Inspection on 18/08/08 for St Oswalds Nursing & Residential Home

This inspection was carried out on 18th August 2008.

CSCI found this care home to be providing an Adequate service.

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 Oswalds Nursing & Residential... 23/04/09

St Oswalds Nursing & Residential... 19/12/07

St Oswalds Nursing & Residential... 17/07/07

St Oswalds Nursing & Residential... 29/06/06

St Oswalds Nursing & Residential... 02/02/06

St Oswalds Nursing & Residential... 02/09/05

St Oswalds Nursing & Residential... 04/01/05

St Oswalds Nursing & Residential... 27/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE St Oswalds Nursing & Residential Home 2 Crowhall Lane Felling Gateshead Tyne & Wear NE10 9PX Lead Inspector Irene Bowater Key Unannounced Inspection 18th August 2008 08:15a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Oswalds Nursing & Residential Home Address 2 Crowhall Lane Felling Gateshead Tyne & Wear NE10 9PX 0191 495 0585 0191 438 1722 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) None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Manager post vacant Care Home 70 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (64), of places Physical disability over 65 years of age (52), Sensory Impairment over 65 years of age (9) St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One person under the age of 65 who also has a physical disability. The Manager will be supernumerary to the staffing complement Date of last inspection 19th December 2007 Brief Description of the Service: The home is of traditional appearance with a tiled roof. It has one passenger lift and because it is built on rising ground there is access to the outside from the two lower floors. There is a lounge and dining room on each floor with additional lounge space close to the first floor entrance. The home has a patio area and a large car park. The grounds are landscaped. Personal care is provided on the ground floor and personal care for people with dementia is provided on the top floor. The middle two floors provide nursing care for older persons. The home is in residential area close to local facilities. The home extends to four stories. It currently has 70 registered beds. The charges range from £370 to £456. The free nursing care element is set nationally. Extras include newspapers, clothing, and toiletries, outings and hairdressing. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 19 December 2007 and 8 July 2008. • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The Visit: An unannounced visit was made on the 18 August 2008.This visit was carried out by two inspectors and started at 08:15 and was completed at 17:00. During the visit we: • Talked with people who use the service, relatives, staff, the manager and visitors. • Looked at information about the people who use the service and how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. • Looked around the building to make sure it was clean, safe and comfortable. • Checked what improvements had been made since the last visit. • We told the manager and Regional Manager what we found. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Further work is needed with care planning so that they clearly detail the wishes of people using the service, and the care and support needed to meet people’s needs. People and their representatives need to be involved in planning their own care with staff. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 7 People’s mental health and nutritional health status must be monitored and any changes recorded and updated in care plans. Fluid balance and food charts must be completed in detail to evidence practice. Information about peoples lifestyles and choices before they moved in need to be written down so that staff can continue to support them or, help them access help from others. The home must make sure that people can be involved with a variety of activities both on an individual and group basis. A record of all activities must be recorded. The menus and food provision need to be looked at again and so that people can have a choice of food at the point of service. Staff must always give assistance in a sensitive discreet manner. Further refurbishment and redecoration is needed especially in bathrooms toilets and the smoking room. Doors need suitable locks so that people’s privacy is protected. Working sluice disinfectors, access to hand washing facilities and anti bacterial gel must be provided to minimise the risk of infection. This includes cleaning of Prompts and signage needs to be introduced on the Dementia care unit so people can find their way around and maintain a degree of independence. The staffing levels, training and skills of the staff team need to be reviewed so that the staff are confident they have the skills to do the job. And to make sure there are always enough staff on duty at all times. Comments from visitors included: “They are always short” “There are not enough of them” The manager needs to progress with the application to become registered with the Commission. The Company’s quality assurance system needs to be followed so that people receive consistent quality of care and their views are taken into account. Staff must make sure they understand fire procedures, make sure doors close properly and are not held open by artificial means. The valves that regulate the temperature of the water must be repaired or replaced so that people’s safety is maintained. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive clear information about the service and good assessments of need before admission. This helps them make the right decision about using the service. EVIDENCE: Everyone admitted to the home has an assessment of all care needs, which is completed by care managers, nurse assessors and senior nursing staff. The Company have a Dependency Assessment Rating Tool (DART) assessment document that includes areas specifically about the needs of people who have dementia, challenging behaviours, physical disability and other complex health care needs. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 11 There have been no new admissions since the last visit to the home therefore this standard could not be tested. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Access to health care is satisfactory, but lack of detailed care planning does not demonstrate that peoples’ needs are being fully met. EVIDENCE: Each person has a plan of care based on the admission information which was carried out by care managers, the home manager and where necessary nurse assessors. Staff complete pressure sore risk using the Waterlow scoring system, dependency, moving and handling, nutritional assessments, using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. These tools help the staff understand the level of risk each person and helps them complete a care plan. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 13 Some care plans for people with dementia were looked at. They are being reviewed and rewritten where necessary to show changes in current needs. Assessments are updated on a monthly basis. The standard of recording was variable. Some plans were nicely personalised and incorporated promoting the person’s independence, and how to respect privacy and dignity during assistance with personal care. There were also some good examples of sensitive approaches to supporting people when they are confused and anxious. For instance one person’s plans stated that they need time to express their feelings and emotions and gain comfort from spending one to one time with staff sharing their memories. Other plans seen had insufficient detail or were not specific enough to guide staff on how best to support the person to meet their needs. Examples included nutrition plans that did not include prescribed supplements, advice given by the dietician, or any indication of the foods the person likes. There was no evidence in corresponding food and fluid charts that people identified as being nutritionally at risk are given additional calorific snacks between meals. Care plans are evaluated at least monthly however when evaluations indicated changes to the person’s care this information was rarely used to update the plan. Ongoing day and night reports are recorded. These were quite detailed and showed some links to care plans. Relatives and people living in the home said they were happy with the care provided. A relative said the home was good at keeping her informed about her family member’s welfare. Whilst physical and mental health needs and associated risks are assessed, the care records did not always demonstrate that support is properly planned or carried out. Two of the three people’s records seen did not have a care plan addressing their mental health needs. Plans for nutritional needs and skin integrity were often bland and unspecific. Another example was a person’s assessment that indicated they should regularly keep their legs elevated but this was not included in any of the care plans. The same person had recently been prescribed antibiotics for an infection but the medication was not obtained from the pharmacist until three days later. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 14 There was a good example of a person’s moving and handling plan having been updated following an injury and a new plan written for pain control. Monitoring records are kept of weights. Food and fluid intake charts are kept, though on the day of the inspection these had not been completed. People living at the home are asked how they wish to be addressed and this is recorded. There was no indication that people are asked their preference for male or female staff to support them with personal care. The three care plans looked at on the nursing unit found that initial care plans and risk assessments had been completed. Care plans showed that social care assessments were not detailed and social care plans are not completed. This means that people’s likes, dislikes and previous lifestyles are not always taken into account when planning care. Staff still need to develop care plans on the nursing unit to show how peoples previous history and lifestyle affects their current needs and aspirations. Decisions on how care is given are based on health care needs and not on a person centred approach. The dietician saw one person in April as staff were concerned about poor gag and swallow reflex. There is clear information given about providing a “soft floppy diet”. The plan had been rewritten in March 2008 but has only been evaluated once in June 2008. Another person has been underweight since admission and although a care plan is in place food and fluid charts are not always completed in detail. For example if this person refuses food and/or drink there is nothing recorded to show what alternatives are offered and accepted. Many people have food and fluid charts to record their daily intake but none were completed at the time food and drink was offered. If staff do not accurately record what people have had to eat and drink there is no guarantee that individual nutritional needs are being met. Everyone has access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. Appropriate pressure relieving devices are available. Several people have air cell mattresses and cushions to prevent pressure damage. And several have profiling nursing beds. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 15 Advice is sought from, occupational therapists, speech therapists and continence advisors. Visits from the multi disciplinary team are recorded in individual care plans. Records are in place for all medicines received, administered and disposed of. An audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. One person had recently been prescribed antibiotics for an infection but the medication was not obtained from the pharmacist until three days later. The treatment rooms are small and cramped. The temperatures are not recorded daily to make sure 25C is not exceeded. Two staff spoken with, who work on the unit for people with dementia, said they have had safe handling of medicines training. Qualified nursing staff have also completed medication training that includes a drug calculation assessment. People living at the home are asked how they wish to be addressed and this is recorded. There was no indication that people are asked their preference for male or female staff to support them with personal care. Staff made sure that personal care was carried out in private and knocked at doors but the style of locks in use do not ensure peoples privacy. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited, and mealtimes are not always well organised. This prevents people from leading full and active lives EVIDENCE: Peoples’ social interests and preferred routines are not properly assessed. Each of the care records seen had a care plan for ‘social isolation’ that mainly stated the person should be encouraged to join in activities. There was very little evidence in daily reports of activities taking place and diaries to record social activities and events and outings were no longer in use. The manager was working as the nurse on duty as well as managing the home and direct the refurbishment of the first floor. This meant the care staff had little time to provide any social care. Their time was spent making sure that individual personal care needs were being met. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 17 The home has an Activities Co-ordinator who works thirty hours weekly, from Monday to Friday. She is enthusiastic about her role though has not been provided with any relevant training. She talks to people and their families about interests and is hoping to get ideas for new activities from a committee that is being started. A monthly activities programme is in place however this tends to be the same week to week and consists of dominoes, crafts, knitting, bingo, hairdresser and church service. This month’s programme showed a visiting entertainer was arranged. A few people also visit a local sheltered housing complex that holds quiz nights and other activities. No activities are planned for weekends. The home has access to a company mini-bus for transport and weekly outings are built into the programme. Outings are dependent upon sufficient staff being available. This has meant that at times outings do not always happen, or only limited numbers of people can go out. Overall there is a lack of structure for assessing and planning how to meet individual’s social needs and providing regular social stimulation, including activities suitable for people with dementia. The home has a four-week menu that offers variety and choice of meals. Breakfast consists of cereals, toast and cooked breakfast is available daily. Tea or coffee and biscuits are served mid-morning. Lunch is a choice of main meal with dessert. At least twice per week lunch is stated as ‘chef’s choice’. This was clarified with the chef as being meals of his discretion, for example needing to use up a particular food stock. Hot drinks and biscuits/baked items are served in the afternoon. The chef has devised a teatime menu with choice of lighter meals and cake or dessert. Suppers were stated as being ‘choice of hot drink with snack if required’. Staff said that in practice sandwiches are served or “we can make toast.” Varied snack suppers should be forward planned and stated on the menus. People are asked their choice of meals the day before and this is recorded on preference sheets. Soft diets are catered for and each food item is presented separately. Some are provided with ‘finger foods’. The chef said he will provide whatever the nursing staff request for people and that he is informed about those who are nutritionally at risk. However in St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 18 practice there was no indication of provision of regular calorific snacks or homemade nutritious drinks. Provisions are delivered regularly across the week. Full fat milk is used however butter is not provided and low fat yoghurts should be replaced with more calorific ones. On the day of the visit no one on any unit knew know what meals would be provided at lunch. Menus were displayed on tables in the ground and second floor dining rooms. Menus on the ground floor were for week three, and on the second floor as week one. When checking with the chef it was confirmed said the current week’s menu was week four of the cycle. Fruit was available in bowls on dining tables, however this was starting to rot. The chef said that staff are supposed to prepare and offer fresh fruit to the residents. On the unit for people with dementia the tables were set with coloured cloths and serviettes. No menus were displayed and no condiments were made available. The majority of people were sat at a table on their own. Staff served the meal from a hot trolley. This was a choice of gammon and peas pudding or sausages and onion gravy with mashed potato, turnip and sprouts. The meal was ready-plated which meant no one had no control over what was on their plate, the portions etc. One person said there was too much gravy for their liking. Another said, “I can’t eat all that” and only had a couple of forkfuls. She was offered some toast instead. One lady said she could hardly face her meal because of the size of it. Dessert was semolina and was served from the hot trolley container, though they were not asked how much they wanted. Orange squash was served with the meal. An assortment of different size glasses was used and one lady had a small, stemmed glass that she had difficulty holding. Staff were attentive and assisted with cutting up food and sitting alongside them to help with eating. One carer said staff aim to encourage independent eating, and only assist where needed. People spoken with said they like the food. Several of the people on the nursing unit needed assistance and support to eat sufficient food. None of the staff sat supporting individuals to eat their meal. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 19 Instead staff stood over them spooning food into their mouths, talking to other staff and then going over to another person and putting food into their mouth. This means people did not receive individualised care and the mealtime experience would not be enjoyable. One person did not eat breakfast and did not want the lunch provided. The only alternative offered was toast. This means that this person would not receive an adequate diet that day. Food and fluid charts are in use but not completed until late in the day. Staff cannot remember detail of amounts of food and drink offered and actually consumed well after the event. This means it will be difficult to gauge that those who have poor appetite and fluid intake receive enough to maintain their health. People said: “The food is champion” “There is always to much” “My relatives food preferences are always taken into account” “The food is always good”. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good complaints and protection procedures are in place and are effectively followed to ensure that people and their relatives are listened to and protected from harm. EVIDENCE: The Company has a comprehensive complaints procedure, which is displayed in all areas of the home. The last complaint received was about poor staffing levels and had resulted in the Commission for Social Care Inspection (CSCI) carrying out a random inspection and issuing a warning letter to the provider. A further eight complaints made in the past year were on file. These included a complaint investigated by Gateshead Council and an allegation of abuse that had lead to the local safeguarding procedure being invoked. The majority of the complaints were about individual people’s care. They were recorded in detail and demonstrated thorough investigation and responses to people’s concerns. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 21 There was evidence of follow up action being taken by the management of the home as a result of complaints being upheld. However the action taken following one complaint could not be checked as a staff member’s training record could not be located. Two members of staff spoken with confirmed they had received training on protecting vulnerable adults. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent investment is significantly improving the appearance of the home but further work is needed to create a more pleasing and comfortable place to live. EVIDENCE: The home has four floors and is serviced by one central lift and stairs. All of the units have their own lounge, small kitchenette, dining room, single bedrooms, bathrooms and toilets. People living on the ground and first floor are able to freely access car parks and a small patio area. The ground floor provides personal and social care and has been decorated to a satisfactory standard. A bedroom has been turned into a designated smoking St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 23 room. The room is practically bare with an old sofa and two chairs for people to use. There are no ornaments, curtains, tables or audio equipment in the room. The carpet was covered in cigarette ash and badly marked from cigarette burns. The extractor fan was very loud and had not been cleaned for some time. The first floor of the home is in the latter stages of being refurbished to a good standard and is unoccupied. This floor will provide general nursing care. The second floor also provides general nursing care and has been redecorated and has new carpets. There is still damage to doors and walls from wheelchairs and trolleys. The third floor provides care for people with a dementia type illness. This floor has also undergone redecoration. The environment has not been designed to help people with memory loss find their way around. For example there are no aids or prompts such as images of bathrooms or toilets, names on doors or well picked out grab rails. The lounge is impersonal and has standard furniture and the main interest is the television in the corner. All of the tiles were missing from around the sink unit in the small kitchen. One bedroom is being changed into a sensory room. This has some fibre optic equipment and audio equipment. Further work is needed to make sure it is suitable for use. On all of the floors ceiling tiles and floor coverings in toilets and bathrooms need to be replaced. In many areas ceiling tiles are missing or are water damaged. Flooring in toilets and bathrooms are stained and marked. For example, one toilet has had the cistern moved and the wall has not been repaired. The flooring in the ground floor bathrooms is badly marked, the toilet flooring next to room seven is splattered with paint and is badly stained. On the third floor panel is missing from one bath and the enamel is worm on the base. There is no hot water to the shower room and only one bathroom can be used on this floor. A number of bathrooms, showers and a toilet were out of order and there were currently insufficient bathing facilities for the number of people living in the home. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 24 The extractor fans in toilets and bathrooms needs to be checked to make sure they are working properly. This is necessary so that air is properly and helps reduce the risk of cross infection. All bedrooms are for single use. People have been encouraged to bring small items with them making their rooms individualised and reflective of their lifestyles. Bedroom door locks do not have a master key system and can be locked and opened from outside only by using a “slot turn” system. This system is not suitable and is unusable by most of the people living in the home. It can be used by staff and may prevent people maintaining a degree of independence and privacy. The laundry is on the ground floor and was generally clean and tidy. Given the size it is not possible to maintain a clean and soiled room. Staff were aware of infection control procedures. There are open sluice hoppers on each floor. They do not have a hand wash sink and anti bacterial gel, gloves and aprons were not readily available. The sluice disinfector on the first floor is broken and the surrounding flooring rusty. Not all areas had foot-operated bins with lids and some used open clinical waste bags were being stored on floors in sluice areas. Liquid soap and paper was not always available at wash hand basins although supplies of antibacterial gel, and disposable gloves and aprons are provided. Covers for pull cords are still needed as many are frayed and dirty. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems around recruitment and selection of staff are satisfactory but staffing levels and training of staff are not adequate to meet the range of needs of the people using the service. This means that people’s lifestyles are restricted and overall affects their quality of life. EVIDENCE: This home has had many staff changes including managers. In addition to the nursing and care staff the home employs domestics, laundry, cook, kitchen assistants, a maintenance and activities person and an administrator. Staff said that when domestic staff on duty is not available they have to complete cleaning tasks, which also detracts from the care provision. On the day of the visit there was only two domestics on duty to clean three units including all communal areas bedrooms, bathrooms and toilets. And the laundry person finished work at lunchtime. The home manager had to work on his day off as a nurse on the Sunday and attempt to be both nurse and manager on the Monday. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 26 On the unit for people with dementia there were two carers for nine people. One carer has NVQ Levels 2 and 3 in care, and said she has had training in caring for people with dementia, medication, protecting vulnerable adults, moving and handling, fire safety, infection control, and nutrition. The senior carer was looking towards studying for NVQ qualification. She had undertaken training in safe working practices, health and safety, medication, protecting vulnerable adults and nutrition. She had also attended person-centred care training in January 2008 and had ‘end of life pathway’ training. Other files showed that some training has been completed including Infection Control, fire safety, medication and care plan workshops. The new manager is in the process of planning and developing training for all staff. A dementia care training course was planned to take place on the day of the visit however this was cancelled due to insufficient numbers of staff attending. One of these staff volunteered to stay on duty, which eased the staffing situation slightly. Neither staff could recall ever having been provided with one to one supervision. On the ground floor there was one carer for eight people. The carer on this unit said should she need any assistance a carer from another floor would have to come and help. And the senior carer from the dementia unit had to come down to this floor to administer medication. The first floor is currently unoccupied. Further recruitment of qualified nurses and care staff will be needed when occupancy starts to increase. There are eighteen people living on the second floor-nursing unit. On the day of the visit the night nurse stayed beyond her duty time to administer the morning medication as the manager had to work as the nurse. There were three carers on this unit and they had to go and help on other floors when needed. This meant that people had to wait for some time to be assisted from their wheelchairs into lounge chairs. The main focus of the day was to make sure people’s personal care needs were met. There was little in the way of individualised care provision. This was due the staff sickness and holidays. It was confirmed that at least four staff have had holidays authorised for September and plans need to be in place to make sure that enough staff are available over a twenty-four period during this time. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 27 Following a complaint about staff shortages and people having to wait for help a random visit took place in July. This found that there were staff shortages due to sickness, holidays and not enough staff employed. A warning letter was sent to the Responsible Person requiring information about how the home would increase staffing levels and be able to use agency staff when necessary. A response has been received and active recruitment of carers is in place. The records for recruitment were satisfactory. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, two written references, proof of identity and professional identity numbers for registered nurses. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Without consistent management there is a lack of leadership and guidance, which means there is only adequate quality assurance systems in place and people may be placed at risk. EVIDENCE: The home has not had a registered manager for some considerable time and historically managers tend to leave after a short period of time. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 29 A deputy manager from another home has now been promoted and is currently completing application to be registered with the Commission for Social Care Inspection. He is a Registered Mental Health and first level Registered General nurse with many years experience. He is aware of the issues in the home and is starting to put things right. He also has to work as the nurse when there are shortages, which prevents effective management and supervision of the service. The constant changes in senior staff result in staff being unsure what is expected of them and then doing what they think is right. This means the focus is on the task, getting the job done without looking at the individual needs of those using the service. The Company has detailed quality assurance and quality monitoring systems in place these are now being completed. Relative, resident and staff meetings are being held on a regular basis. These meetings have identified staff shortages on a regular basis. The Manager has started “an open door policy” and is available evenings and one day over one weekend a month should anyone wish to discuss any concerns they have. People’s personal allowances are held in a bank account that does not accrue interest. Cash is kept on the premises for people to access for personal spending, for example newspapers, hairdressing, toiletries and trips out. Details are kept of all deposits and withdrawals on the computer system and paper records, including receipts that are signed by the individual where possible. Monthly reconciliation checks are carried out of balances and cash. One person holds her own personal allowance and has a locked drawer facility for safekeeping. The manager asked for an extension to complete the AQQA and it was returned by the agreed date. It gave a reasonable picture of the service and information about how it plans to develop over the next year. Records show that the required monthly and weekly checks for water temperatures; legionella, and nurse call system, emergency lighting and fire checks have been completed. External maintenance contracts are up to date. These records also show that there are problems with failed thermostatic mixing valves, which was reported in June 2008. This means water temperatures cannot always be regulated to prevent scalds. There is written evidence that staff have had fire training but none of the staff spoken to could remember when this was. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 30 A few bedroom doors were being propped open; this is a potential fire safety hazard and further door holding mechanisms need to be provided. Some bedroom doors were not closing flush and need to be adjusted. Accidents are recorded but monthly analysis is not carried out to track to examine and track any trends. St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 X X 2 X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered persons must ensure that the care plans are reviewed at least monthly, are person centred and reflect how current and changing needs will be met. The registered persons must ensure that they maintain people’s health. People’s psychological and nutritional health status must be monitored and any changes recorded and updated in care plans. Fluid balance and food charts must be completed in detail to evidence practice. The registered persons must ensure key-operated locks on bedrooms, bathrooms and toilets are provided. This will allow people proper privacy and dignity when using these areas. Timescale of 08/07/08 not met. The registered persons must review the organisation of mealtimes. Varied snack suppers must be St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 33 Timescale for action 01/10/08 2 OP8 12,14 01/10/08 3 OP10 12 (4) (a) 01/02/09 4 OP15 12,14,15 01/10/08 forward planned and stated on the menus. Food provision must include high calorie items. 5 OP19 23(2)(a) The registered persons must ensure that the home is properly maintained to ensure peoples safety and well-being. Timescale of 08/07/08 not met The registered persons must ensure that the smoking room be cleaned, appropriately furnished and the carpet replaced. Timescale of 01/08/08 not met The registered persons must ensure that there are working bathing and showering facilities available to service users, with an adequate supply of hot water, to ensure their hygiene needs can be met safely. Timescale of 28/02/08 and 01/08/08 not met. The registered persons must ensure that the bath panel is repaired and replaced. The wooden boxing of the water pipes must be repaired. Timescale of 01/08/08 not met. The registered persons must ensure that all toilet and bathing facilities must have suitably positioned handrails and mobility aids. Timescale of 08/07/08 not met. The registered persons must ensure that all bedrooms are fitted with suitable locks. Timescale of 08/07/08 not met. DS0000018178.V370412.R01.S.doc 01/12/08 6 OP20 23 01/10/08 7 OP21 23(2)(j) 01/10/08 8 OP21 23 01/10/08 9 OP22 23(2)(c)1 3(4)(a)(c) 01/10/08 10 OP24 16(2)(c) 12(4)(a) 23(2)(d) 01/02/09 St Oswalds Nursing & Residential Home Version 5.2 Page 34 11 OP26 23(2)(b) 16(2)(k) The registered persons must ensure that all extractor fans in bathrooms, toilets and sluice work properly to ensure adequate ventilation and minimise cross infection in the home. 01/10/08 12 OP26 13 OP26 23(2)(k) 13(3) 16(2)(g) 16(2)(j) 16(2)(k) 23 14 OP27 17,18 The registered persons must replace all of the frayed, broken and dirty light cords in all bathrooms and toilets. Timescale of 08/07/08 not met The registered persons must 01/12/08 provide working sluice disinfectors on the nursing units. Timescale of 08/07/08 not met. The registered persons The 01/10/08 registered persons must ensure that there are suitable bins with lids in toilets, sluices and bathrooms. Liquid soap and or antibacterial gel must be provided in all areas including bedrooms to enable the staff to wash their hands. 01/10/08 The registered persons must ensure that at all times suitably qualified, competent and experienced persons at working at the care home in such numbers as are appropriate for the health, safety and welfare of service users. Sufficient domestic staff must be on duty to maintain the home in a clean and hygienic state at all times. Timescale of 31/07/08 not met. The registered persons must ensure that all staff receives suitable training to enable them to do their jobs effectively. A planned training and DS0000018178.V370412.R01.S.doc 15 OP30 12,13,18 01/10/08 St Oswalds Nursing & Residential Home Version 5.2 Page 35 16 OP38 23 development plan must be produced and implemented with records kept. The registered persons must ensure that appropriate door guards are provided. Ensure all doors fit properly into rebate. Provide further fire training for all staff. Ensure all thermostatic mixing valves are repaired or replaced. 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations It is highly recommended that plain English be used in care plans. The registered person should ensure that people have more opportunities to be involved in varied and individualised social activities, which must be recorded in detail. Up to date information about activities must be provided and circulated in formats suited to their needs. Menus should be in large print ,picture style and be easily available. The registered persons should change the colour schemes and provide pictures and signage to help people with memory loss find their own way around the dementia care unit. The registered persons should maintain systems of evaluating all aspects of the service and take the views of people using the service into account. 3 4 OP15 OP20 5 OP33 St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Oswalds Nursing & Residential Home DS0000018178.V370412.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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