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Inspection on 29/04/08 for St Clements Nursing Home

Also see our care home review for St Clements Nursing Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who live in the home have access to external health and social care professionals so that staff receive the necessary advise to enable them to provide appropriate care. However, In some instances this has not happened. A GP visits the home on a weekly basis to assess peoples health needs and to prescribe any necessary treatments. This promotes peoples health and wellbeing. Choices of meals are offered and meals are well presented. The home can cater for specialist diets and cultural needs. A copy of a new menu was supplied and information provided that the home intends to implement it May 2008. It offers a varied and nutritional range of meals for people to choose from. Aids and adaptations are provided so that people can exercise choices about their independence No complaints have been received by the home or us since the last key inspection of November 2007. Some staff have been employed by the home for a long time. This ensures that people know who will be helping them in meeting their needs. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. This promotes peoples privacy and dignity when personal care is required. The home employs staff of ethnic minorities to reflect the various race of people living in the home and to enhance communications. One person residing in the home does not speak English. The manager advised that there is usually one member of staff on duty each day who is able to communicate with her effectively.

What has improved since the last inspection?

A deputy manager has been appointed who has taken on the responsibility for many of the clinical tasks and to oversee the standards of care being provided. This has released the manager to perform his duties of the day to day management of the home. The manager advised that he had not performed any clinical tasks for three weeks. All care plans have been reviewed and some improvements made. More work needs to be carried out to bring them up to standard. The access to the garden has been improved. This allows wheelchair users to enjoy the garden during warm weather. Garden furniture has been ordered so that people will be able to sit outside. The two lounges have been provided with a new large flat screen television and DVD to enhance peoples enjoyment in watching programmes. The large screens will also assist people who have visual impairment. Following a tissue viability audit of all people living in the home during March 2008 the home has ordered the recommended chairs. These will supply appropriate support and comfort for people. Also one new bed per month is being purchased. This will ensure that staff are able to provide care in a safe way. A number of bedrooms have been redecorated. The home has a programme of maintenance. A bathroom is currently being redecorated. Advice was given that this will be followed by the kitchen and main dining room. This has resulted in a steady improvement in the standard of the accommodation provided for people residing in the home. Work has been completed on converting four toilets into two to permit people with wheelchairs to use them and to ensure peoples privacy. The home has budgeted to provide suited bedroom door locks. These will enable staff to gain prompt entry during an emergency situation and for people to hold their own key to preserve their privacy. The stair and corridor carpets have been replaced to improve the appearance of the part of the communal areas. Staff training has improved and they are also encouraged to undertake courses to give them the knowledge and skills to meet peoples specialist needs. The range of training currently offered to staff is viewed as being good practice.

What the care home could do better:

Serious concerns were raised about the lack of adequate progress in bringing the care plans up to an acceptable standard. Health provision and information gained from staff interviews, at times did not correlate with the contents of care plans. Generic care plans had also been introduced but they were not individualised for the respective person and were not specific enough to provide acceptable staff guidance. Terminology such as `apply cream asprescribed` fails to provide enough staff guidance. This has been raised at the previous visit but has not been actioned. Code B of the Police and Criminal Evidence Act 1984 was invoked and copies pertaining to two care plans were obtained for the Commission to consider in respect of what action should be taken. Numerous bedroom doors were found not to be closing into the doorway rebate. This means that in the event of fire that people would be put at unnecessary risks of injuries. Although one to one sessions have been incorporated into the programme, a review of the scope and time permitted for activities should be carried out. The programme offered needs to reflect the preferences of the majority of people living in the home. Consideration should be given to the information provided in care plans when developing and reviewing the programme. People should be offered physical and mental stimulus to enhance their lifestyles.

CARE HOMES FOR OLDER PEOPLE St Clements Nursing Home 8 Stanley Road Nechells Birmingham West Midlands B7 5QS Lead Inspector Kath Strong Unannounced Inspection 29th April 2008 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.V362982.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.V362982.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 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.V362982.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. 21st November 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 assisted thing facilities on each floor. The home has some pressure relieving equipment and a range moving equipment to assist those persons who have restricted mobility. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 5 The current fee rates are clearly documented in the service user guide and includes details of the services that are not included in the fee rate. The conditions of registration are currently under review following which a new registration certificate will be supplied by us. The home has also applied to change the registration from a mixture of residential and nursing to all nursing. A decision has not yet been made by us. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Following the last key inspection a random inspection was carried out. The purpose of the visit was to check that adequate progress had been made in respect of care planning of peoples health and personal care needs. Although all files had been reviewed they did not contain sufficient staff guidance about how peoples needs should be met. The home did not know that the fieldwork visit would be carried out; this is to enable the inspectors to obtain an accurate view of the standards of the services provided. The fieldwork visit was carried out by two inspectors over a period of a long day. On the day of the visit, the home had 32 people living there. Assistance with the inspection process was provided by the manager. At the conclusion feedback was given to the manager. Concerns were made about the standard care plans, these did not correlate with the actual care being provided and the information given to inspectors during staff interviews. Consideration will be given about what further action we will be taking. Information was gathered from various means including interviews with staff. 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 three 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 standards of care provision. Due to the mental illness of people it was not possible to hold meaningful conversations with them. Also the majority of them attended a recreational event during the afternoon, thus restricting their availability. Prior to the visit the home had completed the annual quality assurance assessment 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 how 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 but, to date no questionnaires have been returned to us. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 7 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 process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and aspects of service provision that need further development. The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. What the service does well: What has improved since the last inspection? A deputy manager has been appointed who has taken on the responsibility for many of the clinical tasks and to oversee the standards of care being provided. This has released the manager to perform his duties of the day to day St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 8 management of the home. The manager advised that he had not performed any clinical tasks for three weeks. All care plans have been reviewed and some improvements made. More work needs to be carried out to bring them up to standard. The access to the garden has been improved. This allows wheelchair users to enjoy the garden during warm weather. Garden furniture has been ordered so that people will be able to sit outside. The two lounges have been provided with a new large flat screen television and DVD to enhance peoples enjoyment in watching programmes. The large screens will also assist people who have visual impairment. Following a tissue viability audit of all people living in the home during March 2008 the home has ordered the recommended chairs. These will supply appropriate support and comfort for people. Also one new bed per month is being purchased. This will ensure that staff are able to provide care in a safe way. A number of bedrooms have been redecorated. The home has a programme of maintenance. A bathroom is currently being redecorated. Advice was given that this will be followed by the kitchen and main dining room. This has resulted in a steady improvement in the standard of the accommodation provided for people residing in the home. Work has been completed on converting four toilets into two to permit people with wheelchairs to use them and to ensure peoples privacy. The home has budgeted to provide suited bedroom door locks. These will enable staff to gain prompt entry during an emergency situation and for people to hold their own key to preserve their privacy. The stair and corridor carpets have been replaced to improve the appearance of the part of the communal areas. Staff training has improved and they are also encouraged to undertake courses to give them the knowledge and skills to meet peoples specialist needs. The range of training currently offered to staff is viewed as being good practice. What they could do better: Serious concerns were raised about the lack of adequate progress in bringing the care plans up to an acceptable standard. Health provision and information gained from staff interviews, at times did not correlate with the contents of care plans. Generic care plans had also been introduced but they were not individualised for the respective person and were not specific enough to provide acceptable staff guidance. Terminology such as ‘apply cream as St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 9 prescribed’ fails to provide enough staff guidance. This has been raised at the previous visit but has not been actioned. Code B of the Police and Criminal Evidence Act 1984 was invoked and copies pertaining to two care plans were obtained for the Commission to consider in respect of what action should be taken. Numerous bedroom doors were found not to be closing into the doorway rebate. This means that in the event of fire that people would be put at unnecessary risks of injuries. Although one to one sessions have been incorporated into the programme, a review of the scope and time permitted for activities should be carried out. The programme offered needs to reflect the preferences of the majority of people living in the home. Consideration should be given to the information provided in care plans when developing and reviewing the programme. People should be offered physical and mental stimulus to enhance their lifestyles. 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.V362982.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.V362982.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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective users of the services are supplied with sufficient written details about the home to enable them to make an informed decision about moving in. Pre-admission assessments ensure that the home is able to demonstrate that it can meet the persons needs at the time of admission. EVIDENCE: When people enquire about the services provided they are given a brochure and a copy of the service users guide, which includes details about the fee rate and details of the services that are not included in it. The additional charges include newspapers, hairdressing, library fees, talking books, chiropody, local GP’s and pharmacist, dentist, optician and religious services. The fee rates are reviewed each April. This gives people the information they require to make a decision about the home. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 12 The pre-admission assessment records for the latest two admissions were reviewed. They provided sufficient information for senior staff to determine if the home can meet the individuals needs at the time of admission. St Clements Nursing Home DS0000024892.V362982.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 provide adequate staff guidance and do not always reflect the actual care that is being provided. Staff are failing to fully monitor peoples healthcare needs, this puts them at risk of deteriorating health. The management of medications ensures that people receive their prescribed medications to promote their health and wellbeing. Observation of staff practices suggests that peoples privacy, dignity and self esteem are being maintained. EVIDENCE: Each person has a written care plan. This is an individual plan about what the person is able to do independently and states what assistance is required from staff for the person to maintain their needs. Care plans include risk assessments about the individuals’ activities within the home and the community. These identify the risks and a description of what action is needed to minimise those risks. Care plans should be reviewed regularly to ensure that they are up to date and pertinent to the persons needs. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 14 The care plans of the two latest admissions were case tracked and a further file of a person who had been reviewed during a previous visit was seen to monitor the individuals progress. It was noted that all care plans have been reviewed since the random visit that was carried out 3rd January 2008. Some improvements were found and it was noted that the home was introducing typed care plans. Further improvements were noted in that staff had been carrying out regular reviews of all aspects of care plans. The files were presented in a logical format with an index at the front of each file for ease of access. Although improvements were acknowledged there continued to be significant shortfalls, which raised serious concerns because care plans have been poor for some time. It was also found that the care plans did not always coincide with the actual care being delivered or staff knowledge about peoples needs. The scores of two manual handling assessments were such that they indicated that ‘Resident should be hoisted or appropriate handling equipment used’. However both people were able to weight bear and walk. Upon detailed analysis of the scores allocated they were demonstrated to be incorrect because they did reflect what the person could do. Such as, mobility in bed scored 2 difficult, but the task stated that the person was independent in turning and moving up the bed. Two care plans stated that people were at risk of malnutrition but their weights and body mass index suggested otherwise. One file stated offer shower once a week, the other to ‘give a bath on Friday or when …… wants to’. There was no evidence that personal preferences had been explored about the method or frequency of bathing of these people. Further consideration should be given to the fact that both suffered with incontinence problems and the additional personal hygiene that this incurs. This particular shortfall has been highlighted during previous inspections. Terminology such as, ‘Apply ……. Cream, as required throughout the day’ fails to provide staff with specific instructions about where and how often this procedure should be carried out. This was brought to the homes attention during the random visit carried out 3rd January 2008. A care plan of a person who suffers incontinence does not provide any staff instructions about how often the incontinence product needs to be checked. Another care plan states, ‘Requires prompting to go to the toilet’, but fails to state how often the prompts should be made. This fails to ensure that staff provide appropriate care and to maintain the individuals personal needs and dignity. One care plan stated, ‘Ensure ……. has a wheelchair with footplates and are correctly fitted at all times, ensure lap strap is fitted correctly when St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 15 mobilising’. When the use of lap straps were raised during staff interviews differing responses were given. One said, “We have no lap belts for any of the chairs”. Another said, “Only one, its his own wheelchair”, and later reported, “Only one, …… has a lap strap, have not seen anymore in the home”. When this information was shared with the manager he reported that he had purchased 15 lap straps for use by wheelchair users. This indicates staff failure to comply with the instructions provided for them in care plans. The daily progress notes includes recordings about a GP visit. Treatment was commenced for a skin rash but no short term care plan had been developed. The files also included recordings about resident ….. 13/03/08, which suggests that a sore had developed to her right heel. Staff instructions were to place a pillow between her knees to prevent pressure. There was no care plan in place or recordings to suggest that monitoring had been carried out. During the interview of the nurse she indicated that she had no awareness of a wound or pressure sores. All three staff interviewed failed to demonstrate any knowledge about the recommendation to place a pillow between the persons knees. This suggests that staff are failing to read the instructions in peoples care plans. One person had been refusing to take her medications and the home had obtained written consent from a GP for a tablet to be hidden in the individuals food if she refuses her medication. The file did not include a risk assessment for this arrangement or the appropriate action to be taken to minimise possible risks to the individual. A file about another person contains two separate recordings about the persons risk of choking but no risk assessment had been carried out. This puts these people at risk of physical harm. The recordings made by staff in the evaluations of care plans in some cases fail to provide information about outcomes. The recordings were in line with instructions such as, ‘Unable to mobilise independently but can transfer from wheelchair to chair. Ensure correct hoist and green sling is used”. Another file included the recording, ‘Continue to monitor ……. wellbeing. Two files included information about episodes of physical aggression. The three staff interviews confirmed this but neither file included a care plan about difficult to manage behaviour. This shortfall has been raised during previous visits to the home. The care plan in respect of diabetes fails to advise care staff of what symptoms to look for when a complication occurs to enable them to take the correct action to deal with the situation. Some of the care plans have been typed, are generic and not individualised such as, a care plan in respect of hypertension states, ‘ Record BP as per GP St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 16 instructions’. The inspectors were unable to find any GP instructions about frequency of monitoring the blood pressure. Staff are failing to fully meet peoples needs, which may prevent them from maximising their potential health and wellbeing. The repositioning charts were reviewed during the tour of the premises. One chart had only two recordings for each of three dates, 20th, 24th and 26th April. Another chart had only three recordings for the 24th April. There were no recordings in respect of relieving peoples pressure when sitting in a chair or wheelchair during daytime hours. This was brought to the managers attention. Management of medications were reviewed. An audit of the medications for a number of people was carried out and with the exception of one tablet they were found to be correct. The manager reported that he would investigate the one error and take appropriate action. The controlled drugs were found to be correct. The recordings of the drugs fridge temperatures required attention because they were not within the normal range. The manager advised that the temperature devise was new but there was an obvious discrepancy with the readings. Staff recordings were good in respect of the MAR (medication administration record) charts. This indicates that people were receiving their prescribed medications appropriately. Staff were observed providing appropriate and discreet assistance and approached people in a respectful manner. Personal care was not provided in a communal area but in the privacy of the individuals own bedroom or a bathroom. St Clements Nursing Home DS0000024892.V362982.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. The home needs to demonstrate that the recreations offered are sufficient to stimulate and enhance peoples quality of life. The meals offered were varied, nutritious and choices were available. EVIDENCE: There are a number of activities on offer at the home. They consist of one hour per day for an activity and another hour to carry out one to one sessions with individuals during Monday to Friday. The hourly recreations were dominoes, beanbag target, skittles, jig saws and residents request such as letter writing or shopping. External entertainers come into the home every alternate week to supply an exercise class. Another entertainment was in progress during the afternoon of the fieldwork visit. Attendance at a local coffee morning takes place every three weeks and three people attended a show in January this year. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 18 The activities organiser has maintained records about those who have participated and whether they enjoyed the recreations. The recordings in respect of one person stated that through an interpreter she had requested to be taken outside. The recording had been made two weeks prior to the fieldwork visit but there was no evidence that the request had been actioned. There was no indication that the programme offered had taken into account peoples preferences and aspirations that have been recorded in the care plans. Although it is an improvement that daily one to one sessions have been implemented this leaves only one hour per day of group activities. It is recommended that a review be carried out that includes peoples personal preferences in obtaining a programme that suits the majority of people and that sufficient time is allocated. The home needs to demonstrate that people are offered enough and appropriate physical and mental stimulus to enhance the quality of their lifestyles. The home has developed a new meal menu and the manager advised that it would be introduced the following week. The menu provides people with choices and offered a nutritious diet. Although choices were available the manager advised that people make requests for other meals such as an omelette and that the requests are actioned. The manager advised that he had arranged a resident and relative meeting the previous week but no one had attended. This suggests that people are being encouraged to influence the way in which the home operates. Observations during lunchtime indicated that the meals were well presented and good sized portions were being served. Plate guards were used to promote peoples independence and staff were observed to be providing appropriate assistance to people with their meals. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 19 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 residing in the home from risks of abuse. EVIDENCE: A copy of the complaints procedure is available in all bedrooms. It contains enough information to guide people in how to make a complaint and how long they expect to wait for an outcome. Neither the home nor the Commission have received a complaint since the last key inspection. This suggests peoples satisfaction with the services being provided. The home has written policies about restraint and charter for rights of residents. These contain enough information to give staff instructions on how to respond if abuse is witnessed or suspected. During one of the staff interview she demonstrated enough knowledge to act accordingly if required. All care staff had undergone training in adult protection. There have been no concerns about this aspect of the service. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 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 are provided with a warm, comfortable and hygienic environment to live in. EVIDENCE: The inspectors noted improvements in the standard of the accommodation provided. This ensures that people live in a comfortable and pleasing environment. There is a lounge and dining room situated on the ground floor and a combined lounge/dining room on the first floor. The main dining room is in need of redecorating. The manager advised that the programme of works indicates that the work will be carried out after the kitchen has been painted. There is a nurses station in each lounge to assist in observing and socialising with people. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 21 The garden has recently been made accessible to people including wheelchair users. The manager advised that furniture has been ordered so that people can sit outside during warm weather. There are bathrooms on each floor that provide people with choices about showering or bathing. One bathroom was out of use because it was being redecorated. The communal toilets have been successfully converted into larger rooms to ensure ease of access and that peoples privacy is maintained. The bedrooms of the people whose care plans were seen were visited. They were found to be tidy, clean and personalised. The space in the en-suite facility in each room consisting of toilet and wash hand basin was noted to be restrictive to wheelchair users. The manager advised that the equipment recommended from the tissue viability nurses audit of March has been supplied. It was noted that a number of bedroom doors failed to automatically close. This poses a risk to peoples safety in the event of a fire and was brought to the managers attention. It was noted that continence products had been removed from their packaging and stored on the cistern in bedrooms. This was brought o the managers attention because it is considered to be an unhygienic storage method and fails to promote peoples dignity. The home was found to be generally clean and tidy. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The home deploys adequate staff to provide for the needs of the people living in the home. Recruitment practices are robust; this protects people from risks of harm. Staff had received the necessary training to provide them with the knowledge and skills to meet peoples specialist needs. EVIDENCE: Copies of the four recent weeks staffing rota was provided. Since the last inspection the home has commenced monthly staffing needs analysis that takes into account the number of people and their dependency levels. This is to ensure that staffing levels remain appropriate for the current client group. There is a full range of ancillary staff; this permits care staff to carry out their designated roles in providing personal and healthcare. Three staff personnel files were checked including the two latest recruits. They confirmed that the appropriate checks were being carried out before a position was confirmed. This included receipt of two satisfactory written references. Ongoing follow-up checks were being carried out such as nurses eligibility to practice and to work in this country. Newly appointed staff are given an induction about the home. Care staff are expected to undertake a more in depth induction that includes all the topics St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 23 covered in Skills for Care. This provides carers with the knowledge and skills to work within the care sector. Good improvements were noted in respect of staff training. Mandatory training was being completed by all staff who provide personal care. It included fire safety, health and safety, moving and handling, adult protection and abuse awareness. Other training that some staff have attended includes basic first aid, food hygiene medication, care planning, dementia awareness, incontinence management, risk assessment, stoma care, coronary heart disease, wound care and falls. This is viewed as being good practice because the training provides staff with the skills to meet peoples specialist needs. Of the carers employed 77 have successfully completed NVQ level 2 and five staff were currently completing the course. Four staff had completed level3 and two were undertaking level 4. The manager, deputy manager and a nurse had commenced the registered managers award. This suggests a progressive approach to staff training. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 37. 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 make ongoing improvements for the benefit of those who live in the home but there is no complete quality assurance programme in place to evidence this. Arrangements in respect of peoples personal monies are not safe and fails to protect people from risks of financial abuse. Lack of proper bedroom door closures puts people who live in the home at risk of harm. EVIDENCE: The manager had recently recruited a deputy manager who provides clinical support and observes staff practices. The manager advised that he is still awaiting his CRB (criminal record bureau) check to arrive before he can apply to us for registration. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 25 The files pertaining to quality assurance could not be found. It was not possible to fully review the arrangements in the aspect of the service. There was evidence of Regulation 26 visits being carried out and the reports were noted to be comprehensive and included discussions with people who live in the home and staff. An action plan seen suggested that there were ongoing improvements being made for the benefit of the people who reside in the home. There was good evidence of regular staff meetings being held. The topics covered suggested that peoples care and staff practices were included. The minutes suggested that staff were being encouraged to participate and to raise topics. The personal finances of four people were checked. Three were found to be accurate but one was found to be short. The manager advised that this shortfall would be made up from the petty cash and that he would also carry out an investigation. It was noted that two entries made had not been countersigned. The arrangements fail to protect people from risks of financial abuse. The accident records were good; the accident reports were accompanied by detailed incident form. They provided good information about the circumstances of the accidents, details of injuries and how they were treated and any follow up action taken. All relevant checks and servicing of equipment had been carried out to ensure that it was fit for purpose. The fire alarm and emergency lighting was being regularly tested and the results recorded to protect people from harm in the event of an emergency situation. The failure of bedroom doors to fully close into their rebates means that people are not fully protected from risks of injuries. St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 27 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 12(1) 15(1) Requirement The home must promote and make proper provision for the health and welfare of service users. The home must prepare written plans as to how the service users needs in respect of his health and welfare are to be met. Timescale of 14/02/08 has not been met. A programme of activities must be developed that has regard of service users and is sufficient to meet their social interests. Timescale of 29/03/08 has not been met. Arrangements must be in place to prevent service users from suffering financial abuse The home must establish a quality assurance system that includes consultation with service users and their representatives. Timescale of 31/03/08 has not St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 28 Timescale for action 29/04/08 2. OP12 16(2)(m) (n) 30/06/08 3. 4. OP35 OP33 13(6) 24(1) 15/05/08 31/07/08 5. OP38 13(6) been met. The home must prevent service users being harmed or being placed at risk of harm. 15/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP16 OP20 Good Practice Recommendations 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 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 the programme of installation of suited bedroom door locks be completed. 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. It is recommended that the manager makes an application to us for registration. 3. 4. OP24 OP26 5. 6. OP29 OP31 St Clements Nursing Home DS0000024892.V362982.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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