Inspection on 23/04/09 for St Oswalds Nursing & Residential Home

This inspection was carried out on 23rd April 2009.

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

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 Oswalds Nursing & Residential... 18/08/08

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 20/07/2009.

Key inspection report 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 23rd April 2009 09:30 DS0000018178.V375147.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Oswalds Nursing & Residential Home DS0000018178.V375147.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 st.oswalds@fsch.co.uk www.fshc.co.uk Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Manager post vacant Care Home 70 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) 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.V375147.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 18th August 2008 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.V375147.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 18 August 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 23 April 2009.This visit was carried out by two inspectors and started at 09:30 and was completed at 16:00.A medication inspection was completed separately by the pharmacist. 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. What the service does well: St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 6 The staff collects information together about the person before anyone moves into the home to make sure they can meet their needs. Visitors are always welcomed and there are links with the local community. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. Staff are respectful and sensitive with people when helping them or when speaking to them. Medication training undertaken by staff is well documented and regular medication audit carried out on the residential units is helpful in confirming that staff manage medication in line with the medicines policy. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. The home makes sure that all checks and clearances are received before staff are employed. There are good arrangements for supporting people to keep their personal monies in a safe place if they want. What has improved since the last inspection? The home continues a programme of redecoration, re-carpeting and replacement of furniture in the bedrooms, communal areas and bathrooms, so that people live in a pleasant and safe environment. Working sluice disinfectors, access to hand washing facilities and anti bacterial gel have been provided to minimise the risk of infection. The valves that regulate the temperature of the water are being repaired or replaced so that people’s safety is maintained. Work has been completed on the central heating and hot water systems. This means there is hot water throughout the home and the air temperatures can be controlled properly. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 8 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.V375147.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3, Standard 6 is not applicable to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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 staff. The Company have a Dependency Assessment Rating Tool (DART) assessment document that includes areas specifically about the needs of people who have St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 10 dementia, challenging behaviours, physical disability and other complex health care needs. The pre-assessment documents in the care plans were completed to a good standard and ensured that the staff could be prepared for the new resident before they were admitted. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to health care is satisfactory but staff do not always make sure there is detailed care planning and they have not always made sure people receive their medicines properly. This could affect their well being. 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 ulcer risk using the Waterlow scoring system, dependency, moving and handling, nutritional assessments, using the Malnutrition Universal Screening Tool (MUST), continence and fall risk St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 12 assessments. These tools help the staff understand the level of risk each person and helps them complete a care plan. Staff have made some improvements to the care plans, however they still focus on a medical model of care and more work is needed to show how they are promoting people’s independence and choices about daily living. The moving and assisting information varies depending on who completed the assessment. For example one care plan details which hoist, sling and number of staff needed whilst another was non specific and only detailed to be hoisted for all transfers. Another plan did not have a risk assessment completed for falls or moving and assisting despite information being available about using a Zimmer frame and needing some help. Wound care records are clear and show what action staff are taking to improve and prevent pressure damage. Care plans record the type of mattress to be used and if the person should be nursed at a 30 degree tilt. This is to make sure there is no pressure put on a particular part of the body. Appropriate pressure relieving devices are available. Several people have air cell mattresses and cushions to prevent pressure damage. And several have profiling nursing beds. Advice is sought from the tissue viability specialist when necessary. There was not enough information to show how staff are to support people who have a dementia type illness. One plan records a person as having unpredictable challenging behaviour and has problems with memory and comprehension. There was not enough information to show how staff are to support the person and reduce any anxiety. Also it was unclear how staff are to manage behaviour that may challenge. One comment in the daily records states that “put to bed as disturbing others.” 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. Advice is also sought from speech and language therapists, dieticians, occupation therapists, psychiatrists and continence advisors. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 13 Medication is not stored always appropriately across all the treatment rooms in the home and none of medicines fridges were locked at the time of the inspection. Records for fridge temperature monitoring on the middle two floors were poor and internal medication stored in cupboards is not always separated from medication intended for external application. Treatment room temperatures are not recorded and the treatment room on the ground floor was warm. Comprehensive records of the receipt and disposal of medication are maintained and a registered waste contractor is used to dispose of surplus medication. The dates of opening for medication with a short life once opened are generally not being recorded and some eye ointments and creams appeared to have been in use for longer than recommended by the manufacturer. There were few gaps on the medication administration record (MAR) charts although one service user did not receive codeine phosphate for three days and co-codamol for one day because supplies had run out. For a second service user three different eye drops were not administered for three days and were recorded as out of stock on the MAR chart. Another service user appeared to have received alendronate, prescribed on a once weekly schedule, on two consecutive days. Medication carried over from one month to the next is not recorded on the MAR sheets. This means that it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. Recording quantities of medicine carried over from the previous month also helps reduce overstocking of medicines, particularly those that are not used regularly. There was inconsistency in handwritten entries and changes made to medication. A number of these entries were incomplete and lacked dates, quantities of medicines received, a signature or the signature of a witness to confirm their accuracy. The controlled drugs cupboard on the first floor, although not currently in use, does not meet the safe custody regulations because it is not appropriately secured to a solid wall. Controlled drug records on the other floors were accurate and well maintained although one entry was illegible because it had been altered rather than a separate entry being made to correct the error. Regular controlled drug checks are not being carried out. A number of MAR charts did not have photographs of the service users attached which helps reduce the risk of medication being given to the wrong person. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 14 Staff made sure that all personal care was carried out in private and made sure people were treated with respect. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited which means people are unable to lead full and active lives. EVIDENCE: The home now employs two activity organisers although one has been on sick leave for some time. There is evidence of varied events taking place and there is a planned programme which includes crafts, dominoes and bingo. On the day of the visit several people living on the first floor had a “knitting circle” which lasted most of the morning. Those living on the second and third floor had little meaningful activity as the staff were busy providing personal care. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 16 This was especially noticeable on the dementia care unit where people sat in the lounge with no general or individual activity. People did become animated when chatting to inspectors and then had a spontaneous sing a long. Although there has been some attempt at providing a “sensory room” there is little equipment and further work is needed so that it provides the therapy intended for individuals. Work has started to provide some stimulation and points of interest on this unit but further work is needed regarding providing activities for people with memory loss. Visitors are welcomed and they said that they were “happy with the care” and staff were “helpful”. The home has a four week menu which offers variety and choices for each meal. In addition snacks and hot and cold drinks are always available. 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 meals are prepared in the main kitchen and sent, already plated, to each floor in “hot lock” trolleys. The mealtime experience differed throughout the home. On the second floor the tables were nicely set with appropriate cutlery, crockery and condiments. People were offered choices of drinks through out the meal which gave choices of omelette or beef stew and dumplings with potatoes, swede and sprouts followed by semolina for dessert. Staff were attentive and offered support discreetly. People spoken to said “the food is nice” and “we get too much on the plate”. However everyone had a good appetite and finished their meal. The tables on the dementia care unit were not all set. There were no condiments, there was a lack of cutlery and no napkins. The portion sizes were large and many people did not finish the meal. Some people needed support and assistance but this was not always offered on an individual basis. One persons care plan stated that full assistance was needed but staff only stood by the table offering a spoon of food before going on to another task. One person became poorly during the meal and paramedical assistance was needed. Although this person’s health care need were met the staff were St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 17 unable to control and manage the situation well. Staff from another floor had to be called to assist others out of the dining room as they were becoming distressed and it remains unclear who completed their meal. Nearly everyone has a food and fluid chart .These are not completed until later in the day and staff with the best of intention will not be able to remember what each person has had to eat and drink. This means it is difficult to gauge people’s nutritional status at any given time. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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 readily displayed throughout the home. Since the last inspection he home has dealt with two complaints. One was about care delivery and the other about the hot water supply. These have been investigated under the Company procedures and there is evidence that action has been taken to put the complaints right. Staff have completed safeguarding training and would know what to do should there be any suspicion of abuse. Further training which links into Gateshead’s protocols is needed so that staff know who to contact in the Local Authority safeguarding adults team. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 19 There have been no complaints or safeguarding referrals made to the Commission since the last key inspection. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing 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. There has been a vast improvement to the communal areas and some bedrooms since the last visit to the home. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 21 Lounges and dining rooms have been decorated and carpets and furniture is being replaced. Work has started on the dementia care unit to make it easier for people with memory loss find their way around and give them points of interest in corridors. The manager is aware that further work is needed in this area. Locks on bedroom doors have been replaced and people are now able to have a key to their room so that they can maintain a degree of privacy and independence. Many of the bedrooms have been redecorated and carpets and furniture replaced. People have been encouraged to bring small items with them making their rooms individualised and reflective of their previous life style. 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. An audit of all vinyl flooring needs to be carried out so that the stained worn flooring can be replaced with in a planned programme. Also bathrooms and toilets need to be checked to make sure there are sufficient hand rails for people to use and to repair and replace ceiling tiles which have been damaged by water. The bathroom on ground floor has wheelchair damage to walls and doors and the enamel is scratched of the bottom of the bath. There is some build up of dust and soap scum on the Oxford hoist which needs to be cleaned to prevent any possibility of cross infection. There is a shower on both the first and second floor which is out of order, although there is an alternative shower on the first floor to give the residents the choice of how they have their personal care this is not the case on the second floor. Discussion took place during the visit regarding the outstanding work that needed to be completed to the hot water system and fitting of the sluice disinfectors. There is now hot water to all floors, the central heating is working so the temperature remains stable. There are twenty four thermostatic mixing valves that need attention and these are being replaced by the maintenance person. 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 St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 22 infection control procedures, however bags of soiled laundry blocked access to the sink making hand washing impossible. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems around recruitment and selection of staff are satisfactory but staffing levels and training do not always 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: Historically the home has had many staff changes including managers although there are some staff who have worked at the home for some considerable time. In addition to the nursing and care staff the home employs domestic, laundry, cook, kitchen assistants, maintenance, two activity organisers and an administrator. The home has a manager who is a qualified nurse and has experience working with older people and people with memory loss. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 24 Since coming into post he has worked hard to ensure there are enough staff employed and trained. This is ongoing and there are still vacancies for all grades of staff including qualified nurses. When there is a shortfall the home requests staff from the Company’s agency staff so that there is a consistent care provision. The recruitment and selection files showed evidence of Enhanced Criminal Record Bureau checks, Safeguarding, two written references, proof of identity and professional identity numbers for registered nurses. Staff have completed statutory training and there is further training in Dementia Care, National Vocational Qualifications and a “person centred approach” to care planned for the coming year. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is showing leadership and guidance to the staff team. Shortfalls have been identified and work has started to improve the quality of life for those living in the home. EVIDENCE: The manager is a Registered Mental Health and first level general registered nurse. Although he has applied to be registered the application has not been submitted to the Commission. He has many years experience and has been St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 26 aware of the many issues in the home and continues to work hard to put things right. Previously the focus of the staff has been to concentrate on the task of the day without thinking or working towards delivering individual care based on assessed needs. The training programme and quality assurance programme is starting to address these issues but there is still work to do. This includes having more meetings with those using the service, their relatives and the staff team. The last recorded meetings took place in August 2008. Once a deputy manager is employed the manager will have more time to focus on improving and developing the service provision and making sure staff have a good understanding of person centred care. The AQQA was completed and gives a reasonable picture of how the home is to develop over the next year. There have been ongoing problems with the lack of hot water, failed thermostatic mixing valves and the home either being far too hot or cold. The Company have confirmed that the problems with the hot water and central heating systems have been put right with hot water being available on all floors and the central heating controllable. It was also confirmed that the failed thermostatic mixing valves are being replaced. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 27 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 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 X 3 X 2 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 28 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 Timescale for action 01/08/09 2 OP9 12 3 OP9 12 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. Timescale of 01/10/08 not met. The registered persons must 29/06/09 ensure that systems are in place to request, obtain and maintain supplies of prescribed medicines for service users so that they can be given them as and when prescribed. This will safeguard the health and well being of people living in the home The registered persons must 29/06/09 ensure that best practice guidance and the provider’s policy be followed when storing and recording all medicines. Medication must be stored securely and at the temperature recommended by the manufacturer. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 29 A system must be in place to check expiry dates of medicines and medication with limited use once opened. This will safeguard the health and well being of people living in the home The controlled drug cupboard on the first floor should be secured to a solid wall This will ensure that storage of controlled drugs meets safe custody regulations and to protect service user’s medication from misuse or diversion. The registered persons must ensure that repairs are completed to damage to ceilings and baths and ensure all extractor fans are cleaned. The registered person must ensure that there are appropriate grab rails and other aids in bathrooms and toilets. The registered persons must ensure that bath hoist seats are cleaned after each use. Ensure that suitable hand wash facilities are readily available in the laundry. The registered persons must ensure that all staff receives suitable training to enable them to do their jobs effectively. A planned training and development plan must be produced and implemented with records kept. Timescale of 01/10/08 not met. 4 OP9 13 29/07/09 5 OP21 23 03/08/09 6 OP22 16,23 03/08/09 7 OP26 13,16,23 01/06/09 8 OP30 12,13,18 01/07/09 St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 30 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 OP9 Good Practice Recommendations It is highly recommended that plain English be used in care plans. Staff should sign and date handwritten entries they make on MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. A photograph of each service user should be filed with their MAR chart to reduce the risk of medication being given to the wrong person. A system should be in place to record all medication kept in the home including any medication carried over from a previous month. The medication policy should be supplemented with medication guidance issued by the Royal Pharmaceutical Society and the Care Quality Commission. The temperature of all treatment rooms and fridges should be regularly monitored to make sure that medicines are being stored at the temperature recommended by the manufacturers. Medicines fridges should be locked when not in use and the key kept by the person in charge of the unit. 3 OP12 The registered person should ensure that people have more opportunities to be involved in varied and individualised social activities, which need to be recorded in detail. Up to date information about activities should be provided and circulated in formats suited to their needs. 4 5 OP15 OP20 Menus should be in large print, picture style and be easily available. The registered persons should change the colour schemes DS0000018178.V375147.R01.S.doc Version 5.2 Page 31 St Oswalds Nursing & Residential Home and provide pictures and signage to help people with memory loss find their way around the dementia care unit. 6 OP21 It is recommended that a full audit of the bathing facilities be carried out to make sure that residents have choice as to how they receive their personal care. Also audit of the flooring in bathrooms, toilets and en suites should be carried out and the vinyl flooring replaced as part of the ongoing refurbishment plan. 7 8 OP31 OP33 The manager should progress with application to become registered with the Commission. The registered persons should maintain systems of evaluating all aspects of the service and take the views of people using the service into account. St Oswalds Nursing & Residential Home DS0000018178.V375147.R01.S.doc Version 5.2 Page 32 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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