equipment. Calibration of the weighing scales. A record of checks for hot water temperatures. On discussion with the manager he stated that training had recently been undertaken in respect of fire prevention plus moving and handling. However, it was noted that inappropriate handling techniques were being used and staff were unable to a give an accurate account of the fire procedure. Other areas of training that need to be addressed include basic food hygiene, nutrition, tissue viability, infection control and first aid. On inspection of accident records it was noted that the acting manager had not informed the Commission of accidents and incidents affecting residents as required under the regulations. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 2 2 2 3 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 2 X 1 X 2 St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 23 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 5 Requirement The registered provider must ensure the service users guide includes the most recent report, contract and details regarding fees as required in the amended regulation 5. This area was not assessed and has been carried forward from 30/12/03. The registered provider must; Enhance the statement of purpose and provide more detailed information. When completed a copy should be sent to the Commission. Ensure the statement of purpose includes details of arrangements for emergency admissions and service users admitted for respite care. This area was not assessed and has been carried forward from 30/12/03. The registered person must; • Ensure residents assessments are fully completed outlining all areas of need with risk assessments. • The assessments must DS0000024892.V281130.R01.S.doc Timescale for action 28/02/06 2. OP2 4 30/01/06 3. OP3 14 30/03/06 St Clements Nursing Home Version 5.1 Page 24 4 OP4 12(1) 5. OP4 18(1) 6. OP7 15 12(1) include continence and mental health assessments where appropriate. • The assessments must involve residents or their representatives. • Systems are in place to write to prospective residents confirming that the home is able to meet their needs in respect of health and welfare. • There are systems in place for regular auditing of these documents. • Training is provided to staff where necessary to ensure continuity. Timescale of 30/9/03 not met. The registered person must 30/01/06 ensure; • Staff undertake regular changes of position for residents who require this and records are maintained accurately. • All nurses are aware of the arrangements for PEG feeding. 30/03/06 The registered person must ensure; • All staff undertake training in respect of caring for people with dementia commensurate with their position. Timescale of 30/10/03 not met. • All staff undertake training in respect of managing challenging behaviour Timescale of 30/12/05 not met The registered person must 30/03/06 ensure; • Care plans are fully completed and set out in detail the action to be taken by staff to meet all residents needs. DS0000024892.V281130.R01.S.doc Version 5.1 Page 25 St Clements Nursing Home 7. OP8OP4 12(1) 8. OP8 12(1) 13(1) Care plans are reviewed at least once a month and updated where there are any changes in residents conditions. • Residents or their representatives are involved in the process and this is demonstrated in the records e.g. signed by them. • Systems are in place to ensure that all staff are aware of care plans. • The manager has systems in place to ensure care plans are implemented and audited on a regular basis. • Training is provided in care planning where required to ensure consistency. Timescale of 30/11/03 not met. The registered person must 30/01/06 ensure that when pressure relieving mattresses are in use with bed safety rails the rails are of sufficient height to ensure residents safety. Timescale of 30/9/05 not met. The registered person must 30/03/06 ensure; • Regular monitoring of residents psychological health. • Systems are in place for regular monitoring of chronic diseases such as diabetes. • All residents have the opportunity for regular checks with health professionals such as dentist, chiropodist, and optician and records are clearly maintained. • There is a supply of neurological charts in the home. • Consult residents about their DS0000024892.V281130.R01.S.doc Version 5.1 Page 26 • St Clements Nursing Home 9 OP8 12(1) 13(4) 10 OP8 12(1) 11 OP9 13(2) bathing preferences. Timescale of 27/8/03 not met. The registered person must 28/02/06 ensure all residents have appropriate seating seeking advice from specialist professionals where necessary. The registered person must 28/02/06 ensure; • Where a risk is identified with nutritional screening appropriate action is taken. • Undertake a review of all residents BMI and where it is below 20 appropriate professionals are consulted. • Regular oral care is provided to residents who require it and this is documented in care plans. The registered person must 28/02/06 ensure; • When medication is administered staff ensure residents take it. • Written consent is obtained for vaccinations. • All creams are dated on opening and discarded after 28 days. • Hand written medication details are countersigned by two members of staff. • An accurate record of all medication that is destroyed is maintained and they are stored in a locked cupboard until they are removed from the home. • Medication trolleys are secured to the wall. • All equipment must be stored off the floor. • The floor in the medication room needs replacing. • Single use syringes must not be re-used. St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 27 12 OP10 12(4)(a) 13. OP11 12(1) 14. OP12 16(2)(m) (n) 15. OP15 12(1) 12(4)(a) 16. OP13 23(2)(i) 17. OP16 22 The registered person must ensure residents privacy and dignity is respected at all times to include; The use of slippers, socks, stockings, the arrangment of reisdnts clothing and ensure catheter bags are not on show. The registered person must review current procedures in respect of caring for residents whose condition is deteriorating to provide a co-ordinated approach and ensure policies and procedures are updated to reflect practice. This area was not assessed and has been carried forward from 30/11/04. The registered person must ensure all residents are consulted about past interests/hobbies and draw up a up a plan of activities for them (group or individual) ensure the plan is implemented and records are kept in the home. Timescale of 30/11/03 not met. The registered person should undertake a review of the use of blue plastic aprons at meals times and incorporate more fresh vegetables into the meals. The registered provider must provide accommodation for service users to meet visitors in private which is separate from their own private rooms. Timescale of 30/3/04 not met. The registered person must ensure: • All residents or their representatives are informed of the procedure for making a complaint. This area was not assessed carried forward from 30/08/03. DS0000024892.V281130.R01.S.doc 30/01/06 30/03/06 30/03/06 28/02/06 30/03/06 28/02/06 St Clements Nursing Home Version 5.1 Page 28 18 OP18 13(7)(8) 19. OP18 13(6) All systems are in place for all staff to inform a senior member of staff about any concerns. • A record of all complaints is retained in the home and is available for inspection. This area was not assessed and has been carried forward from 30/09/05. The registered person must ensure; • All staff undertake training in respect of restraint. • No resident is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of the resident are there are exceptional circumstances. • Where restraint is used a record must be retained including the circumstances and the nature of the restraint. The registered person must ensure all staff undertake training in respect of abuse and the appropriate procedures. Timescale of 30/11/04 not met. The registered person must ensure that where there is any incident of abuse it is reported to Social Care and Health and the Commission. The registered person must ensure all carpets are kept clean at all times. The registered person must ensure the home is kept odour free at all times. The registered person must ensure; • All areas of the kitchen are kept clean. DS0000024892.V281130.R01.S.doc • 28/02/06 30/03/06 20 21 22 OP19 OP19 OP19 23(2)(d) 16(2)(k) 16(2)(j) 10/02/06 10/02/06 30/01/06 St Clements Nursing Home Version 5.1 Page 29 23. OP19 23(4) 24. OP21 23(2)(d) (n) 25. OP24 16(2) 23(2)(n) Sauces etc are dated when opened. The registered person must 28/02/06 ensure: • All fire doors are kept closed when not in use. If there is a need to keep them open they must be linked into the fire alarm system. Timescale of 30/10/04 not met. • Intumescent strips on all doors are in satisfactory order. The registered provider must 30/06/06 ensure; • Call bells are accessible to all toilet and bathing facilities. • Provide suitable locks on all bathrooms doors that indicate when engaged. • Provide appropriate bathing facilities in sufficient numbers to meet all residents needs. • Bathrooms are re-decorated. • Damaged or missing tiles are replaced in bathrooms. Timescale of 30/03/04 not met. 30/03/06 The registered provider must: • Provide suitable locks to all residents beroom doors. • Consult residents as to their wishes in respect of furnishings in line with the minimum standard, provide where appropriate and record in their care plan. • Provide adjustable beds where necessary to meet residents needs following assessment. Timescale of 30/04/04 not met. • Continue with the programme of furniture replacement and provision of loackable facilities. Version 5.1 Page 30 • St Clements Nursing Home DS0000024892.V281130.R01.S.doc 26. OP24 23(2)(p) 27 28 OP26 OP26 13(4) 23(2) 13(3) 29 OP28 18(2) 30 31. OP29 OP30 19 18(1) 32. OP32 10(1) 12(1) 24 33. OP33 The registered person must ensure all residents can access a light from their bed. Timescale of 30/10/05 not met. The registered person must ensure all extractor fans are in working order. The registered person must ensure suitable systems in respect of infection control are put into place to include: • Where rooms are shared toiletries are labelled and separate washbowls are available for residents. • Staff remove gloves and wash their hands afterwards. • There is always clean linen on resident’s beds. • Suitable clinical waste bins are available where required. • Staff have clean uniforms regularly. The registered person must ensure that at least 50 of care staff successfully complete NVQ level 2. The registered person must ensure there is a robust recruitment procedure in place. The registered person must ensure all newly appointed staff complete updated induction training within 12 weeks to the Common Induction Standards for Adult Social Care. The registered person must ensure systems are put in place to improve communication within the home and support for staff. The registered person must implement a quality assurance system ensuring that stakeholders views are obtained and an annual development plan is drawn up. DS0000024892.V281130.R01.S.doc 30/03/06 28/02/06 30/01/06 30/09/06 28/02/06 30/08/06 28/02/06 30/06/06 St Clements Nursing Home Version 5.1 Page 31 34. OP35 20 17(2) Sch 4 35. OP36 18(2) Timescale of 30/10/04 not met. • The registered person must ensure all policies and procedures are up to date and all staff are aware of them. This area was not assessed and carried forward from30/10/04. The registered person must 30/03/06 ensure: • Any monies belonging residents must be deposited in an account in the name of the resident and the home must retain a record of this. • The home must maintain records of all monies and valuables held on behalf of all residents. • There must be two signatures for all transactions, one of them being the resident where possible. • Individual receipts must be obtained from the relevant company and kept for all transactions where monies are spent on behalf of residents. Timescale of of 30/9/03 not met. The registered person must 30/04/06 ensure all staff receive formal supervision at least six times a year and records are retained in the home. Timescale of 30/11/03 not met. The registered person must ensure that staff who undertake supervision have training in the process to provide them with the appropriate skills. The registered person must 30/06/06 ensure all staff undertake basic training in respect of first aid and records are kept in the home. Timescale of 30/12/03 not met. DS0000024892.V281130.R01.S.doc Version 5.1 Page 32 36. OP38 13(4) St Clements Nursing Home 37. OP38 16(2)(j) 38 OP38 13(3) 39 OP38 12(1) 18(1) 13(4) 40 OP38 41 OP38 13(4) 41. OP38 13(4) 18(1)(p) 42 OP38 12(1) 18(1) 43. OP38 37 The registered person must ensure all staff undertake training in respect of basic food hygiene and records are kept in the home. Timescale of 30/12/03 not met. The registered person must ensure all staff undertake training in respect of infection control and records are retained in the home. The registered person must ensure all staff undertake training in respect of nutrition and tissue viability. The registered person must ensure the following areas in respect of maintenance are addressed: • Asbestos survey. • Servicing of pressure relieving mattresses and scales. The registered person must ensure the temperature of water from hot water outlets is checked on a regular basis and if it is not within the normal range action is taken. The registered person must obtain evidence to demonstrate the perons undertaking the electrical testing is suitably qualified. The registered person must ensure systems are in place to effectively evaluate staff training to ensure it is suitable and it will lead to an improvement in practice. The registered person must ensure all accidents and incidents affecting the well being of residents is reported to the Commission. 30/04/06 30/05/06 30/04/06 28/02/06 10/02/06 30/03/06 30/04/06 15/09/05 St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. 4. Refer to Standard OP3 OP7 OP8 OP14 Good Practice Recommendations It. is recommended that monitoring of residents blood sugar levels is reviewed in line with recent guidelines It is recommended that a system is adopted enabling residents to be aware of members of staffs name. (Carried forward). It is recommended that the G.P. be consulted where aromatherapy is used for residents. (Carried forward). It is recommended that all residents be informed in writing of their right to access records and provide information regarding advocacy schemes. (Carried forward). It is recommended that the arrangements for activities be reviewed. It is recommended that the manager commence a system for auditing accidents and infections in the home. (Carried forward). 5 6. OP15 OP38 St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Clements Nursing Home DS0000024892.V281130.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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