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Inspection on 07/11/06 for St Clements Nursing Home

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

This inspection was carried out on 7th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

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

All bedrooms have en-suite facilities consisting of wash hand basin and toilet. This assists with ensuring residents privacy and dignity. The choice and standard of meals are good, this was confirmed by residents spoken with and is considered by them to be an important service. The home has an activities organiser whose role is to provide a programme that suits individual`s recreational preferences to improve the quality of their lives. Two relatives advised of the satisfaction with the services provided to their respective residents in promoting their well being.

What has improved since the last inspection?

The home has a maintenance operative who works full time who also decorates the bedrooms and other areas of the home as required. The maintenance operative was in the process of fitting automatic bedroom door closures to improve the privacy for residents. Two bedrooms have had new carpets fitted. Some improvements with staff training was noted but further work is required in this area to ensure that staff possess the knowledge and skills to carry out their roles effectively.

What the care home could do better:

Virtually no progress has been made from the inspections carried out May and August of this year. Further slippage was evidenced leading to six Immediate Requirements from this fieldwork visit. Continual improvements are needed to ensure that residents receive the care and services they are entitled to. Staff must carry out and document the change of resident`s positions as directed within the care plans to prevent residents from developing pressure ulcers. This was a requirement made during the May 2006 inspection and must be addressed as a matter of priority. Care plans must be developed on a timely basis following the admission of a resident. The longstanding shortfalls identified previously in care plans must be addressed to evidence that appropriate care needs are being identified and met. Trained staff and carers are not being adequately supervised either formally or on a day to day basis. The home is unable to demonstrate that staff knowledge and practices are of a good standard. All trained staff must adhere to safe guidelines for the administration of medications. Monitoring of foods consumed must be carried out comprehensively and weights regularly monitored in order to identify trends in residents health and well being. The long standing problem of an inadequate supply of assisted bathing facilities must be rectified to ensure that residents receive the personal hygiene that are an expectation. Staff practices must ensure that resident`s dignity is maintained at all times.Health and safety must be complied with, propping open bedroom doors puts residents at risk of injury. The provision of activities requires review including the programme, time allocated, consultation with residents and the method of recording those residents who have participated. The home needs to offer sufficient recreations to ensure residents have a meaningful lifestyle.

CARE HOMES FOR OLDER PEOPLE St Clements Nursing Home 8 Stanley Road Nechells Birmingham West Midlands B7 5QS Lead Inspector Kath Strong Unannounced Inspection 7th November 2006 09:25 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.V318224.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.V318224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Clements Nursing Home Address 8 Stanley Road Nechells Birmingham West Midlands B7 5QS 0121 327 3136 0121 328 1461 stclements@bmlhealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Noblefield Limited Vacant 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.V318224.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 ancillary staff should be provided in addition to the care staff. 25th August 2006 5. 6. Date of last inspection Brief Description of the Service: St Clements is a purpose built three-storey home situated in a built up residential area of Birmingham. The home provides accommodation to thirtyseven elderly residents in 27 nursing beds and 10 residential beds. There are twenty-five single bedrooms and six double rooms, one of which is located on the lower ground floor and all have en-suite facilities consisting of a toilet and wash hand basin. Access to the home is gained by the lower ground floor and a passenger lift gives access to the ground and first floors. There is limited covered parking on the lower ground floor to the front of the property. There is a small garden with steep elevations that is accessed from the ground floor. Communal facilities consist of a large lounge on the ground and first floor. There is also a dining room situated on the ground floor that is adjacent to the kitchen, which provides all the meals. Residents are able to have meals on either of the upper floors or in their own room. A laundry facility is situated on the lower ground floor, where washing of resident’s personal clothing is undertaken. There are bathing facilities on each floor; however, some of these are not suitable for the client group resulting in insufficient assisted bathing facilities. The home has a range of pressure relieving equipment and moving St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 5 equipment to assist those persons who have restricted mobility. The current fee rates are £333.00 for shared rooms and £363.00 for single rooms per week for nursing care and there may an additional fee paid by the Primary Care Trust of £45.00, £85.00 or £134.00 per week depending on the estimated level of nursing car needs. Residential fees are £305 for a shared room or £336.00 for a single bedroom. A charge of £5.00 per week is also made for those persons requiring continence products. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork visit was carried out over a period of one day, assistance was provided by the acting manager. The vacant managers’ post was due to be filled within the week. There were 33 residents living at the home on the day of the visit. Information was gathered from speaking with residents, relatives and staff including two staff interviews. 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. Due to some residents having dementia it was at times not possible to hold a meaningful discussion with them. At the conclusion verbal feedback was given to the acting manager and six Immediate Requirements were left at the home: • A care plan must be developed for the resident who was admitted 20 days previously • A change of position regime and recordings must be introduced for the resident admitted 20 days prior to the fieldwork visit with grade two pressure ulcers • Staff must action and record those residents who require regular change of position as per the care plan • The records of all foods consumed in respect of some residents must be completed • Trained staff must ensure that a safe system is utilised when administering medications • The practice of propping open bedroom doors must cease, this poses a health and safety risk. What the service does well: All bedrooms have en-suite facilities consisting of wash hand basin and toilet. This assists with ensuring residents privacy and dignity. The choice and standard of meals are good, this was confirmed by residents spoken with and is considered by them to be an important service. The home has an activities organiser whose role is to provide a programme that suits individual’s recreational preferences to improve the quality of their lives. Two relatives advised of the satisfaction with the services provided to their respective residents in promoting their well being. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Virtually no progress has been made from the inspections carried out May and August of this year. Further slippage was evidenced leading to six Immediate Requirements from this fieldwork visit. Continual improvements are needed to ensure that residents receive the care and services they are entitled to. Staff must carry out and document the change of resident’s positions as directed within the care plans to prevent residents from developing pressure ulcers. This was a requirement made during the May 2006 inspection and must be addressed as a matter of priority. Care plans must be developed on a timely basis following the admission of a resident. The longstanding shortfalls identified previously in care plans must be addressed to evidence that appropriate care needs are being identified and met. Trained staff and carers are not being adequately supervised either formally or on a day to day basis. The home is unable to demonstrate that staff knowledge and practices are of a good standard. All trained staff must adhere to safe guidelines for the administration of medications. Monitoring of foods consumed must be carried out comprehensively and weights regularly monitored in order to identify trends in residents health and well being. The long standing problem of an inadequate supply of assisted bathing facilities must be rectified to ensure that residents receive the personal hygiene that are an expectation. Staff practices must ensure that resident’s dignity is maintained at all times. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 8 Health and safety must be complied with, propping open bedroom doors puts residents at risk of injury. The provision of activities requires review including the programme, time allocated, consultation with residents and the method of recording those residents who have participated. The home needs to offer sufficient recreations to ensure residents have a meaningful lifestyle. 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.V318224.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose does not provide prospective residents with sufficient written details about the services for them to make an informed decision about living at the home. The home carries out a pre-admission assessment in order to determine if the identified needs can be met but these are not being signed. EVIDENCE: The further developments required within the statement of purpose were noted to have not been actioned. Room sizes and residents and/or relative others should be invited to participate with care planning and formal reviews. Information about staff training needs to include Health and Safety. The details of the proposed manager will also require inclusion. Residents must have comprehensive details about the services provided. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 11 Although the acting manager has carried out pre-admission assessments that are satisfactory in depth of details the forms must be signed and one was noted to have not been dated. All documentation pertaining to residents must be dated and signed. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was little evidence that either staff practices or care plans ensured that residents receive appropriate standards of personal care to ensure their health and well being. Staff practices in respect of medications were found to be unsafe, which puts residents at risk of harm. Observations indicated that the dignity of residents is not being maintained by trained or care staff. EVIDENCE: Each resident has a written care plan. This identifies the assessments carried out and how care should be delivered by staff to promote the health and well being of each person residing at the home. Four care plans were sampled for assessment. The inspector was disappointed to note that no progress has been made in care planning mechanisms since the inspection of May 2006. Many shortfalls were found: • The assessment and care plan of a resident regarding mobilisation does not provide staff with instructions of which equipment is required St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 13 • • • • • • • • • • • • • • • • • A resident admitted with a chest infection had not had a care plan developed for this condition Monthly weights not being carried out and recorded A care plan developed concerning weight loss states that it should be reviewed monthly but this had not been carried out for October Care plans regarding difficult to manage behaviour fail to give advice about the likely triggers and type of resultant behaviour A resident who suffers from episodes of a physical nature did not have a care plan for how staff need to monitor and react when the condition occurs Staff are not being advised of the sling size to be used when a mobile hoist is required Lack of personal preferences regarding activities of daily living over a twentyfour hour period No personal preferences in respect of personal hygiene and bathing. The home does not have sufficient assisted bathing facilities to provide choices Failure to invite residents and/or relevant others to participate with the care planning process There was no evidence of formal reviews being carried out Risk assessments are incomplete in that they do not provide details of the action to be taken to reduce the identified risk A signed disclaimer in respect of a bedroom door being propped open was not accompanied by a risk assessment Inappropriate written terminology, ‘Cot sides’ demonstrates lack of dignity One care plan failed to include any of the diagnosed conditions Failure to obtain the life history and background information of residents. This is especially important for those who have dementia in providing reasons for behavioural trends Failure to develop a care plan for a resident who was admitted 20 days previously. This resulted in an Immediate Requirement Failure of staff to commence and document change of positions needed for a resident who had been admitted 20 days ago with grade two pressure ulcers. This resulted in an Immediate Requirement. The home is failing to provide documentary evidence that care needs are being met. Comments received included, “They look after you, it’s not bad, I’ve no complaints”. Another person said,” The home’s alright but I don’t want to be here, I’m finding it difficult to settle”. A relative advised, “Staff look after him well, I go home with an easy mind but will feel better when a manager is here”. There was evidence that residents are being supported in attending hospital appointments. Staff are not carrying out changes of positions in order to St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 14 prevent pressure ulcers and in one instance the procedure had not been commenced at all. This has been outstanding since the May 2006 inspection. Those persons who have been identified as being at risk of malnutrition are not having their foods consumed recorded or weight checked each month. This clearly indicates poor staff practices, lack of day to day supervision of staff and failure of the home to protect the health and well being of those people residing at the home, which ultimately increases their risks of further ailments. The written procedures concerning medications the administration of homely remedies were noted to be satisfactory but the process for disposal of medications needs to be included. The system for the administration and recording of medications was observed whilst staff were carrying out the task. A number of concerns were brought to the attention of the acting manager: • Prescribed creams are still being administered by carers who have not received medication training and the trained staff are unable to validate that the creams have been applied as per the instructions detailed on the prescriptions • The file containing MAR (medication administration record) charts included a paper hand towel and a napkin both advising that prescribed medications had been taken from another residents supply. Such practices are deemed to be illegal • Both staff left an open trolley unattended for a short period of time whilst residents were also departing from the dining room • The acting manager described the method deployed in administering a controlled drug. The practice of putting a slip of paper containing the residents name in the tot with the drug is not safe practice or signing of the controlled drug book as being administered before the drug had been offered to the resident. This procedure was carried out between two trained staff as part of an induction programme. The home is unable to evidence that medications are being administered as prescribed or that resident’s health is being maintained. The above practices are considered to be unsafe and resulted in an Immediate Requirement. Concerns were raised regarding staff practices that fail to ensure that resident’s dignity is being maintained. A carer was observed letting a bedroom door slam shut. A commode was found in the corridor of the ground floor. A pair of resident’s pants were draped over the handrail on the first floor corridor. This is an unacceptable and unpleasant for residents and relatives who pass by. A trained member of staff administered eye drops in a full dining room. This was carried out as part of an induction programme and the acting manager made no comments about the lack of appropriateness of this procedure. Bathroom doors were left open with continence pads stored opposite doorways were clearly on view. Some toilets are too small to accommodate a resident and assistant. To overcome the problem doors are not closed and doorways have been fitted with plastic curtains; this is not a dignified means of providing personal care. During lunch the dining room was St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 15 noted to be very crowded, one resident was located in the doorway. Failure to ensure adequate space negates the resident’s ability to enjoy their meals. Two of three carers assisting residents to eat their meal were unable to sit down due to crowding and lack of seating. A carer was observed mixing the meal together on the plate, this prevents the resident from enjoying various tastes and textures and does not maintain dignity. Lunch did not appear to be a pleasing experience for residents. Some urgent attention is required to resolve the problems noted. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not supply sufficient social activities to meet resident’s expectations and stimulus to improve their quality of life. Residents are not consulted and given choices about how they wish to live. A wholesome and varied diet is offered and specialist dietary needs are catered for. EVIDENCE: The home does not have a pre-planned activity programme on display for residents to refer to. A carer reported, “The activities are not structured, which means that some residents miss out”. There was no indication that residents who remain in their bedrooms receive visits from the activities organiser or care staff to socialise or read to them. The records suggest that board games, coffee mornings and parties are held. One entry stated, “Helped service users to see doctor for flu jabs”. This practice must cease, as this is not part of her role. Documentation of people who had participated was inadequate, as only Christian names had been entered. It was noted that the home organises external entertainers and that the activities organiser takes some residents out to do shopping. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 17 There was no evidence that residents are consulted about how the home is run or given choices about the type of activities they would like to have. A carer was noted sitting and socialising with a resident resulting in laughter, whereas another carer was observed making little effort in communicating with residents. The menus suggest that varied and balanced meals are offered, which constitutes a wholesome diet is provided. Cooked eggs may be ordered at breakfast time. Lunch is the main meal of the day with choices given. The evening meal consists of soup, a light cooked meal, sandwiches and a desert. Residents are able to order snacks between the evening meal and breakfast. Lunch was observed being served. Due to the lack of heated trolley to serve residents who wish to remain on the first floor the dining room on the ground floor was over crowded. Residents are able to choose to remain in their bedroom during mealtimes. The meal was seen to be well presented with soft and pureed diets served appropriately. As discussed previously resident’s dignity was not maintained due to staff practices. A resident said, “I’ve never complained about the meals here, food is alright, we get choices, I enjoy the food, I like my food”. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives are confident that their opinions will be listened to and any complaints dealt with effectively. Lack of staff training or an adequate written procedure fails to protect residents from the risk of abuse. EVIDENCE: The written complaints procedure is satisfactory and accessible. Neither the home nor CSCI have received any formal complaints since the last inspection. Although the home has re-written the adult protection policy it was not available on the day of the fieldwork visit. The policies and procedures files contained a copy of the old policy dated 1999, which during a previous inspection was found to be grossly inadequate. Approximately 50 of staff have received training in prevention of abuse and only 8 have undergone training in challenging behaviour. The home must ensure that staff are provided with the information, knowledge and skills to act appropriately in protecting residents from the risk of abuse and how they should act when abuse is suspected. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is generally comfortable. Communal rooms and garden offer a good range of choices. The dining room is too cramped to accommodate residents comfortably. The assisted bathing facilities are not adequate to cater for the client group. EVIDENCE: There is a large lounge situated on the ground floor and a separate dining room, which is too small resulting in cramped conditions and staff inability to provide discreet and appropriate assistance. Following the inspection of May 2006 the home was required to purchase a heated trolley to serve meals at an appropriate temperature for those residents who wished to remain on the first floor. This needs to be actioned as soon as practically possible to ensure that resident’s dignity is maintained. The communal rooms are quite well appointed and residents were noted to be seated in comfortable chairs. There St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 20 is a small garden, which partially surrounds the premises for residents to frequent during clement weather. The staff toilet and sitting room are shoddy and uninviting for the regular usage they receive. The assisted bathing facilities are unacceptable for the numbers and dependency levels of residents. Additional assisted bathing has been a requirement for some considerable length of time and needs addressing as a matter of urgency. The bathroom on the lower ground floor is unused. The bathroom on the ground floor contains a bath that will accommodate a mobile hoist. However, the bath is situated against the wall; this restricts staff ability to provide assistance. The ground floor also has a walk-in shower room. The bathroom situated on the first floor contains a bath with bath seat to provide assistance for those residents with restricted mobility. The second bathroom was found to be unused and full of wheelchairs and walking aids. These arrangements are not satisfactory to cater for the personal hygiene needs of residents and restrict choices. Some communal toilets are too small to accommodate a resident and carer. A review of toilets and assisted bathing facilities needs to be carried out and work completed to improve these facilities for the benefit of residents. All bedrooms include en-suite facilities consisting of toilet and wash hand basin. The bedrooms visited were personalised to the extent preferred by the respective resident. A number of rooms do not have a lockable facility for secure storage of resident’s financial and personal items and suited door locks have not been fitted. These remain outstanding from previous inspections and continue to restrict safekeeping of personal items and privacy of residents. A resident and two visitors were spoken with in the bedroom. All three persons were sitting on the bed, as no chairs were available in the room. An audit of all bedrooms should be carried out to ensure that bedroom furniture meets those listed in Standard 24.2. The kitchen and laundry rooms appeared to be well organised and clean. The system used for the storage of food was noted to be satisfactory in protecting residents from the risk of infections. The first floor lounge and a bedroom were noted to have a malodour. The home must improve the arrangements for odour control to ensure a pleasant environment is maintained for those people who live there. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are maintained in sufficient numbers ensuring that resident’s care needs can be met. Recruitment practices are robust and protect residents from the risk of harm. Some staff training is needed to ensure that staff are supplied with the knowledge and skills to carry out their roles effectively. EVIDENCE: The most recent staffing rotas indicated that the home is complying with the conditions of registration. The home uses bank staff prior to agency staff during shortages to promote continuity of care. There is a full compliment of ancillary staff to enable care staff to carry out their designated roles. The maintenance operative works every weekday and carries out regular redecorating. A resident reported, “Everything is lovely and staff are lovely and very caring”. Staff files examined revealed that all necessary checks were being carried out before an applicant is offered a position. This indicates that residents are protected from risks of harm. Examination of the training matrix indicates that 50 of care staff have successfully completed training in NVQ level 2, three staff possess level 3 and St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 22 three staff have commenced level 2 training. Some staff need to undertake mandatory training in: • Fire Safety • Moving and Handling • Food Hygiene • Health and Safety • Abuse • Challenging Behaviour • Dementia Care. Some staff have undertaken other courses, which reflect the needs of the current client group. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is failing to oversee the day to day operations of the home to an acceptable standard. The quality assurance programme needs to be further developed and implemented to evidence that sustained improvements are made on a continual basis. Staff practices fail to ensure that residents are protected from risks of injuries. EVIDENCE: The home does not have a manager; however a new manager was due to commence employment later in the week. A trained nurse advised that she was temporarily acting manager. When questioned about this she said that she still carried out her full clinical duties and that any management tasks undertaken had to be carried out as extra time. This is not an acceptable arrangement and further slippage of the standards of care was evidenced. The St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 24 organisation has failed to ensure a practical means of ensuring that residents continued to receive appropriate care. Care staff informed the inspector that the home currently has no leadership. Senior managers carry out regular Regulation 26 visits and complete a report of their findings. A quality assurance folder indicates that the organisation is planning to commence a new regime of auditing, which will include the opinions of stakeholders. At the conclusion of these the home will be required to complete a report outlining the achievements and identifying shortfalls and when they should be resolved. The arrangements for the safekeeping and financial transactions of residents personal monies are robust, this prevents financial abuse of residents. Staff formal supervisory meetings have lapsed. This combined with the poor practices seen during the fieldwork visit indicates that staff are not being managed resulting in delivery of poor standards of care. The policies and procedures files indicated that the dates of reviews vary from July 1999 to April 2006. This suggests there is no consistent approach in ensuring that staff are supplied with up to date written guidance. The checks and mandatory servicing of equipment was found to be satisfactory. A review of the accident file indicated that these are being completed appropriately. The home was working towards meeting the requirements made from the recent WMFS (West Midlands Fire Service) inspection of the home. Some concerns were evidenced, which puts residents at risk of injury: • Bedroom doors must not be propped open. An Immediate Requirement was left at the home • The door of a sluice room was found open • A few staff have not received Fire Safety training. The home needs to take appropriate action to protect residents from injuries. St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 2 2 x x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 1 x 2 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The registered person must further develop the statement of purpose to include Health and Safety training of all staff, room sizes and that care plans are developed and formal reviews carried out with the resident and relatives invited to participate. Timescale of 30/09/06 has not been met. The registered person must ensure that all pre-admission assessments carried out are signed and dated. The registered person must ensure: • All staff undertake training in respect of caring for people with dementia, commensurate with their position • All staff must undertake training in challenging behaviour. Timescale for action 31/01/07 2. OP3 14(1) 15/12/06 3. OP4 18(1)(i) 28/02/07 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 27 4. OP7 15(1)(2) a-d The registered person must improve care plans to include: • Details of staff instructions regarding which equipment is required within mobilisation • A resident admitted with a chest infection had not had a care plan developed for this condition • Monthly weights not being carried out and recorded • A care plan developed concerning weight loss states that it should be reviewed monthly but this had not been carried out for October • Care plans regarding difficult to manage behaviour fail to give advice about the likely triggers and type of resultant behaviour • A resident who suffers from episodes of a physical nature did not have a care plan for how staff need to monitor and react when the condition occurs • Staff are not being advised of the sling size to be used when a mobile hoist is required • Lack of personal preferences regarding activities of daily living over a twentyfour hour period • No personal preferences in respect of personal hygiene and bathing • Failure to invite residents and/or relevant others to participate with the care planning process • There was no evidence of formal reviews being DS0000024892.V318224.R01.S.doc 15/12/06 St Clements Nursing Home Version 5.2 Page 28 5. OP8 12(1)(2) carried out Risk assessments are incomplete in that they do not provide details of the action to be taken to reduce the identified risk • A signed disclaimer in respect of a bedroom door being propped open was not accompanied by a risk assessment • Inappropriate written terminology, ‘Cot sides’ • One care plan failed to include any of the diagnosed conditions • Failure to obtain the life history and background information of residents • Failure to develop a care plan for a resident who was admitted 20 days previously • Failure of staff to commence and document change of positions needed for a resident. The registered person must ensure that: • Weights are carried out monthly • Where concerns are found about loss of weight staff must maintain comprehensive details of food and fluids consumed • Changes of positions are carried out as prescribed in the care plans. • 15/12/06 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 29 6. OP9 13(2) 7. OP10 12(4)(a) The registered person must 30/11/06 ensure; • That prescribed creams are administered and recorded • Never leave an open drugs trolley unattended • Cease the practice of borrowing prescribed medications from other residents supply • Cease the practice of using inappropriate tools for recording of other information • A safe mechanism be utilised by all trained staff regarding administration of controlled drugs. The registered person must 30/11/06 ensure that staff practices are such to maintain the dignity of all residents. Timescale of 15/10/06 has not been met. The registered person must ensure: • A review of the activities provided and the allocated hours is carried out • The activities organiser must not carry out duties that are not part of her role • Explore the needs and include residents who remain in their rooms within the programme • Following consultation compile a programme of activities and display it • Individual preferences and documentation must be maintained in an appropriate manner. 8. OP12 16(2)mn 31/01/07 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 30 9. OP14 12(2)(3) 10. OP15 12(4)(a) The registered person must ensure that residents are consulted. Residents/Relatives meeting must be established. The registered person must ensure that meals served on the first floor are maintained at an acceptable temperature. N.B. Timescale of 20/06/06 and 31/10/06 have not been met. The registered person must ensure; All staff undertake training in respect of restraint. All staff must undertake training in prevention of abuse. Timescale of 30/09/06 has not been met. The registered person must further develop the policy regarding adult abuse as discussed in the body of this report. The registered person must cease the practice of overcrowding of the dining room. The registered person must adapt the toilets to ensure they provide sufficient space and maintain privacy and dignity of residents. The registered person must review and ensure that adequate assisted bathing facilities are available on each of the upper floors to meet residents’ needs and provide them with choices. 31/12/06 31/12/06 11. OP18 13(6)(7)( 8) 31/01/07 12. OP18 13(6) 31/12/06 13. 14. OP20 OP21 23(2)e-i 23(2) 15/12/06 28/02/07 15. OP21 23(2)j 28/02/07 16. OP24 16(1)(2)c d Timescale of 30/10/06 has not been met. The registered person must carry 31/12/06 out an audit of bedroom furniture and where shortfalls are identified provide the furniture. DS0000024892.V318224.R01.S.doc Version 5.2 Page 31 St Clements Nursing Home 17. OP24 12(4)a 18. OP26 16(2)(k) The registered person must ensure that all bedrooms include: • A lockable facility • Suited door locks. The registered person must ensure the home is kept odour free at all times. 31/01/07 31/12/06 19. OP30 18(1) Timescale of 30/06/06 and 31/10/06 have not been met. The registered person must 31/12/06 ensure all newly appointed care staff complete updated induction training within 12 weeks to the Common Induction Standards for Skills for Care. Timescale of 15/07/06 and 15/09/06 have not been met. The registered person must ensure that all staff receive training in: • Fire Safety • Health and Safety • Food Hygiene • Moving and Handling Timescale of 30/09/06 has not been met. The registered person must implement a quality assurance system ensuring that stakeholder’s views are obtained and an annual development plan is drawn up as per Standard 33.1 to 33.10 inclusive. Timescale of 30/10/04 and 30/09/06 have not been met. 20. OP30 OP38 18(1) 28/02/07 21. OP33 24 28/02/07 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 32 22. OP36 18(2) The registered person must ensure all staff receive formal supervision at least six times a year and records are retained in the home. Timescale of 30/11/03 and 15/09/06 have not been 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 review and update the written policies and procedures. N.B. Timescale of 30/10/04 and 31/07/06 have not been met. The registered person must ensure all staff undertake training in respect of infection control and records are retained in the home. Timescale of 30/09/06 has not been met. The registered person must ensure that staff cease the practice of wedging open residents bedroom doors. The registered person must ensure that staff close and lock unoccupied sluice room doors. 15/12/06 23. OP36 18(1) 31/12/06 24. OP38 13(3) 28/02/07 25. OP38 13(4) 30/11/06 26. OP38 13(4) 30/11/06 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 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. Refer to Standard OP1 OP14 Good Practice Recommendations It is recommended that the service user guide be produced in large print and/or audiocassette for the benefit of those persons who are partially sighted. It is recommended that all residents be informed in writing of their right to access records and provide information regarding advocacy schemes. No evidence found that this has been addressed. It is recommended that the complaints procedure be produced in large print and/or audiocassette for the benefit of those persons who are partially sighted. It is recommended that the staff toilet and sitting rooms be redecorated. It is recommended as being good practice for the home to carry out ongoing CRB checks for those staff that have been employed in excess of three years. No evidence found that this has been addressed. 3. 4. 5. OP16 OP19 OP29 St Clements Nursing Home DS0000024892.V318224.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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