Inspection on 09/02/06 for St Nicholas

This inspection was carried out on 9th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Nicholas 15/11/07

St Nicholas 13/09/06

St Nicholas 11/10/05

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 Unannounced Inspection 9th February 2006 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.V282785.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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.V282785.R01.S.doc Version 5.1 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) www.bupa.com BUPA Care Homes (CFHCare) Limited 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.V282785.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 120 OP, 26 LD, 30 DE. 3 named out of category service users 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, both Brocklebank and Gladstone units have enclosed gardens, the other units have identified courtyard areas. Each unit has single bedrooms, sufficient bathrooms, a large living / dining room, small kitchen, medication room, sluice and office. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 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 and the home have recently introduced the role of hostess on some of the units. This member of staff is based in the lounge and supports residents with their meals, drinks and general support needs. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by 5 inspectors who inspected the following areas. Julie Garrity – Alexandra & residents’ monies Joanne Revie – Gladstone, medication on Canada & Brocklebank Debbie Corcoran – Brocklebank Diane Sharrock- Huskinson and visit to Langton. Lorraine Farrar – Canada, quality assurance, kitchen area & staff training. The inspection involved, reading care plans and documents, talking with residents, relatives, staff and the management team and a partial tour of the building. Previous inspection requirements given to the home were checked upon and feedback from this inspection was verbally given to both the person in charge on the units and the home manager and deputy manager. The Commission for Social Care Inspection has identified ‘core standards’ which are the minimum standards looked at in each inspection year. Information about core standards and some of the other standards not looked at during this inspection can be found in the report of the unannounced inspection of the home which took place in October 2005. All units except Langton were visited and inspected, Langton unit was briefly visited but not inspected at this time. Most of the standards listed below were assessed on all units and the findings are recorded individually below. 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: St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 7 Relatives spoken with said that they were “welcome to visit the home, staff were kind and always offer me a cup of tea”. The staff have good relationships with the relatives. Staff were described as ‘caring’, ‘very good’ and ‘attentive’ by a number of residents or their relatives, with one relative explaining that they were, “welcome to visit the home, staff were kind and always offer me a cup of tea”. And a resident explaining “they always help I never have to wait to long” and another explaining “its like the things I got at home”. The atmosphere on all units was seen to be friendly and relaxed with bedrooms personalised for residents and communal areas generally welcoming and very clean. Meal times in the home are well managed with staff aware of the need to provide a good level of support in a dignified manner. Residents are offered a choice of meals and are not rushed or interrupted at these times. The standard of food in the home was described by residents as “lovely” “acceptable” and “excellent”. Staff spoken with were motivated, has a good knowledge of residents and their needs and expressed satisfaction with the way the home operates, the level of support and training offered and improvements made to practices and documents used. Care plans in the home were generally up-to-date with some of a very good quality providing a good basis for meeting residents, health and personal care needs and their choices. The home have worked hard to provide training for staff which meets residents basic care needs and also their more specialist needs. The home operates good systems for assessing the quality of their care and acts positively on the findings of these. What has improved since the last inspection? The home are working with projects with the local Primary Care Trust (PCT.) These have resulted in the home improving mealtimes for residents, reducing the number of falls over the site and reducing emergency admissions to hospital. The management of medications has generally improved and in general records are maintained to a good standard. The deputy manager undertakes regular audits of the medicines and this has helped improve the quality of all aspects of medicines management. The number of qualified nursing staff has increased overall and a new ‘hostess’ role has been introduced, which have assisted the unit manager’s to improve the management of the unit. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 8 At the last inspection of the home in October 2005 there were 19 requirements given to the home. At this inspection the home had met 14 0f these, improvements had been made in various areas, including, care planning, assessing potential residents, involving residents in their care plan, record keeping and the environment. Brocklebank- A number of areas of improvement have been noted since the previous inspection. Discussions with the manager and team leader showed that they are aware of current good practice in providing a service for people who have a learning disability and are looking to develop the service further in line with this. The home has started to provide relevant information in plain language and using pictures this includes a new service user guide, which has been produced for Brocklebank. There has been some increase in the level of community and leisure opportunities for residents and residents are being offered the opportunity of an annual holiday. . What they could do better: Some records are repetitive and confusing, which has resulted in vital information being missed and on one occasion appropriate planning was not available for a resident at high risk of falls. Although medication management has improved a number of painkillers for one resident could not be accounted for and some records had not been completed, this could result in some residents medication being mis-managed. The number of staff across site has been increased however on the day of the inspection some staff did not have the minimum levels of staff agreed which could result in residents not receiving all of the care they require. The home should provide and support residents with more access to outside advocacy agencies who can support them. It was identified on one unit that a resident did not have all the equipment available to meet their needs. Staff identified the need for further training and guidance in tracheotomy care, it was also noted the unit did not have a policy/ guideline in place, this should be provided to ensure all practices are up to date. Brock- Each of the service users has a care plan. Many of these are of an appropriate quality, however some could be improved upon to include more detail as to how to meet the resident’s needs. The format of the care plans St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 9 allow for a good balance of information on the resident’s care, health and social needs and therefore if they are completed well they could provide a very good source of information on how to meet the resident’s needs. Risk assessments are carried out relating to the resident’s care. These need to be developed to include all areas of risk and not just those associated with the residents’ personal care. Some of the residents are not having a great deal of community access. This is most definitely an area where the home should improve to meet the resident’s health, welfare and quality of life needs. The manager should review how the communal space in the home is used to the best effect of the residents. 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.V282785.R01.S.doc Version 5.1 Page 10 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.V282785.R01.S.doc Version 5.1 Page 11 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): YA 1&2 OP – 3, General - A through and relevant assessment is available and used that helps staff determine if they can meet the needs of the residents before they are admitted. Assessments from placing authorities are also obtained to ensure the home has all available information to support the person. Brocklebank - A service user guide is available in an appropriate format, to provide to prospective residents. EVIDENCE: Alexandra - All the residents were assessed before they moved into the home. Student nurses and junior staff accompanied by the unit manager have attended assessments with potential residents in order to gain experience and to learn how the unit assess residents. A through assessment tool is available for staff to use, which is designed to find out the needs of the residents and determine if they can be met and how staff will support potential residents. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 12 One resident spoken with said, “staff know what I need, they are all very good”. Gladstone - A discussion was held with the homes manager the units deputy manager and three care plans were viewed. The plans contained assessment documentation, which showed that the unit manager prior to admission taking place had undertaken an assessment. The documentation also showed that on the day of admission a further assessment is undertaken, which included assessing risk and assessing the person’s mental health needs. The deputy unit manager confirmed that only senior staff undertake assessments of new residents. The home manager confirmed that the service has complied with a requirement issued following the last visit and that each prospective resident now receives written information about the home which includes information about the home, the unit and dementia care. Canada – Care plans and assessments for two existing residents and a resident due to be admitted later that day were looked at. All had copies of a pre-admission assessment completed by the home, the unit manager explained that she visits the person in hospital or at home to meet with them and obtain information. The unit had also competed a nursing assessment on the day of the residents’ admission to establish their care and support needs. The unit manager has recently piloted an new individual assessment form, this was very clear and provides staff with the means to identify the persons needs and gives advice on the equipment and care plans that will need to be in place. Brocklebank - A service user guide has been produced. This needs to be completed and ready for circulation. The guide includes a good level of information on the aims of the home and the services and facilities offered. The guide has been written in plain language and includes pictures. One new resident has been admitted to the home since the previous inspection. Records confirmed that an assessment of the resident’s needs, as carried out by relevant professionals, had been provided to the home before the person moved in. Staff at Brocklebank also carry out their own assessment of the resident’s needs. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 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 General – care plans are in place for all residents, which are updated regularly and audited by the homes management. The contents of care plan range from very good to limited, particularly for younger adults. Good practice was noted throughout in that the home are now involving residents and relatives more in the planning of their care. All plans have copies for risk assessments for the residents. Again the content of these varied with some being detailed and others overly complicated which have resulted in vital information essential to a resident’s care being missed. For younger adults risk assessments were only available for their healthcare and not other areas of their lives. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 14 Staff are pro-active in keeping residents healthy and health care services are accessed as appropriate with the home working closely with external experts in order to maintain good levels of healthcare. The management of medicines has generally improved, with storage and documentation generally maintained to a good standard. However there are some areas of poor practice that need to cease. Staff have a good understanding of resident’s right to privacy and how they should ensure residents are treated with dignity however it was noted that access to appropriate equipment was needed to enhance one persons privacy and dignity. EVIDENCE: Alexandra- Three care plans were viewed all were up to date and had been reviewed. The care plans are very complicated and not easily accessible by the residents. Two residents spoken with were unsure what was in their care plan one resident said “staff look after me really well, I’m not sure I need to know what they write down”. There were a variety of risk assessments, some of which were complicated and repetitive. The manager explained that this has been reviewed and it is anticipated that new plans that are less repetitive will be put into place in the next 6 months. One resident had, had several falls over the last three months, this was not reflected in their risk assessments and there was no plan to detail to staff what actions they needed to take to reduce the resident’s risks. T he unit has been involved in the local Primary Care Trust and have undertaken to be involved in initiatives in reducing falls for residents. The home access’s external healthcare services when needed, these have included GP’s, chiropody, opticians and dental services. Relatives are encouraged to attend hospital appointments with the resident. Records in the home detail advice from GP’s and hospitals and changes in treatment are reflected in residents care plans. One resident explained “I see my doctor whenever I need and the optician visits the home”. Medicines for the residents were clearly recorded and staff would be able to give medicines as prescribed. Storage of medicines was appropriate. The unit manager gave out the medicines at breakfast time, this was well managed and unrushed. The medicine round was also used as a learning opportunity for the student nurse allocated to the unit. Of the three residents case tracked, two had a painkiller both of which were missing a large amount that should have been available. One missing box was located after the inspection and CSCI was informed of this however there were 27 tablets unaccounted for, for one resident. It is likely these were either given to the resident and not signed for or used for another resident on the same medication. Either explanation is poor practice. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 15 Gladstone - Three care plans were viewed. A discussion was held with the deputy unit manager and the home manager. Medication administration records and storage systems for three residents were also viewed. Care plans were found to be well written, specific to the resident and written in clear plain language. Each residents needs are assessed using a key system, which makes the plan individual. Plans are reviewed monthly. Resident’s preferences and wishes are recorded clearly. Each plan also contains risk assessments such as the risk of pressure sores occurring, falls occurring and nutritional risk assessments to monitor weight and appetite. These were all found to be current. No input from a resident or their representative could be found in the three plans viewed. However the deputy unit manager produced plans, which evidenced relatives/representatives input. The service has developed a form specifically for this purpose called a “ formal review form”. The deputy unit manager explained that the staff had attempted to make contact with representatives but that in some cases this had been difficult. The Deputy home manager stated that she had written a letter for staff to use to make contact with representatives who were not regular visitors. During the visit the deputy unit manager stated that staff had compiled and agreed a care plan for one resident who has no known family or friends. He also confirmed that he was unaware of any links with advocacy services. A discussion took place regarding the use of advocacy services for vulnerable residents who may need someone independent to represent their needs and choices. The care plans showed that staff are proactive regarding residents health needs. As well as risk assessments and clear written instructions staff carry out monthly checks on residents blood pressure, pulse, temperature, urinalysis and weight. G.P records evidenced that any changes are reported to Doctors for advice. Visits by doctors and other health care professionals were clearly recorded in the plans of care. Reading daily progress records evidenced that staff are quick to respond to changes in a residents health needs. However staff had written comments that suggested they were taking the lead role in making diagnoses rather than the Doctor. One G.P. record clearly showed that a doctor had refused to visit the home. The Deputy unit manager was unsure if the PCT had been made aware of this. Medication Administration records (MAR) for three residents were viewed. These were clear to follow neat and tidy and had all the required signatures. Staff were following good practise by ensuring two staff signed hand written instructions. Medication for each resident could be found quickly and was stored in a clean, tidy and well organised trolley. Each MAR was found to have a photograph of the resident and personal details such as date of birth, G.P and any known allergies. Staff were recording the date and amount of medicine received onto the unit clearly. Two staff confirmed that only senior carers administer medication to St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 16 the residents. Viewing staff files showed that this group of staff have had training in the administration of medications. Brocklebank – The care plans for four residents were looked at. The format of the care plans 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. Some plans are comprehensive and include a good level of information on how to support the resident with all aspects of their care and support whilst others include minimal information and were still in the development stage. The plans, which are of a good standard, should be used as a ‘benchmark’ for the standard to be achieved for all resident’s plans. Some of the plans are signed as agreed by the resident or other relevant parties. One of the residents was staying at the home for a short break and this person had written their own care plan. This is very good practice where possible. Three members of staff have undertaken ‘Essential Lifestyle Plan’ training and it was reported that there are plans to provide this to all staff in the future. Resident’s care plans are evaluated monthly and new care plans are produced annually this is clearly good practice. For some residents there was little evidence to show that their care is being reviewed. Reviews can take different forms but the home should ensure relevant others are included in the reviewing process and review meetings may be appropriate for many individuals particularly as many of the residents on this unit are younger adults. The team leader has reported that he intends to develop the review process. Each of the residents has a risk assessment as part of their care plan. The risk assessments focus on matters such as moving and handling and nutritional risks. The team leader should ensure that risk assessments are more individualised to each of the residents and are more holistic. For example risk assessments should be in place for residents who may present with behaviour which challenges or when supporting a resident with a particular social activity. The resident’s care plans include information on the support they require with personal care. A s with other information in the resident’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 brief statement. Detailed and individualised guidelines should be in place for each of the residents. Residents are reported to choose when they get up and go to bed and this was confirmed during general discussions with residents. Generally the personal care practices at the home appear to be good and residents gave good feedback on the quality of their support. A relative of one of the residents said that they felt staff were ‘very caring’ and the personal care was very good. Residents have regular access to a G.P as a G.P visits the home on a regular basis. Resident’s records showed that they are supported in attending other health related appointments for example, chiropody, dentists and opticians. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 17 Many of the residents are now being supported to access community based primary health care resources and the team leader has reported that this will continue to include a greater number of residents. One of the residents needed support with a pressure area. The team leader must ensure that clear records are maintained of how wounds are being managed and was advised to seek professional advice as to managing this person’s wound. Medication administration records (MARS) were viewed for three residents. One set was clearly written, completed to a good standard and had all the required signatures. The second set of records showed that the resident had been prescribed a cream to be applied twice daily. No signatures had been recorded so it was not known if this had been given as prescribed. All other administrations were signed for correctly. The third set had handwritten instructions, which were only signed by one staff member. This was discussed with the nurse in charge of the unit. Some signatures were also missing so it was not known if this resident had received all their medication as prescribed. The word “ intrasite” was also recorded on this set of records but no instructions as to where and how often. The medication trolley was viewed. Medication was stored appropriately in a locked trolley. Staff were recording the amounts of medication received onto the unit on the MARS. Medication, which had been prescribed for each resident, was available in the medicine trolley. Canada – Care plans are detailed with clear information about the person’s health and their choices. All plans looked at had been updated monthly and one had been recently audited, by the homes management. Assessments and plans were in place for the persons, personal care, including bathing, their nutritional needs, pressure area care, moving and handling needs and medication. The unit maintains very good progress notes for each person, which clearly link to their plan of care and document concerns or progress made. In addition to care planning for the person health and personal care needs the persons choices are also noted, for example one plan recorded that the person likes to sleep with the lights on, radio low and the door ajar”. Staff spoken with were aware of this information and advised that it is followed. Records also showed that the unit supports residents to access regular health appointments with the Chiropodist, GP and Optician. Good records are kept of any wounds or pressure sores, with on-going assessments completed. Photographs are used to record progress and the residents or their relatives asked to sign to give permission for this. The home have begun the progress of asking residents or relatives to discuss their plan of care and sign to say they agree with this. They have a named Nurse system in place and have begun the process of introducing a keyworker system for all residents. A discussion took place around one care pan that was not signed and the unit St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 18 manager advised that the resident is unable to read it. It was recommended that as part of the keyworker duties they discuss the persons plan with them on a regular basis and record their views. Medication administration records (MARS) were viewed for three residents. All were found to be completed to a good standard and had all required signatures. One set was handwritten but had two staff signatures showing that staff are aware of and follow good practise. The medication trolley was viewed. Medication was stored appropriately in a locked trolley. The trolley appeared clean and well organised. Staff were recording the amounts of medication received onto the unit on the MARS. Medication, which had been prescribed for each resident, was available in the medicine trolley. Huskinson - residents, visitors and relatives were very happy with the care provided by the unit. The care records seen had a lot of detailed information including resident and relatives’ signatures agreeing to their care plan. Relatives had recent invites to look at the plans and staff were helping with enquiries while relatives and residents looked at their plans. Relatives said they understood the plans and liked the idea to keep looking at the care especially when they had questions to ask. 1 residents care plan has been updated since the last inspection and they were pleased with the progress. However they had not always received the plan as requested, one aspect for arranging baths twice a week needed to be reviewed and implemented with direct communication to be given to the Resident. Langton - One care plan reviewed showed evidence of a recent review and signature of the next of kin who had agreed to the care plan on behalf of their relative. 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. The storage of insulin was discussed especially when opened as it was identified that a review should take place with all staff to ensure they all carry out the same process. Various Residents needs were discussed as one Resident was identified as sitting in a standard wheelchair with a lap strap as there was no other suitable chair specific to their needs and comfort. This must be reviewed so that all Residents are supplied with suitable facilities and equipment suitable to their needs. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 19 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 - 12,15 YA - 12, 13 ,14 Residents are offered a variety of choices at mealtimes and the home are active in improving the quality of meals provided, with mealtimes well organised, relaxed occasions. The quality of food is good with staff generally providing a high level of support and the attention given to mealtimes by staff has resulted in residents’ weights increasing, which should have beneficial effect on their health. Some residents are happy with the level and type of activities offered, other feel that these could be improved upon. The home employs activity organisers and are looking at ways to improve residents access to and involvement in activities within the home. Brocklebank- Opportunities for residents to have community access and be involved in leisure pursuits outside of the home continues to improve. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 20 However, there are still restrictions in this and some residents may have little community access. EVIDENCE: General – The home has worked closely with the local Primary Care Trust (PCT) to set up a scheme at mealtimes known as ‘protected mealtimes’, which is now in place on all units. This involves staff ensuring the units are quiet at mealtimes and professional visitors are asked not to visit during this time. Tables are nicely laid and food served quietly and efficiently by staff with support offered discreetly. This scheme has been a success within the home, the kitchen reports less wasted food and records evidence that residents’ weights have increased. The home are involved with talking to the Department of Health about the benefits of the project and have also given talks to other care homes about the scheme. The home operates a set menu with choices of main meals and snacks. A system is in place whereby all residents are asked the afternoon before to choose their meals for the following day. The kitchen provides home made bread, soups and cakes regularly and also plans theme nights, with a valentines night planned and a recent Burns night held. There is a central kitchen with each unit having a satellite kitchen equipped to make drinks and small snacks. The central kitchen was visited and was spotlessly clean with staff aware of and following a cleaning rota. Sufficient supplies of fresh vegetables, fruit juice and fruit were available along with frozen and tinned goods. The Chef advised he visits each unit regularly and speaks with staff and residents, he gave as an example the fact that several residents had requested butter beans and these are now on the menu regularly. Staff advised that some residents require a semi-solid or soft diet and at present the kitchen decides the contents of the meal. This was discussed with the Chef who explained that he is actively seeking advice and training in this area and the home are in the process of trying to find a dietician who can provide this. Alexandra - The unit has recently started “protected mealtimes”, during this time relatives are asked to not visit the home unless they wish to become involved in the residents care. This has worked very well, the majority of residents have gained weight over the last two months. Records of resident’s weights are recorded in three different places on the unit and this has resulted in several of the records being out of date. One resident said, “mealtimes are lovely, there’s loads of staff available to serve and lots of choice”. Staff were observed to take their time in helping residents to eat and to encourage St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 21 residents to have a good meal. Residents were offered a variety of choice at breakfast time and all the residents were asked what they preferred. Gladstone - Residents care plans and the breakfast meal was observed. Discussions were held with the Deputy Unit manager and the home manager. The inspection started during the breakfast meal. The unit has signs displayed informing visitors about protected meal times and offering the opportunity to assist if they wish. Staff could be heard offering choices and gently encouraging residents to eat their meal. Staff were seen to support residents with their meal in a dignified manner. The Deputy manager confirmed that the protected, mealtime scheme had been successful. Staff were overheard offering residents choices of food for forthcoming meals. Staff sounded patient and kind when doing this. Three care plans showed that staff undertake nutritional assessments on the risk of residents not eating and this includes recording body weight monthly. Viewing of six staff files showed that some staff have undertaken training on the importance of nutrition. Dining Tables were nicely set with cloths and condiments. Both the Deputy Home manager and the Home manager confirmed that the unit manager had assessed the safety of those residents who wished to carry out light domestic chores to promote independence. Two residents helped set the tables as part of this. The deputy unit manager and the home manager confirmed that photographs of meals have been taken but as yet have not been laminated. This is to be done in the near future to support residents in making choices. Huskinson - The home employ’s staff to support residents with activities and a variety of activities are offered each week. This unit now has 2 mornings and 2 afternoons were activities are offered. However some of the residents explained that there are periods of time when there is little to do. This was noted during the morning of the inspection were no activities were organised and Staff were busy with the morning routine. Staff suggested the activities programme would be best suited being offered every afternoon rather than mornings, this suggestion should be reviewed with all parties on this unit to ensure everyone is involved in identifying what is more suitable for themselves. The homes manager told the inspector that the unit had taken on a ‘hostess’ who can work flexibly to the needs of the unit and residents. It is planned that this post will be developed into helping residents with activities as it becomes more established. 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. Although some staff felt it was difficult to fully achieve in the mornings. Relatives visiting felt it was a useful idea and seemed to be working and they were able to access care plans to check around nutrition, diet St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 22 and weight. There were various complementary comments about the food with no complaints. Canada- Lunchtime was seen to be generally well organised with tables nicely laid with clothes, flowers, cutlery and condiments, the doors were closed to minimise interruption and soft music was playing. Staff were seen provide support quietly and efficiently in the main dining area and residents were served drinks before and during their meal. On the day of the inspection lunch was a choice of, homemade soup, jacket or mashed potatoes, hash browns, beans, bacon and black pudding. Crockery was of a good standard with divided plates provided to help people eating a semi-soft diet. Comments form residents about their meals and mealtimes varied and included “he does a lovely sweet and sour” “the food is adequate” “ the food is excellent” “I drink coffee, she knows that, after breakfast she asks if I want a fresh coffee, its like the things I got at home”. Some of the residents eat their meals in their rooms and during a discussion with one resident it was noted that they were helped with their main course but then waited some time before being served their dessert. This was discussed with the unit Sister and Deputy who advised they have requested trays are ordered to help with serving people in their rooms. Brocklebank - There are two activities co-ordinators linked to the unit and their job is to arrange all indoor and outdoor activities with residents. Residents are supported indoor activities on a fairly regular basis. These include activities such as art, cooking, entertainment and films. There was some evidence that residents are involved in leisure pursuits outside of the home, and the activity co-ordinators try to arrange at least one outdoor activity per day. However, there are up to 26 residents living at the home and therefore there may be long gaps between outdoor activities and records confirmed this. A relative also confirmed this and felt that relatives are restricted due to the staffing levels as the staff are busy all of time attending to the residents daily care needs. Staff were observed to be busy all of the time supporting residents with their basic care needs. Records indicate that generally there has been some increase in the level of community access for residents. However, records also show that some of the residents may not have been involved in community activity for weeks or months at a time. The home has a new mini bus which is modern and much more appropriate for use by small numbers of service users. The residents are having the opportunity of a holiday this year. Three holidays have been arranged and one of these is abroad. This is an area where the home has improved over the past couple of years, as many residents had not had the opportunity of an annual holiday for a long time. There is a ‘snoozlem’ or light and sound room on Brocklebank. This is a great facility and asset to the home. However, it is unfortunate that this room is no longer being used for its intended purpose and it has become a storeroom. T St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 23 he team leader should review the use of this room and ensure it is used to the best effect for the residents. 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. The unit has what is referred to as ‘protected mealtimes’ whereby the resident’s mealtime is as relaxed, private and free from interruption as possible. 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 and evening meal. Residents are asked to choose their meals the day before. There is a small kitchen area where snacks can be prepared. Residents spoken with about the food said that it was nice and they confirmed that they are offered a choice. Where a resident has special dietary needs this information is recorded in their care plan and staff are aware of this. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 24 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): 16,18 The home has good polices in place for dealing with complaints and adult protection. EVIDENCE: A relative spoken with was aware of how to raise concerns and said “when I’ve had concerns its been dealt with promptly”. (Alexandra) Huskinson - 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. There had been no recorded complaints since the last inspection. Training records and staff confirmed ongoing training in Adult Protection, which ensured staff were knowledgeable in the local procedures to protect Residents. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 25 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 – 24 & 26 YA – 24 & 25 Gladstone - Residents are encouraged to make their bedrooms feel like home. The unit is clean and tidy. Brocklebank – the unit is well maintained and resident’s bedrooms are well presented and personalised with their own belongings. The home offers an appropriate amount of communal space, however space is not used to best effect. EVIDENCE: St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 26 Alexandra – These standards were not fully inspected on this unit, however the following was noted. The furniture in the dayroom has been re-arranged and residents spoken with liked this arrangement, with one resident explaining, “its much nicer like this”. A number of pieces of resident’s artwork were displayed on the dayroom walls and in their bedrooms adding to the personalised atmosphere. Gladstone - Three bedrooms were looked at and each was decorated different from the others in furniture and bedding. They appeared comfortable and were furnished with personal items of the residents making the rooms look homely. Each bedroom viewed had a lockable drawer. The Deputy unit manager stated that all bedrooms on the unit had lockable drawers available. A tour of the communal area was undertaken. Everywhere smelt pleasant and appeared clean. The unit presented as a comfortable homely place to live. Staff have developed the number of displays available on the entrance corridor since the last inspection. Themes of wartime England, old movie stars and pictures of Liverpool have been displayed to aid reminiscence. One resident stated she particularly enjoyed the paintings of animals that were on display. All bedrooms have a memory box outside the door, which is filled with thought provoking objects belonging to the occupant. The back corridor on the unit has some pictures available but significantly less than the entrance corridor. The deputy unit manager and the home manager confirmed that a request has been made for funds to be made available in next years budget for a bathroom to be turned into a shower room to offer further choice to the residents. Canada – Several bedrooms and bathrooms were viewed and some bedrooms visited, all were noted to be well maintained with residents having some of their personal belongings around them, the unit was noted to be clean. Brocklebank - A tour of Brocklebank was carried out. The home has one main lounge area and two smaller lounge areas. The two smaller lounges rooms are not currently being used to their full potential. The registered manager should review the use of communal space across the home as currently the main lounge area is large, impersonal and is a thoroughfare to many other parts of the home. Communal space may be better utilised if smaller areas were created. All areas of Brocklebank are well maintained and presented to an appropriate standard in terms of both maintenance and cleanliness. The bathrooms are functional and somewhat clinical in appearance. There have been some small attempts to make the bathrooms more homely but this has had little effect and should be reviewed again. A number of resident’s bedrooms were checked and these were presented to a good standard and have been personalised with the resident’s own belongings. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 27 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, 28 & 30 YA - 33 Residents receive care from staff that have had training to meet their needs. The home are providing more staff in some areas than at previous times, however the management of staffing levels should be reviewed in light of some shifts not providing the minimum agreed staffing levels. On one unit staff were noted to be very busy and unable to provide a service to residents over and above meeting their personal care needs. On other units staff felt that the introduction of the hostess role had eased the pressure on staff and it was noted that staff appeared less rushed and more able to carry out their work at a reasonable pace with time to talk with residents. EVIDENCE: General – The home provides a variety of training for staff to meet residents’ care and support needs. The national minimum standards for care state that 50 of care staff working in a home should hold a care qualification (NVQ) at level 2 or above. At present 49 of staff working at St Nicholas hold this St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 28 qualification and the home are supporting other 28 of other staff to work towards this. In addition the home are supporting 15 of staff to work towards this qualification at level 3. Training in the past year has included, diabetes, peg feeds, nutrition and cancer, medication and record keeping. Staff spoken with had undertaken appropriate training and stated they were satisfied with the support offered in this area. The home have a very good training programme in place which covers basic health and safety courses as well as more specialist courses such as working with people with dementia. Training is provided by staff within the home, the organisation and outside bodies. 100 of staff have received training in Protection of Vulnerable Adults, understanding dementia, basic food hygiene, moving and handling and Control of Substances Hazardous to Health (COSHH) and the deputy manager confirmed that this training is on-going for new staff. All new staff have an introduction to the home based on national care standards. Gladstone - Six staff files were viewed and training records. Discussions were held with the deputy unit manager and two staff members. The files showed that all six staff members had obtained an NVQ qualification in care. A file was viewed of another staff member who is undertaking training towards this. The Deputy Manager stated that he believed that most of the staff that worked on the unit had achieved this qualification. The staff files viewed showed that mandatory training has been ongoing since the last inspection. Some staff have undertaken training in managing challenging behaviour but not all. All staff have undertaken training in Dementia awareness, Protection of Vulnerable adults and abuse awareness. Both the deputy unit manager and unit manager have undertaken training in first aid and work opposite each other so there is always a qualified first aider available. Both of these staff have recently undertaken CPR training (resuscitation techniques), and recently used this by successfully resuscitating a resident. Huskinson - Previous staff rota’s were viewed and a discussion took place with the Nurse in charge and the manager. These showed that staffing levels fluctuate on the unit. Staff confirmed that the unit had on occasions had a lowered staffing level in times of sickness absence, including the day of inspection. However the manager discussed a few initiatives that had been implemented to ensure staffing levels were always in place and agreed to review the procedures with senior staff. Following the previous inspection a separate duty rota is in place for one resident who receives one to one support. It was confirmed that on occasions this support will be used to provide help to other staff. This must be reviewed as a matter of priority so St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 29 that all Residents receive necessary staffing levels to provide their care and support. Langton - Staff rotas were seen for the day of inspection and reflected the usual numbers of staff. Staff were unaware of management initiatives to cover absenteeism and confirmed they had never brought staff in for later shifts when they were unable to get staff for the earlier shifts so that work could be prioritised. This is to be reviewed with the manager and her senior staff to confirm the companies staffing initiatives and procedures to follow in the event of absenteeism 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. Staff felt they had received all necessary training to assist them with their job. One staff member felt they would benefit from an update in training for tracheotomy care. It was noted a policy and guideline sheet would also be necessary for staff to ensure they have evidence of current updated practice for tracheotomy care any other necessary nursing guidelines. Brocklebank - On the day of inspection there were two qualified nursing staff on duty and three members of care staff. The number of care staff on duty did not meet the staffing notice, which the home is working to. In addition to this there should have been an additional member of staff to support one of the residents on a one to one basis as per the resident’s assessed needs. As at the previous inspection staff appear very busy all of the time and do not appear to be able to provide any level of one to one support to the service users outside of personal care. Staffing levels should be based on the assessed needs of the residents. A review of staffing levels is needed to ensure that the home is meeting the needs of the resident’s on this unit. Relatives feedback was very positive about care staff and they were described as being ‘caring’, ‘attentive’, ‘very good’ but ‘very busy’. The day to day running of the home is overseen by a unit leader. The unit leader has been allocated twelve hours per week when he is off rota in order to undertake some of his management duties. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 30 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 – 33,35, 36 , 38 Resident’s funds are safeguarded and the home has good internal and external quality assurance systems in place, which they act upon. Most 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. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 31 EVIDENCE: General – The home has several systems in place for making sure they audit the quality of the service provided regularly. This includes the responsible individual for the organisation visiting the home unannounced once a month and preparing a report of their findings with an action plan for any issues raised. Copies of this report are forwarded to the Commission for Social Care Inspection (CSCI) regularly. The home are also through about sending notifications to the CSCI regularly to ensure they are informed regarding any occurrences within the home. An external audit of quality was carried out in August 2005, this involved obtaining the views of staff and residents as well as spending time in the home. The home were awarded a 4 star rating out of a possible 5 for the service provided. The organisation also carries out an internal audit twice a year, which they base on national care standards. This involves the home providing evidence and someone working for the organisation but not within the home carrying out an audit of this. A recent audit included a staff survey, which identified staff felt that there needed to be an improvement in the activities offered to residents. The company have reacted positively to this and have responded by providing a small budget for activities. St Nicholas has re-organised the deployment of their activities coordinators so that each house has this support for a few hours four days a week instead of the previous arrangement whereby each unit had the coordinator 1½ days per week. The home has computerised records of all the residents’ money that they look after. Records are clear and receipts are retained for any spending on behalf of the residents. Residents can arrange for small amounts of money to be available from petty cash and that can be done within minutes. Larger amounts need to be ordered and the administrator can arrange for a cheque to be generated. When the administrator is on duty a resident can find out exactly how much money is available for them to spend. Some residents keep their own funds and a lockable facility in the bedrooms is available. Ad hoc opportunities such as trip to the local shops of a weekend cannot be accommodated. One resident explained that on one occasion it was necessary to borrow “a few pennies” from a member of staff. Arrangements for access to funds are managed differently for Brocklebank unit. A small amount of funds per individual is sent to the unit on a weekly basis. Anything not spent is St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 32 returned to the individuals account. A record is made of the amount of funds given to each resident and all receipts are kept. It is a recommendation of this inspection that a small fund of money is held on each unit so that residents can access some of their money when they choose rather than just during office hours. Huskinson - Staff acknowledged that they have commenced supervision and most staff have already had some sessions, however further review needs to take place to include all staff. Langton - The unit has a supervision file and showed evidence that most staff have had supervision sessions however some were outstanding including those of some night staff. Health and safety risk assessment’s are in place. Fire safety checks the home are organised by the maintenance person. Each unit has a new fire book but the nurse in charge stated they do not use them as one central one is used, this should be reviewed so there is no confusion as to what document should be utilised to evidence compliance in safety checks. Accident and incident reports were examined and found to be in order and gave appropriate details taken to ensure residents safety. Residents and elatives spoken with were very complimentary about the staff and the unit and had no complaints. St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 33 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 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X ENVIRONMENT Standard No Score 19 X 20 X 21 X 22 X 23 X 24 3 25 X 26 3 STAFFING Standard No Score 27 2 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 X 33 3 34 X 35 3 36 3 37 X 38 3 St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 34 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 OP9 Regulation 13(2) Requirement Alexandra, - The Manager must ensure that medications are given as prescribed. This requirement is repeated and is outstanding from previous inspections. 2 YA1 5(2) Brocklebank- The home must ensure all residents receive a copy of the service user guide. This includes the people on Brocklebank This requirement is repeated form previous inspections. The home provided evidence that they are working towards meeting the requirement with an easy to access version of the guide. 3 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 inspections. DS0000017273.V282785.R01.S.doc Timescale for action 17/03/06 07/06/06 12/04/06 St Nicholas Version 5.1 Page 35 4 YA6 15(1) Brocklebank - the home must develop care plans for a number of residents to include sufficiently detailed information on how to meet the individuals needs. This is a previous inspection requirement. 10/05/06 5 YA14 16(2)(m) Brocklebank - The manager 10/05/06 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 inspections. Gladstone - The home manager must ensure that links are made with Advocacy services and that this information is displayed and utilised for those residents who have infrequent contact with relatives/representatives. Brocklebank – The home must ensure that all medication is recorded and signed for correctly. General - The Responsible Person must ensure that the staffing of the home meets the ongoing needs of the Service Users, and submit evidence to the CSCI describing the actions taken to meet this regulation. Langton - The Responsible Person must ensure that all Residents are suppiled with suitable equipment and facilities assessed as needed to provide necessary care and support . DS0000017273.V282785.R01.S.doc 6 OP7 12(2) 10/05/06 7 YA20 13(2) 17/03/06 8 OP27 18 17/03/06 9 OP10 14(1)(2) 16 (2) (c) 10/05/06 St Nicholas Version 5.1 Page 36 10 YA33 18(1)(a) Brocklebank – The manager must ensure that staffing levels are maintained at an appropriate level at all times. Brocklebank – The manager must review how communal space across the home is being utilised and identify where this may be improved to the benefit of the service users. This must include the use of the ‘light and sound room’. 17/03/06 11 YA24 23(1)(a) 10/05/06 12 YA19 13(1)(b) Brocklebank – The manager 17/03/06 must ensure that wound assessment records are maintained and specialist wound care management advice is sought as appropriate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA3 Good Practice Recommendations 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. This is a previous inspection recommendation Brocklebank - Bathrooms should be made to feel more homely and less clinical. This is a previous inspection recommendations Gladstone - the unit manager should write to those representatives who rarely visit to ask if they wish to be involved in the care planning process. DS0000017273.V282785.R01.S.doc Version 5.1 Page 37 2 YA27 3 OP7 St Nicholas 4 OP9 Gladstone - the home manager should explore the comments made regarding acquisition of antibiotics on the Doctors visits sheets as discussed during the visit. Appropriate action should also be taken. Gladstone - Management should carry through their intention to laminate the pictures taken of meals to support residents with choice. Gladstone - Staff should develop displays for the back corridor of the unit so that both corridors have interest. Gladstone - An audit should be undertaken identifying which staff have not undertaking training on managing challenging behaviour and first aid. This training should then be offered. Huskinson - To arrange consultation with residents and all other parties about the programme of activities to enable the developments in the activities programme to meet their needs. Huskinson - To provide further review of one Residents care plan and ensure they have consultation and agreement to their plan of care covering bathing and trips out. Canada – The unit should introduce a system for keyworkers to discuss their plan of care regularly with residents. General - To ensure that all staff receive supervision at least six times per year. General - To review the storage and administration of insulin with all staff as per the current guidelines to ensure compliance General – To review specific training needs and the suggestion of an update in tracheotomy care. To supply an updated clinical policy/guideline. General - - Consideration should be made to making small floats of funds available to each unit of a weekend to allow residents access to their funds for activities that were not planned. 5 OP15 6 OP24 7 OP30 8 OP12 9 OP7 10 11 12 13 14 OP7 OP36 OP9 OP28 OP35 St Nicholas DS0000017273.V282785.R01.S.doc Version 5.1 Page 38 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.V282785.R01.S.doc Version 5.1 Page 39 - 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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