Inspection on 11/10/05 for St Nicholas

This inspection was carried out on 11th October 2005.

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

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

Other inspections for this house

St Nicholas 15/11/07

St Nicholas 13/09/06

St Nicholas 09/02/06

St Nicholas 22/03/05

St Nicholas 05/10/04

St Nicholas 30/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Nicholas 21 St Nicholas Drive Netherton Liverpool Merseyside L30 2RG Lead Inspector Ms Lorraine Farrar Announced Inspection 11th October 2005 10:00 X10029.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 Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 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 and Care Homes for Adults 18 – 65*. 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 Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Nicholas Address 21 St Nicholas Drive Netherton Liverpool Merseyside L30 2RG 0151 931 2700 0151 932 1216 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) BUPA Care Homes (CFH Care) Limited No. 2741070 Irene Marsden Care Home 176 Category(ies) of Dementia (30), Learning disability (26), Old age, registration, with number not falling within any other category (120) of places St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 120 OP, 26 LD, 30 DE. 2 named out of category service users (both female) under pensionable age. This condition applies only to those named service users, should they leave the Home, then the condition will be amended/removed. That there is a minimum of 13 staff on site at all times, including between the hours of 8pm - 8am. That each unit completes a documented review of staffing levels on a monthly basis. A recognised monitoring tool must be used for this purpose and copies made available for inspection. This must take into account dependency levels of service users. That the Home do not operate below agreed minimum staffing levels, as per sliding scale staffing notice, dated 13th February 2004, and provide extra staff where identified to meet service users` assessed needs. This applies to all units with the exception of Gladstone. The Gladstone Unit does not operate below staffing levels as per sliding scale, issued with this variation and provide extra staff where identified to meet service users assessed needs. That the Home provides care with nursing to no more than 146 service users. 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: St Nicholas is owned and operated by BUPA a large national organisation who provide a variety of care and health services across the country. The home is in a residential area of Netherton and is well located for accessing local shops and transport links. There are six care units across the site and a main administration block which houses the manager and deputy, administrators, a main kitchen, laundry, hairdressing salon and staff room. Outside there are large grounds with pathways to go for a walk in warmer months. Each unit has single bedrooms, sufficient bathrooms, al large living / dining room, small kitchen, medication room, sluice and office. In addition Brocklebank and Gladstone have private courtyard areas. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 5 The units are dotted around the site and accessed by covered walkways. Alexandra, Canada, Langton and Huskinson units all provide care with nursing for older people. Brocklebank provides care with nursing for adults who have a learning disability and Gladstone unit provides care without nursing for people with dementia. There are staff available 24 hours a day, meals and basic laundry are included in fees, activities co-ordinators work part time on the units although the cost of activities is met via fund raising. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Due to the size of the home the inspection was carried out by 8 Inspectors who looked at the following: Pat Carragher – staff interviews, observation Natalie Charnley – Canada Unit Debbie Corcoran – Brocklebank Unit Lorraine Farrar – Health and safety, staff files, monies, staff interviews Julie Garrity – Alexandra Unit Joanne Revie – Gladstone Unit Diane Sharrock – Huskinson Unit Trish Thomas - Langton Unit During the Inspection Inspectors spoke to residents, relatives and staff, files and records were read, parts of the building were examined and time was spent observing daily life in the home. Formal questionnaires were completed with 14 staff working on the day of the inspection, their responses have been included in the body of the report, these staff covered a range of job descriptions within the home. Most of the standards listed below were assessed on all units, standards for the younger people living on Brocklebank were assessed in line with the national standards for younger adults, however the scores given at the end of this report relate to standards for older people as they form the majority of people living at the home. Judgements as to how the home are meeting each standard have been given for the home as a whole and general comments are included which cover information relating to the whole site. What the service does well: The home provides residents with varied meals and are working well on improving residents experiences at meal times. They work well with other professionals and are taking part in several pilot projects, which will improve the health and wellbeing of people living in the home. Recruitment of staff is carried out correctly and appropriate checks carried out to ensure new staff are suitable to work with residents. The management of the home are able to identity issues of poor practice and then take action to address these. Residents stated throughout that they like the staff and good relationships between staff and residents were observed. Care practices are generally good with staff having a good understanding of individuals’ needs and the way in which they communicate. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 7 Overall the home is clean and the premises maintained safely with appropriate checks carried out. What has improved since the last inspection? What they could do better: St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 8 The home need to continue to build on their care planning and risk assessment documents to make sure they provide all relevant information to support and involve the person. On Alexandra they need to make sure that resident’s medication is managed within guidelines to ensure residents safety. On Brocklebank they need to build on the work started to ensure the people living there receive a service that is appropriate for young adults. Environmentally the home need to carry out some audits of furniture to ensure it is replaced when needed. Senior staff need to audit practices on their unit to make sure residents right to privacy and dignity is respected at all times. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 – OP. 2-YA Full assessments are carried out on prospective residents before they move into the home. These involve staff from the home, the person themselves, relatives and other professionals as appropriate. This ensures that the home can meet the person’s needs. EVIDENCE: St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 11 Canada Unit - Residents living at the unit all have a pre admission assessment completed before they move into the home. This is usually completed by the unit manager. The nurse discusses details of the residents medical conditions, likes and dislikes and daily needs. This is then recorded and put on file for staff to read, making them aware of how a resident needs to be looked after. If a resident is not able to talk with staff themselves then relatives can assist in giving information. Residents on the unit told the inspector that they liked meeting staff before moving into the home as it made them feel more at ease. The inspector spoke with one relative whos mother had recently moved into the home. This lady had found meeting the staff prior to admission “helpful and reassuring”. Alexandra - All care plans viewed contained an assessment undertaken by staff in St.Nicholas and copies of Social Services Assessments. These assessments were used to identify the residents needs and to write a care plan to meet those needs. Risk assessments are up dated on a regular basis in order to make sure that residents needs can be identified and action taken by the staff to meet residents changing needs. A recently admitted resident recalled that “some-one from the Home came and spoke to me about what the Home was like and what care I needed. It was very helpful”. Gladstone Unit - A discussion was held with the manager and 3 assessments were viewed which had been undertaken by the home and three were viewed which had been undertaken by a social worker prior to admission. The Manager stated that “ things are great now, now that I can assess the residents myself”. Viewing assessments confirmed that she is carrying this out. The Manager stated she usually takes another staff member with her also from the unit as she believes this is good experience for the staff and a further opportunity for residents to meet staff. Assessments showed that full information is being obtained prior to admission.A relative confirmed that she had had a full tour of the unit prior to her relative being admitted. It was stated” they really put me at my ease (staff) “ The Manager is taking very little information with her about the home when assessing new residents. This was discussed with the home manager who stated that BUPA had recognised this issue and were deveoping an assessment pack for use when assessing new residents. This would contain information about the home that the resident could look at before they decided if it was suited to them. Brocklebank - The team leader reported that it is now normal practice that the home request assessment information from relevant agencies prior to admission of a resident and this has been evident at previous inspections. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 12 However on this occasion the file for the most recently admitted resident was examined and there was no indication that an appropriate assessment had been attained for this person. There was a copy of an assessment carried out by a member of staff from Brocklebank. However the information contained in this was minimal and the assessment was not signed or dated. The assessment tool which is used as Brocklebank for their own assessment purposes is quite a good tool if used appropriately. Langton - The unit provides aids to mobility, which were seen on a tour of the premises, including hoists and assisted baths, grab rails and height adapted toilets. The building is of one-storey and purpose built with level exterior access. There was evidence on care plans of referral to paramedical services, general practitioners and continence advisers. Care plans had been regularly reviewed in accordance with ongoing assessment and change in needs. The range of needs assessed includes physical, sensory, mobility and behavioural needs, including memory and orientation. Training in dementia care has recently been established for staff and NVQ and mandatory training are ongoing. During the inspection, a visitor discussed the possibility of speech therapy and physiotherapy for his relative, who lives on Langton unit, and this request was passed on to the manager. Huskinson - Relatives and Visitors explained they can visit whenever they want and are always made to feel welcome. The care records for assessments for new Residents showed a detailed assessment carried out by Staff. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): OP - 7,8,9,10. YA – 6, 9,16,18,19,20 There have been improvements to the care planning process within the home, staff have a good understanding of what should be recorded and how to do so and residents and relatives involvement is now beginning to happen. Overall residents’ healthcare needs are identified and met by the home who liaise with other professionals. Risk assessments are in place for residents, in some areas these meet the persons needs, however in other areas they need to be reviewed to ensure the persons safety. Medication management has improved overall within the home, however there were some issues identified on one unit which if not addressed could place residents at risk. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 14 Staff have a good understanding of resident’s right to privacy and how they should ensure residents are treated with dignity. Residents spoken with stated they were satisfied with this aspect of there care, however there were a couple of issues observed in which staff failed to ensure the persons privacy and dignity was fully respected. EVIDENCE: General – A new system for writing care plans has been introduced across the units which support older people, this system is based on wrting individual plans rather than using pre-printed forms, staff across the site have worked hard towards introducing these and the home manager carries out audits of a selection of plans each month. The home are working well with the local Primary Care Trust (PCT) and are pioliting several schems to help improve resdients health. This includes “unplanned care” which looks at reducing the number of times residents are sent to hospital. The manager advised that with scheme has helped them refuce this from 29 admissions one month to noe or just emergencies another month. They have also commenced a “falls” project looking at the times, places people fall with a review to planning ho this can be reduced. The management and staff in the home have worked hard to improve the ways in which they manage medication. All medication rooms have been cleaned and cleared and the deputy manager carries out unannounced audits on each unit of their medication. Staff spoken with were clear that if a resident asked to do something not coverd by their planthey would not ignore this but would use their judgement to either agree or explain they had to seek advice from a more senior member of staff. All explaiend that if they felt a resdients needs had chenged they would discuss this with a Senior staff who they believed would respond appropriatly. Senior staff all said that they regularly read care plans, carers responses ranged although all said that any changes are fully explained at handover and by Senior staff. All staff interviewed were able to explain how they help residents with their personal care, some staff said they had a routine which they stuck to for helping people go to the toilet and have a bath, other staff explained that this was flexible and they understood resdients different ways of communicating ehat they wanted or needed. All staff were ble to explain how they ensure resdients privacy and dignity with responses ranging from 2always knock on their door” to “ encourage them to be as independent as possible”. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 15 Staff were able to given examples of how resdients are encourged to make choices, these ranged from basic choices regarding food and care to good examples of taking time to support choices in people who don’t communicate verbally. Canada Unit - All residents living on the unit have an individual plan of care. This is based upon the information given before they arrive and during the first few days when they move in. The inspector looked at six care plans which were in the process of being updated. Residents spoken to and records looked at, showed that the unit is beginning to involve residents in the development of their care plans, those who are able to, are now signing plans to say they agree with what is in them. The unit manager told the inspector that individual staff are responsible for a set number of care plans each and for completing the monthly reviews. Three of the plans looked at had not been reviewed in August/September of this year. Residents living on the unit have access to a range of health workers such as doctors, opticians, speech therapists and chiropodists. Details of these visits were recorded in detail in a residents care plan. The inspector looked at a variety of health related records, some of these were very hard to read due to the poor handwriting of some staff, the unit manager stated that she would look into who this matter. Wound records were not always clear as some records were not signed or dated. Photos of wounds were in place to help staff see if wounds were healing. This is an example of good practice. The unit had worked hard on completing a large amount of risk assessments since the last inspection, however staff must make sure that they only use risk assessments that are releveant to individuals. One lady living at the unit who was diabetic and had swallowing problems needs to have her nutritional risk assessment re-done as the inspector found that it had information recorded that was wrong. This was discussed at the end of the inspection with the home manager. Many residents did not have their falls diary recorded despite having had a number of falls. The inspector looked at the medication records and storage areas during the inspection. All records were of a high standard and had no mistakes in them. Storage areas were clean and tidy and records were in place to show medication that was coming into and going out of the home. The unit has shown significant improvement since the last inspection in this area. One resident spoken to during the inspection said, “ Staff are polite and well mannered” another said that, “staff always make sure we are happy and safe”. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 16 The inspector watched staff communicating with residents and found that they were always polite and respected their privacy. One member of staff was observed knocking on the bedroom door and waiting for a resident to say ‘come in’ before entering the room. Residents confirmed that can meet visitors or health workers in private if needed, and that they were welcome in shared areas of the unit. Alexandra - Discussions with residents detailed that they were supported to access GP’s, Opticians, Dentistry and Hospital appointments as necessary. The Unit also monitors residents healthcare needs via risk assessments such as “nutritional” risks and makes sure that health care services are contacted as needed. Care plans were available for all residents and staff have reviewed these on a monthly basis. The Unit has undertaken a lot of work to reduce the amount of paperwork in the care plans and their efforts have shown considerable progress in making the care plans more accessible and easy to read. A recently admitted resident did not have a full care plan in place after 4 days. The policy of the Unit is to complete a plan with 24 hours. The risk assessments had been completed, however instructions to staff as to how to meet the needs of the resident would not be available until the care plan was completed. There has been some progress towards maintaining the safety of medications. However on the day of inspection a member of staff was observed to give out medications in a manner that did not promote safety. It was also noted that staff had not accounted for the reasons why an essential medication was not given. Records regarding medications given to the residents were inaccurate. One of the residents spoken with said, “I am very happy here, the staff are lovely and look after me really well”. Another stated, “staff treat me very well, they are happy laughing girls and boys”. Most of the comments from residents and families were positive and supportive of the care received. Several residents need to be cared for in their bedrooms, several bedroom doors were left open and residents in main corridors could be viewed by any visitor attending the Unit. Staff were also noted to attend to residents, such as assisting them at meal times with the door open. This practice means there is a lack of privacy for the resident at times. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 17 Gladstone - A discussion was held with the manager and three care plans were viewed all of whichjwere found to be specific to the individual residents. A document called a ‘residential assessment’ is used which identifies which needs are most important to the resident rather than just completing the needs in the order they come in the plan. This reflects good practise and shows that staff accept residents as people with individual needs. Plans were found to contain all the necessary assessments including falls, general risks, nutritional, manual handling and pressure sore risk assessments. All plans viewed showed that regular reviews were being carried out. Staff are writing clear daily records which relate to each need in the care plan rather than writing standard phrases which also reflects good practice. The manager has colour coded the plans so each Senior is responsible for updating and reviewing plans. Relatives are informed who the Senior is, with this information clearly displayed on a notice board. The manager confirmed that whenever possible she is trying to include relatives within the review and evidence of this was seen. The manager stated her intention to develop this by approaching all relatives . During discussion with a relative it was confirmed she was` aware of a care plan and had attended care plan reviews. She stated that “ it makes you feel involved”. Records showed that residents are regularly attended to by G.Ps, Chiropidists and District Nurses. District Nursing notes showed that staff request extra visits /advice if the residents needs change. Staff regularly undertake checks on weight, blood pressure, pulse and and urine, this reflects good practise. A relative stated “ Mums never been so well looked after for years”. Viewing the medication trolley and records showed that staff are managing medication safely and that residents are receiving medication as pescribed. Four staff files were viewed which showed that only Senior staff give out medication and all have undertaken training on Drug administration, and Drug awareness. A staff member was observed giving out medications safely. Since the last inspection the deputy manager confirmed that she is undertaking unannounced spotchecks on the management of medications. Staff were observed supporting residents with their needs. Residents were supported well and were not hurried. One relative confirmed that staff are always respectful. Viewing the visitors book for the unit showed that with the exception of meal times relatives and friends are free to visit their loved one when they choose. Viewing Life biographies within the care plan showed that staff are recording which people are important to the resident. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 18 Brocklebank - The format of the care plans used on Brocklebank is very good and allows for a good balance of information on the resident’s health and social care needs and it is based upon a person centred plan. However, the quality of information in the plans varies greatly and some plans were still in the development stage. Some of the plans include minimal information and some of the wording used is questionable and yet other resident’s plans are of a very good standard. The plans of a good standard should be used a ‘benchmark’ for the standard to be achieved for all resident’s plans. If fully utilised and completed to a good standard the plans should include a good level of information on how to meet the holistic needs of the service users. Some of the plans are signed as agreed by the resident or other relevant parties. Three members of staff are to undertake ‘Essential Lifestyle Plan’ training and it was reported that there are plans to provide this to all staff in the future. Plans are evaluated monthly and this is clearly good practice. However, there was little evidence to show that the residents’ care is being reviewed. Reviews can take different forms but the home should ensure relevant people are included in the reviewing process and review meetings may be appropriate for many individuals particularly as many of the service users on this unit are younger adults. Each of the service users has a risk assessment as part of their care plan. The risk assessments currently focus on matters such as moving and handling and pressure areas. The team leader reported that there are plans to develop the risk assessments to ensure that they are more individualised to each of the service users and to be more holistic. For example to risk assess for residents who may present with behaviour which challenges or when supporting a resident with a particular social activity. In a number of records there was evidence that a risk assessment had been carried out and the assessment indicated a high risk. In these cases there should be evidence that risk management strategies have been devised or managing the risk should be reflected in the resident’s care plan. For example if a resident has a high at risk score on a pressure area assessment then how to avoid associated complications should be made explicit to care staff. Residents care plans include information on the support they require with personal care. As with other information in the service user’s plans the quality of this information varies and may range from detailed guidelines as to how to support a resident with all aspects of their personal care to a statement reading ‘follow the bathing policy as indicated paying due respect to BUPA’s policies and procedures’. Detailed and individual guidelines should be in place for each of the service users. It was reported that residents choose when they get up and go to bed and this was confirmed during discussions with one of the service users. Generally the personal care practices at the home appear to be good and service users gave good feedback on the quality of their support. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 19 At the previous inspection it was noted that the staff are supporting residents with using the toilet / bathing facilities and are not closing the bathroom doors but are using a curtain to restrict viewing to the bathroom. A requirement for this to cease was given following the previous inspection. However, the same practice was noted during this inspection. The team leader was advised that staff must cease this practice immediately as the resident’s dignity and privacy is not being respected. The team leader must deal with any reoccurrences appropriately. Training on the principles and values of care should be provided to all care staff. Each of the resident’s has a risk assessment as part of their care plan. These currently focus on matters such as moving and handling and pressure area’s. The team leader reported that there are plans to develop the risk assessments to ensure that they are more individual to each of the resident’s and cover all of the areas of their daily life. For example to risk assess for residents who may present with behaviour which challenges or when supporting a resident with a particular social activity. In a number of service users records there was evidence that a risk assessment had been carried out and the assessment indicated a high risk. In these cases there should be evidence that risk management strategies have been put in place or managing the risk should be reflected in the resident’s care plan. For example if a resident has a high score on a pressure area risk assessment then how to avoid complications should be made explicit to care staff. Care plans include information on the support people need with personal care. As with other information in the service user’s plans the quality of this information varies and may range from detailed guidelines as to how to support them with all aspects of their personal care to a statement reading ‘follow the bathing policy as indicated paying due respect to BUPA’s policies and procedures’. Detailed and individual guidelines should be in place for each of the service users. It was reported that residents choose when they get up and go to bed and this was confirmed during discussions with one of the people living there. Generally the personal care practices at the home appear to be good and service users gave good feedback on the quality of their support. At the previous inspection it was noted that the staff are supporting residents with using toilet / bathing facilities and are not closing the bathroom doors but are using a curtain to restrict viewing to the bathroom. A requirement for this to stop was given following the previous inspection. However, the same practice was noted during this inspection. The team leader was advised that staff must cease this practice immediately as the resident’s dignity and privacy is not being respected and must deal with any reoccurrences appropriately. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 20 Training on the principles and values of care should be provided to all care staff. There was evidence that the residents have regular access to a G.P as a G.P visits the home on a regular basis. There were some good examples of records which indicate good practice in the frequency of health checks for residents and some examples where records could indicate some gaps. This was identified at the previous inspection, as it would seem that health related appointments are not always recorded in the resident’s records. Many of the residents are now being supported to access community based primary health care resources and the team leader appeared confident that this would continue to include a greater number of residents. Each of the residents has a care plan, which includes information as to the residents’ skills and needs with managing their medication. Medication storage and medication administration records were examined and found to be in good order. An audit of medication is now carried out on regular basis by the team leader. Langton - Three care plans were tracked and the reviews on five further care plans were checked. All the care plans referred to, had been recently reviewed. Care plans have been transferred to a new format since the last inspection. Care files contained nursing assessments on admission, and care plans for nursing and personal care. There was reference to social and religious needs and dietary preferences and needs. A wide range of risk assessments had been undertaken for the residents concerned, including those for pressure care, bed rails, falls, fire safety. There had been recent evaluations in all instances. There were action plans contained, to meet the residents’ nursing and personal care needs in accordance with assessed dependency. It was obvious that staff have worked hard to transfer and upgrade care plans and to ensure they are well maintained. A regular visitor to the home said, “the care is good.” Residents looked well cared for and attention had been paid to their personal grooming and clothing. Care plans supported residents’ independence through ongoing assessment of need including their potential for self-caring. There was evidence on care plans of pressure care assessments and recorded interventions in pressure care prevention and treatment, where necessary. Residents who commented said they were registered with a G.P. and received chiropody services and had access to paramedical services in relation to audio, optical and dental care. Respect for privacy for residents of Langton Unit, was discussed with three residents and four visitors and two members of staff. No concerns were raised by those receiving the service or their relatives and staff expressed awareness of best practice in this. Through direct observation, staff were seen to be respectful towards residents and there was a pleasant atmosphere. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 21 Bedroom, bathroom and toilet doors remained closed when staff were providing personal care and nursing treatment. Assistance with meals was provided with discretion, and staff were respectful towards residents and their visitors. Huskinson - residents, visitors and relatives were very happy with the care provided by the unit. One Resident said they were happy with their care but wanted to have their care package reviewed to include other things. The Manager agreed to arrange a formal review with the care Manager and with the Resident concerned and to carry out an update to this persons care plans following this inspection. The care records seen had a lot of detailed information including resident and relatives’ signatures agreeing to their care plan. Risk assessments seen were very detailed and in place. The master records for care plans covered all parts of the standards however some records had been fully completed and some had yet to be completed in full. One care record was found to be in need of review especially in relation to being appropriate and up to date for wound care, the Manager acknowledged that the Staff member who had carried out the assessment would need further support and guidance in providing updated and appropriate care records. The home has its own medication store room, which is kept locked. This area is managed by the nurses at the home and was found to be very organised and well run, with regular in house audits taking place. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 22 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP - 12,13,14,15. YAThe home employ’s staff to support residents with activities and a variety of activities are offered each week. However many of the residents and staff spoken with explained that there are periods of time when there is little to do. There have been improvements to the support residents on Brocklebank receive with activities however given the number of people living on the unit and staffing levels the home are still not meeting all of peoples needs in this area. Visitors are welcomed to the home at reasonable times. Residents are offered a variety of choices at mealtimes and the home are active in improving the quality of meals provided and the residents right to a peaceful mealtime. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 23 EVIDENCE: General – The home has a central kitchen, which provides all main meals for residents and supplies the smaller kitchens on each unit with food for snacks, drinks and lighter meals. Meal times across site are, breakfast 9am, lunch1pm and evening meal 5pm. In addition there is afternoon tea with homemade cakes each afternoon and the supper meal is arranged on the units. BUPA have introduced a series of training days for Chef’s, the Head Chef at the home is very motivated and enthusiastic and has introduced a number of these ideas, this includes offering each resident the chance to have at least 5 portions of fruit and vegetables daily and holding monthly theme nights. A lot of the meals are homemade including soup, cakes and pies, residents are asked to choose from the menu on a daily basis the meals that they want the following day and kitchen staff were able to explain how they provide alternatives to individual people. Some special diets are catered for including diabetic diets and semi-solid meals. The Chef has purchased new pottery plates to make sure that people who eat a semi solid meal have it presented attractively. Food is ordered by the home regularly and stocks were sufficient to meet residents’ needs. The home have been working with the local Primary Care Trust (PCT) on a project called “protected meal times”. This has been fully introduced on Gladstone Unit, other units have introduced some of the ideas and the home manager explained staff will need to attend training before fully introducing this to their unit. This project is based in the idea of protecting residents’ rights to peace and quiet and an uninterrupted mealtime. This includes closing doors, asking professional visitors not to visit at those times and switching the TV off. The Manager advised that this will be evaluated soon but appears to be working well with residents having time to enjoy their meal, an improved atmosphere and increase in weight for some residents who will benefit from it. The Chef also advised that kitchen staff had noted a lot less waste food being returned. Of the staff interviewed all were able to explain a variety of activities, which took place on their unit, comments ranged from “would like more time to talk to them” to “not enough activities” to “more days out would be good”. Canada Unit - The unit has an activity co-ordinator who visits the on a Tuesday afternoon, on the other days there are no planned activities. This was discussed with the residents that were sat playing bingo during the inspection. They all stated that on the other days they “amuse themselves by reading and chatting”. The ladies went on to say that they would like to know what was planned on other days but that it wasn’t a big concern of theirs. The unit manager and residents told the inspector that the unit had taken on a ‘hostess’ who works Monday – Friday. It is planned that this post will be developed into helping residents with activities as it becomes more established. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 24 The unit has a lot of photographs around the home of residents joining in with activities. Residents were able to tell the inspector about plans being made for Christmas including plans for a ‘Stars in Your Eyes’ competition. Residents on the unit can have visitors at anytime. The unit has a variety of religious visitors including a weekly visit for Holy Communion and there is a local Methodist church that has close connections to the unit. They run occasional social evenings and organise visits to the home, especially over the winter months. The residents had seen a copy of the new home newsletter and one resident had participated in a recent residents committee event. The inspector spoke to one resident and looked at her bedroom. She stated “ I was encouraged to bring some of my close possessions from home to make me feel more comfortable”. Her room was very homely with lots of photos and personal furniture. The resident’s family stated they had been supported by staff and were allowed to visit the home numerous times to decorate the room. They went on to state “the items that we have moved in have helped mum settle”. Another resident spoken to had recently had a ramp put in to help her go out into the garden area from her patio door. The lady told the inspector she was very pleased with this. Residents on the unit told the inspector they enjoyed all of their meals, describing them as “smashing” and “delicious”. They all stated that they could have a choice if needed, however no one had ever had to ask for one. Residents stated that they enjoyed meal times, as it was a nice social occasion where they could chat. People who have a semi-solid diet, have this well presented on a specially designed plate. Residents enjoy the chefs home made cakes for afternoon tea stating that they especially like the “ones with all that icing”. Alexandra – Three residents said that the food was “very good”, and “tasty”. Menus detail a variety of choices for the residents, these are ordered on a daily basis. Staff makes choices for those residents unable to make choice, both with the food they have and in their daily routines. Two members of staff were observed assisting a resident to eat with very little communication from the staff member to the resident. Although the hobby therapist has details regarding resident’s choices of activities there is very little information available in the unit regarding food choices and daily routine choices. There are different activities available and the residents spoken with particular enjoy the hobby crafts that they were involved in. Two residents said that they would like “more activities” and to “get out and about, even just down to the shops”. The majority of information about the choices made by residents who are not able to communicate their opinion easily is verbally passed from one staff member to another. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 25 Families detailed that they are always welcome to come to the Unit and that the staff were “lovely, excellent carers with a very nice approach”. Gladstone - Viewing the visitor’s book showed that visitors can visit at any time except for mealtimes. A discussion took place with the unit manager and the home manager about this and their intention is for residents to have peaceful mealtimes. They said that visitors are welcome to assist their loved one with their meals but this information was not displayed which could cause some confusion for relatives and friends. The activity record and 3 care plans were viewed, a discussion was held with the Manager and a relative and staff were observed supporting residents with their meal. Staff were heard offering choices of food, drink and seating to residents and were recording residents food preferences and preferred activities within the plan of care. A relative confirmed that she believed that staff offered appropriate choices. Since the last inspection activity records have been greatly developed. Staff are recording preferences clearly on the care plan. A new document has been developed called” a map of life” which gives a good overview of what is important to the resident. This also includes what the residents’ dreams are which reflects good practise. The Hobby Therapist is also recording what activities are undertaken by the residents. A range of activities is offered including support to visit the local church. The manager explained that residents accompany staff when they undertake errands outside the home also. Activities available on the unit include Singing, Reminiscence, quizzes, and musical videos. During the summer residents were supported to go on a barge trip and visit Botanic Gardens in Southport. A discussion took place with the manager around maintaining residents independence. It was stated that some residents still like to help with small tasks such as making tea etc. A relative confirmed “ that there is always something going on”. Three care plans were viewed a discussion was held with the manager and meal times were observed. The home are piloting a scheme on this unit called ‘protected mealtimes’ - this means that disruption and activity are reduced to a minimum, quiet relaxing music is played and each table is allocated to a member of staff who knows the residents needs. Food preferences are recorded in the plan of care. Staff were heard to ask residents if they would like more to eat or drink before they left the dining table. Viewing weight records showed that residents have put weight on since this was developed. The manager stated her intention to have meals photographed to assist residents in making choices. Four staff files showed that staff have received training on the importance of fluid intake and measuring fluid input and output. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 26 Brocklebank - There is an activities co-ordinator linked to the home and this person arranges in-door activities on a regular basis. There was some evidence that residents are involved in leisure pursuits outside of the home, however, for many residents this is minimal. The main factor restricting the amount of community access for residents is the current staffing levels. Although records indicate that there has been some increase in the level of community access for residents they also show that some of the residents may not have been involved in community activity for months at a time. A number of residents have been away on holiday this year for the first time in many years. And the number of outings seems to have improved. There may have been some in house activities but residents need the opportunity of community based activities and community access. Residents are accessing primary health care resources and hairdressers. The majority of residents have their meals together in the dining area but can choose to eat in the privacy of their own room. Many of the residents require assistance with eating and mealtimes are therefore a busy time of the day. It was observed that there was a choice of meals available. The menu is run on a 4 week basis and there are 2 or 3 choices of lunch or evening meal. Residents are asked to choose their meals the day before. There is a small kitchen area where snacks can be prepared. Two residents spoken with said that their food was nice. Where a service user has special dietary needs this information is recorded in their care plan and staff are aware of this. Langton - Reference was made to the activities file where reports of in-house leisure events were read. Records were kept under the headings, “Date, Activity, Comments”. There is a range of in house activities, aimed for the more able bodied, who participate communally, to individual time with residents of high dependency, who remain in their bedrooms. Residents’ leisure activities appeared to have been planned in accordance with their assessed needs. For example, it was recorded that some residents like to watch the communal events, but not take part, others take part occasionally but sometimes refuse, a number are fully involved in events of their preference. The in-house events referred to were, sing-alongs, bingo, quiz, film show, dominoes, visiting entertainer. Residents of high dependency receive special one-to-one time in their rooms for a drink and chat. There was evidence of choice of rising and retiring times, one lady said she was having a lie-in that day and was served breakfast and lunch in her bedroom. She appeared relaxed and said she enjoys doing crosswords. She said staff call in to see her in her room, when they have the time. Residents’ social and religious preferences were recorded on care plans. There was a generally relaxed atmosphere on the unit. There were a number of visitors to the home during the inspection. Four who commented said they visit regularly and are welcomed by staff. One visitor St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 27 was known to a number of residents and got a blanket for one lady who was not her relative, when asked. She said there is a good atmosphere in the home and this does not change. Staff are consistently very kind and approachable. There was evidence of relatives’ written comments on care plans, and a visitor said the staff are good communicators and she is informed of any change in her father’s condition. One gentleman said his wife visits regularly and she is always made welcome and transport links to the home are convenient for her. Five residents said the meals are good. One lady said she would like more salt on her vegetables, but in general, she had no cause for complaint, as it is a modern thing not to eat much salt. Residents were served their midday meal where they wanted. A number are served in their bedrooms, some in the lounge and some at tables in the dining area. Residents were served a drink before their meal. Meals are brought from the main kitchen by hot trolley. Several residents need assistance with their meals and staff take time to ensure they receive their meal when it is hot. Huskinson - Residents and Staff described the activities on offer, there was no display of an activities programme and the Manager acknowledged that this area would be developed further to offer the residents’ further choice and to meet all parts of the standards. Some comments from residents stated that “there’s not much going on,” “there’s no trips to go on”. There were positive comments about the new Manager and changes to the home and that the atmosphere in the home was so much better. There were positive comments about the food especially since the new Chef commenced employment at the home. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 28 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP – 16. YA – 22,23 The home has good polices in place for dealing with complaints and adult protection. They have worked hard to ensure that staff receive training in adult protection and with one exception this is reflected in the home’s practice. EVIDENCE: General – complaints are dealt with centrally by the home manager who maintains records of these. The home have worked closely with Sefton Social Services in providing training in adult protection for all members of the staff team, records show that the majority of staff have received this training and further training is planned. Since the new management team started work in the home there have been no adult protection investigations and the manager seeks advice and refers any concerns appropriately. All staff interviewed were clear about how they would deal with a complaint and that they would report it to the Senior or manager. Staff were also clear about the action they would take if they witnessed another member of staff acting inappropriately with a number of staff saying they knew this would be dealt with. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 29 Canada Unit - Residents on the unit stated that they knew how to make a complaint, stating that they would tell the unit manager first. The complaints procedure was available for residents within their service user guide, which is kept in the bedrooms. Alexandra - Of the staff spoken with 2 stated that they had received training in Protection of Vulnerable Adults. Staff spoken with were aware of the means to protect residents. 2 relatives detailed that they were aware of how to raise concerns or make a compliant if needed. Gladstone - A copy of the complaints procedure was displayed in a prominent place on a notice board. Small concerns are recorded in the resident’s notes usually on the relatives contact sheet. Staff training records of the unit showed that staff have undertaken training on abuse awareness and Protection of Vulnerable Adults. The unit has a copy of the Local Adult Protection procedures. Through discussion the manager was able to prove that she had the knowledge to know what steps to take if she suspected abuse had occurred. Brocklebank - A complaints notice is clearly displayed on the notice board in Brocklebank. This includes information as to how to make a complaint and includes details for referring the complaint to the Commission for Social Care Inspection if the complainant wishes to. There has been one complaint made to Brocklebank since the previous inspection. Details of the complaint have been logged and issues raised were responded to with immediate effect. Many of the staff have been provided with adult protection training and the team leader reported that all staff are now required to undertake training in this area/ There was an Adult Protection procedure available on the unit. Huskinson - Staff described their policies and what they would do if there was a problem. There seemed to be variances in how Staff investigate and report complaints which the Manager acknowledged would be reviewed so that all parties were clear in this process, one complaint had not been reported to head office for a week and highlighted a need for Staff to be updated in the Protection of Vulnerable Adults policy. The home has recently instigated the use of relatives’ communication records, which help Staff to identify issues that need to be addressed. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 30 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP - 19, 22, 26. YA – 24,30 Parts of the home are pleasant and well decorated, there are however other areas that require attention to provide a safe, pleasant environment for people to live in. The home provides aids and adaptations to meet the residents’ needs. Overall the home is clean and hygienically maintained, exceptions to this were noted in the storage of laundry and some bedrooms, which had an unpleasant smell on Canada unit. EVIDENCE: St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 31 General – There is a cleaning schedule for the main kitchen and this area was observed to be maintained to a high standard of cleanliness. The home has a separate laundry facility catering for the whole site. Staff working there advised they do not have a cleaning schedule but carry this out as needed and the area was clean and well maintained on the day of the inspection. There are good systems in place for preventing cross infection between soiled and clean laundry and for making sure the work in completed. However some of the bags being sent from the units were seen to be overloaded which could cause injury to staff. Staff also advised that units do not always place soiled items in the correct bags with the result that they could handle these without knowing. This could lead to an outbreak of infection across the site. Both the home manager and laundry staff said that actions being taken to address this problem. All staff interviewed said that there are enough supplies of gloves, aprons etc to ensure good hygiene, although at times stocks can run low not all had received training in infection control. Canada Unit - The inspector looked around the home and found some areas of concern regarding maintenance. Bedrooms 4,23,26,34 and 34 all had items of broken furniture. Bedrooms 9,20 and 35 needed replacement flooring. Bedroom 33 needed a new bedside lamp and the corridor wall area next to bedrooms 26-40 needs to be repaired/painted as it is scuffed on the walls and radiator. The inspector suggested to the unit manager that an audit should be conducted to look at area of concern. The unit had plenty of supplies of gloves, aprons, wipes and cleaning material. There were also good stocks of clean bedding. During a look around the unit, bedrooms 10,27 and 36 were found to have a bad smell to them, which needs to be investigated. The rest of the unit was found to be clean and tidy. One resident told the inspector “ my room is cleaned daily and the lounge is always spotless”. Alexandra – There were aprons, gloves and pads available for staff and residents usage. All areas viewed were clean and well presented. The lounge area has been redecorated and there are plans to decorate other areas in the Unit. Staff area aware of the means to prevent the spread of infection and take appropriate action when needed. One resident said “my room is always kept clean and tidy, I’m very happy with how the staff keep it clean”. This was supported by a relative who said, “when ever I come its always clean and tidy”. The Unit has nearly completed the refurbishment of a shower room and the bathrooms have been refurbished with appropriate moving and handling equipment available. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 32 Gladstone – During the tour of the environment, all bathrooms were viewed. One bathroom contained an adapted bath, which is no longer used. The manager stated that she thought a shower was going to replace this, as this would be more useful. The home manager confirmed this is planned. Several residents were noticed to frequently wander the length of the corridor. The manager explained that seating had been made available to allow them to rest however this had been removed due to Health and Safety risks. This was discussed with the Home manager who felt that confusion had occurred around this issue. While viewing the environment the unit was clean with no offensive smells. A stock cupboard was well stocked with gloves, aprons and alcohol hand rub. All sluices and bathrooms had appropriate supplies of liquid soap and paper hand towels. Residents’ laundry is washed separately from the unit’s laundry, which promotes good practice. The manager stated that domestic staff are available daily and three domestics are on the unit one day a week at the same time to enable a deep clean to happen. Brocklebank - The home was presented as clean and hygienic. During a tour of the premises the availability of aprons, gloves etc was checked and they were found to be strategically placed around the home and in plentiful supply. Hand washing and drying facilities were appropriate in all bathrooms. One member of staff observed to be carrying out intimate personal care without having taken appropriate health and hygiene precautions. This was discussed with the team leader. Staff training records were examined and indicate that staff are not being provided with training in health and safety or infection control. At the time of the inspection new carpet and vinyl flooring was being laid in the lounge and dinning area. It was noted that the carpet in corridors needed replacing and corridors painting, since the inspection the home manager has confirmed that both of these have been carried out. A number of toilets had no locking facility, which needs to be addressed to provide residents with privacy. Blinds on a number of bathroom windows were dirty and damaged and in need of replacement. All of the bathrooms remain clinical and purely functional although the team leader has started to address this and further plans are in place to introduce pictures and other fixtures in the bathrooms. Langton - See standard 4 (also). There is a nurse call system throughout the home and call bells were in reach of those who were visited in their bedrooms. The building is one storey and purpose built, toilets and bathrooms situated in areas close to residents’ bedrooms and the lounges. Three staff who work on Langton said the equipment in place was adequate to residents’ needs at that time. Personal aids such as wheelchairs and zimmer frames were stored safely when not in use, during the inspection. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 33 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP - 27,29,30. YA – 31,32, 34,35 The home are providing more staff in some areas than at previous times, however some residents and staff feel that whilst basic needs are generally being met there are not enough staff to ensure all their needs can be met. The home have provided a lot of training in the past few months for staff and have identified more specialist training which once delivered will improve the service offered to specific resident groups EVIDENCE: General – A selection of staff files were read, these confirmed that the home follow the procedure they have in place for the recruitment of new staff, this includes obtaining two written references, checking identity documents and getting Criminal Records Bureau and protection of vulnerable adult checks. Staff are provided with copies of their job description and contracts of employment. These practices help the home to make sure they are employing staff who are suitable to work with the people living there. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 34 The home have arranged a variety of training opportunities for staff in recent months, these have ranged from distance learning training packs, on-site training and national courses via universities. The main focus of training for staff has been in the areas of health and safety, adult protection and care of people who have dementia. Training records show that most staff have up to date training in fire, manual handling, protection of vulnerable adults and dementia. In addition specialist training is arranged depending on the needs of the people the member of staff is supporting. This has included more in-depth training in dementia and nutrition. The home have planned training for the next few months in accordance with residents needs, records show that this will include, using a syringe driver, tissue viability, falls management, risk assessment and person centred planning as well as basic courses including fire, health and safety and food hygiene. It was evident through discussion with staff and observation that the home employs enough kitchen, laundry and domestic staff to meet residents’ needs, and provides training for these staff in appropriate areas. The home employs one full time handyman and a fulltime gardener / handyman. As the site is so big and there are a number of routine tasks to be carried out, staff felt that this was insufficient to maintain the site adequately. The manager advised that she is aware of this and is using some outside contractors and looking into providing extra hours for this department. The home are starting to employ extra staff at peak times and staff spoken with said that this is helping a lot and making the care they give less rushed. The home are also complying with a condition of their registration that they monitor how dependant residents are on each unit and alter staffing levels if needed. Over previous months they have increased staffing on occasion to meet an individuals needs and unit staff have confirmed that they can refuse to accept a resident to that unit if they cannot meet their needs based on the staffing levels and other residents needs. Of the staff interviewed 3 felt there are sufficient staff, 3 felt there were sometimes enough staff and the others felt that more were needed. Comments ranged from “no time to do activities and talk” to “we are a good team”. Newer staff all recalled that they had a planned introduction to them home to suit their role. Some staff said that they feel the 12 hour shifts are too long and can be stressful for staff. Canada Unit - The unit has 24 hour cover by trained nurses and is currently over staffed, which helps in covering sickness and holidays. There are two trained nurses on the morning shift and one in the afternoon and at night. During the day there are 4 care assistants and two at night. Staff working on the unit felt that they had enough staff to meet the needs of the residents. Residents spoken to liked the staff and felt there were always enough people to look after them. Residents stated, “ staff are wonderful here” and “they look St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 35 after me so well”. Relatives commented that they could always easily find staff if they needed help. Rotas checked confirmed that the unit is well staffed. The unit manager has developed a ‘training matrix’ to help in planning for staff. This showed that all core areas had been covered except for health and safety and first aid training. The unit manager stated that this was being planned. Records showed that staff had done recent training on nutrition and protection of vulnerable adults. Staff from overseas have access to communication training, however some other members of staff have attended this and found it useful. Alexandra - The unit has recently recruited several new staff who said that they were undergoing an induction. One member of staff was on her first day and had not received an induction. She was aware of the fact that she had not received appropriate training such as moving and handling and had been instructed not to undertake these activities until her induction was completed. One member of staff had identified the need to undertake training in care planning and the Unit was arranging this. The staff handling of medications brings into question their competency within this area, this is also supported by the lack of communication observed for 2 staff whilst they assisted residents at lunchtime. It was also noted that when the unit manager was off duty nursing staff did not undertake to write the care plan of a recently admitted resident which went for 3 days until the unit manager returned before it was addressed. Gladstone – Previous staff rota’s were viewed and a discussion took place with the manager and a relative. These showed that staffing levels fluctuate on the unit. The manager confirmed that the unit was staffed according to residents needs and that she is able to arrange for extra staff if the need arose. A relative commented” They are never alone (residents) – there is always someone with them”. Four staff files were viewed these showed that staff have recently undertaken training on: “ Understanding Dementia”, Documentation and record keeping, How to perform vital signs (i.e. pulse, blood pressure, temperature, Alzheimer’s society- Dementia awareness day, Risk Assessing, managing challenging behaviour, Food Hygiene, Moving and Handling, How to manage continence and use aids, Nutritional Guidance, First aid, Fire training COSSH. Two files viewed showed that staff were undertaking Level 2 NVQ in Care. The manager keeps a list of who has` attended which course so that she can prompt staff to undertake refresher training as necessary. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 36 Brocklebank - Staff training records were examined. These showed that staff are provided with regular fire safety training and moving and handling training. Many of the staff have undertaken adult protection training and a number of staff have undertaken training in supporting people who may have challenging behaviour. It was reported that all staff have recently been provided with dementia awareness training. The team leader reported that it is intended that staff will be provided with training on learning disability issues. There was no evidence of staff training in health and safety issues or in more specialised training for example in supporting people with a mental health concern. Staff were reported to identify their training needs in supervision. It is recommended that a training needs analysis is carried out for each member of staff and for the staff team as a whole and that this is used to inform future planning for training. The team leader reported that 90 of full time day staff have attained an NVQ and 75 of full time night staff have NVQ level 2 in care. Langton - Reference was made to the staff rosters. Staff on duty - Day 2 RGN’s, 4 Care Assistants, 1 Domestic (services of cook and handyperson shared by all units). Night staff 1 RGN and two Care Assistants. One RGN employed on days, is the unit manager, another is her deputy. There is also a home manager on site who has overall responsibility for all units, and an administration team. A resident said “staff are busy, especially at meal times.” Others agreed and visitors said staff are hard working and sometimes appeared pressured. The situation was discussed with the home’s manager who said that additional staff are to be recruited for busy periods such as meal times. Also, there is scope in the admission process to control levels of dependency of residents who are accepted on the unit, for example, in relation to those who may need assistance with their meals, in addition to those in residence. Interviews had been arranged to recruit for two RGN vacancies at the time of inspection. Staff on duty referred to the following training they had completed or which had been arranged, Basic Food Hygiene, NVQ2, COSHH, Moving and Handling, Dementia care, POVA, First Aid. Huskinson - Residents and relatives say they are happy with the care and say the Staff are lovely. Staff interviewed was very enthusiastic and motivated to do a good job and provide a homely atmosphere and give as much choice as possible. Everyone in the lounge was seen to be given a good level of care and respect, the atmosphere was very informal and happy were everyone was helped to feel comfortable. Staff rotas reflected the usual staffing numbers however there was a query around the numbers usually given in addition for 1 Resident, the Manager agreed to clarify the number of hours that should be provide for activities and to support personal care with the residents care manager and to then keep the Resident informed of any outcomes. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 37 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP- 31,32, 34,36,38. YA – 37,38,4243 The home has a good clear management structure in place, which provides clear leadership and most but not all staff now receive formal supervision. The home are aware of their responsibilities to ensure the health and safety of residents and ensure all relevant checks are carried out. EVIDENCE: St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 38 General – Mrs Irene Marsden has been registered as the manager of the home, she is supported by a deputy manager Mrs Collette Corfield, both work flexible hours but are not directly part of the care teams on the units. In addition each unit has an identified Manager and deputy manager, their titles vary from Senior Sister to Unit Manager, or Junior Sister to Senior Carer, these staff have additional responsibilities but work as part of the care team and generally work shifts. The registered manager has extensive experience in managing a large care home, she is a registered nurse and has obtained management qualifications, in addition to which she has further qualifications in dementia care and aspects of nursing and is currently planning a programme of learning for herself in the field of learning disabilities. Since commencing her position the manager has demonstrated a commitment to the home, along with the staff teams she has met a large number of outstanding requirements from previous inspection, in a short space of time. She is clear in her role in both supporting and managing staff and has demonstrated an ability to take appropriate action if standards are not as they should be. Staff spoken with were pleased with the new management team with comments ranging from “we get back up now”, “there have been big improvements here” to “things are a lot better”. Staff consistently stated that they feel informed and supported and that they have confidence in the management of the home. Staff in the kitchen receive regular supervision form the head Chef who in turn has supervision from the management of the home. Records in the kitchen showed that they carry out all required health and safety checks including keeping a cleaning schedule and checking food and fridge temperatures. The general health and safety of the site is overseen by the maintenance department. Health and safety records and certificates looked at during the inspection were up to date and satisfactory, these included, fire checks, electric and gas certificates, testing of small appliances, aids and adaptations, water and boilers. Risk assessments have been carried out for the site and action taken if needed. The majority of staff interviewed said that they are receiving formal supervision from their manager. The organisation do act as appointee for some residents benefit monies and this along with any money held for individual residents is managed by the homes administrator. The home are encouraging this practice and have reduced the number of people they act as appointee for. Records are held on computer and updated centrally as well as by the administrator. Wherever possible the resident or their family are encouraged to act as appointee and St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 39 the home bill them each month for fees and sundries. Where the person’s benefits are paid directly to the organisation records show the persons allowance is paid to them on the same day. Records checked were generally in order, there was a query with a member of staff using their visa card to pay for large purchases, this has been looked into by the home manager who has put policies into place to ensure the residents protection. It is recommended as part of this report that the home introduce regular sample audit checks on their records of residents monies. Canada - The inspector found the home to have no fire doors wedged open at the time of the inspection. Three old accident forms were still in the accident book in the office, despite the residents having passed away. This is a breach of confidentiality. Other records of accidents were well recorded and stored in individual files. These records are looked at on a regular basis by the home and unit managers. The unit kitchen had a health and safety notice on the door stating that the door is to be kept locked at all times. The inspector was able to go in this area twice during the course of the day, as it was not locked. The home have completed a risk assessment on carbon monoxide poisoning as the unit has a boiler attached to it, this is an example of good practice as it was as a direct result of a problem at another BUPA home. Carbon monoxide detectors are now in place on the unit. Alexandra - Staff said that there is sufficient moving and handling equipment available and they use this as appropriate. One member of staff on induction had been suitably instructed not to undertake health and safety activities until training was received. A review of equipment on the unit showed that is was well maintained and regularly checked including appropriate electrical checks. The unit appropriately keeps and monitors records of accidents. A relative spoken with said, “I am glad my mum is here I know she’s safe”. Gladstone - Three accident records were viewed which were clear and concise. The manager stated that she reviews all accidents and this was seen on the accident records. Accident forms are stored according to Data protection. Records showed that the fire alarm on the unit is tested every Wednesday. Touring the unit showed that all fire extinguishers were present on the unit and all had a current sticker attached. Staff have access to a comprehensive policy, which was seen to be stored in the office. A full set of risk assessments covering all aspects of the building were viewed and were found to be current. Brocklebank - Staff are provided with fire safety training on a regular basis and receive moving and handling training annually. The team leader reported that all staff are now required to undertake first aid training. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 40 Water temperatures are checked daily and these are further checked on a monthly basis, these were checked and found to be regular and up to date. Health and safety risk assessment’s are in place and staff have signed as having read these. Fire safety checks the home have been using alarm test as a drill and have now introduced drills to take place 2 x yearly. Accident and incident reports were examined and found to be in order and no issues of concern were identified. Langton - An interview was carried out with a member of staff who said that she had not had formal supervision since working on Langton Unit. Due to personal circumstances, (as discussed with the home’s manager), this person’s supervision session should be prioritised. Otherwise, the supervision requirements for the remaining staff had been met. Huskinson - Staff acknowledged that they have commenced supervision and most Staff have already had at least one session. The way that Staff are supervised must include opportunities for formal 1:1 time so that staff can discuss issues and develop care practices at least 6 times over a three year period. There were compliments from the Residents and staff about the Manager and her style of management, which some felt was a great improvement to the home. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 41 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 X 2 X 3 3 4 3 5 X 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 N/a DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 N/a 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 3 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 4 33 3 34 X 35 2 36 2 37 X 38 3 St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 42 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 5(2) Requirement Gladstone - The Home Manager must follow through her intention to implement assessments packs once these have been developed by BUPA. In the meantime the unit manager must take copies of photos brochures etc for new residents to view prior to admission. Huskinson - The Responsible Person is required to provide evidence that all Service Users will be provided with a detailed, accurate and appropriate care plan according to their needs. Please submit an action plan to the Commission detailing what actions will be taken to meet this regulation especially in relation to wound care and 1 Residents requests made during this inspection. Canada - The home must ensure that all care plans are reviewed at least once a month. DS0000017273.V256961.R01.S.doc Timescale for action 08/12/05 2 OP7 15(1) 08/12/05 3 OP7 15(2)(b) 08/12/05 St Nicholas Version 5.0 Page 43 4 OP7 13(4)(c) Alexandra, Gladstone, 05/01/06 Huskinson - The Manager must ensure service user involvement in the care planning process and obtain service users’ signatures or that of their representatives. All care plans must be reviewed annually. This was a requirement from the previous inspection. It has been complied with on other units. Alexandra - The home must 08/12/05 carry out risk assessments and wherever possible receive consent in relation to the practice of wedging open service users’ bedroom doors. This was a requirement from the previous inspection, it has been met on the majority of units. Canada - The home must ensure that all documentation is legible and signed and dated. Alexandra, - The Manager must ensure that medications are given as prescribed. This is a previous CSCI requirement. It has been met on other units. 08/12/05 5 OP7 13 (4)(c) 6 OP8 17 7 OP9 13(2) 17/11/05 8 OP9 13(2) Alexandra - The Manager must ensure that Staff follow the Homes procedure regarding medications and sign for medications given and an explanation available for those not omitted. This is a previous inspection requirement, has been met on other units. 17/11/05 St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 44 9 OP9 13(2) Alexandra - The Manager must ensure that administration of external preparations is recorded. This is a previous inspection requirement. Gladstone - The managers must ensure that clear information is given to all visitors regarding visiting during “ protected meal times”. This information should be displayed alongside the information of what protected meal times are to prevent any confusion. Canada - The home must undertake a full audit of furniture on the unit and repair the following: Bedroom cupboards in room 4,23,26,34, flooring to bedroom 9,20and 35 and the corridor area next to room 26-40 All units – The home must ensure that a lockable facility is available for each service user. This is a previous inspection requirement - the date for compliance has not yet passed. 17/11/05 10 OP13 12(1) 08/12/05 11 OP19 16(2)(c) 08/12/05 12 OP24 23(2)(m) 01/01/06 13 OP37 17(1)(b) 14 YA1 5(2) Canada - The home must ensure that all accident records are stored appropriately to ensure resident confidentiality. Brocklebank- The home must ensure all residents receive a copy of the service user guide. This includes the people on Brocklebank This was a requirement from the previous inspection. This information is now available residents on other units. DS0000017273.V256961.R01.S.doc 17/11/05 31/01/06 St Nicholas Version 5.0 Page 45 15 YA6 13(4)(c) Brocklebank – the home must make sure that risk assessments relating to service users must be individualised and comprehensive. This was a requirement from the previous inspection Brocklebank – the home must develop care plans for a number of residents to include sufficiently detailed information on how to meet the individuals needs. 05/01/06 16 YA6 15(1) 02/02/06 17 YA14 16(2)(m) Brocklebank - The manager 02/02/06 must ensure that service users have social opportunities and community access at a frequency to ensure their emotional health and well being. This was a requirement from the previous inspection. Brocklebank – the home must make sure that residents’ privacy and dignity must be maintained at all times. This is a previous inspection requirement. 17/11/05 18 YA18 12(4)(a) 19 YA27 23(2)(a)(b) Brocklebank – the home must make sure that locks on bathroom doors are refitted and blinds replaced in a number of bathrooms. 08/12/05 St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 46 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP8 OP12 Good Practice Recommendations Alexandra - the home should make sure that care plans should be completed within 48hours of admittance. Canada – the home should audit risk assessments to ensure that they are pertinent to individual residents. Huskinson - The Responsible Person must consult Residents about the programme of activities to enable the developments in the activities programme to meet this regulation especially in providing support for people with dementia. Gladstone - The two sets of records held on the unit should be compared so that the hobby therapist can plan group activities according to the majority of wishes. Gladstone - Residents independence should be promoted by assessing what domestic skills they have on admission. These tasks should be risk assessed and staff support should be provided so that theses skills can be continued which will help to maintain independence. An example of this could be bed making. Gladstone - The manager should follow through her intention to photograph meals to assist residents in making choices. Gladstone – The home should provide suitable seating in the corridors following assessments of risk Gladstone - To replace the assisted bath with a shower as discussed during the visit Alexandra - The training needs of staff identified in the report such as care planning, assisted feeding and medications should be addressed 4 OP14 5 OP14 6 OP15 7 8 OP19 OP21 9 OP35 St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 47 10 OP36 Huskinson - The Responsible Person must ensure that all staff receive supervision at least six times per year. Langton –The manager should provide regular formal supervision for one member of staff (as discussed in feedback). Brocklebank - The home should provide service users documents, including the service user guide in appropriate, accessible formats. This was a recommendation from the last inspection, evidence was available that the home are working towards this. Brocklebank - The manager should consider commissioning specialised advice regarding learning disability services and current good practice in working with people who have a learning disability. Brocklebank - The manager should ensure that systems are in place to ensure that the service users are involved in the day to day running of the home to as great an extent as possible. This is a recommendation from a previous inspection Brocklebank - Bathrooms should be made to feel more homely and less clinical. Brocklebank - The manager should ensure the team leader has supernumerary hours to undertake their additional duties as team leader. This is a recommendation from a previous inspection 11 YA1 12 YA3 13 YA14 14 15 YA27 YA33 St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 48 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. St Nicholas DS0000017273.V256961.R01.S.doc Version 5.0 Page 49 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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