Inspection on 16/04/08 for Stadium Court Nursing Home

This inspection was carried out on 16th April 2008.

CSCI 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

Stadium Court Nursing Home 22/02/10

Stadium Court Nursing Home 14/01/10

Stadium Court Nursing Home 16/03/09

Stadium Court Nursing Home 18/07/06

Stadium Court Nursing Home 06/02/06

Stadium Court Nursing Home 20/09/05

Stadium Court Nursing Home 01/12/04

Stadium Court Nursing Home 28/06/04

Stadium Court Nursing Home 17/12/03

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Stadium Court Nursing Home Greyhound Way Cobridge, Hanley Staffordshire ST6 3LL Lead Inspector Yvonne Allen Key Unannounced Inspection 16th April 2008 09:30 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 Stadium Court Nursing Home DS0000026967.V362434.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. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stadium Court Nursing Home Address Greyhound Way Cobridge, Hanley Staffordshire ST6 3LL 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) 01782 207979 01782 266027 bradbury@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Miss Sandra Bradbury Care Home 168 Category(ies) of Dementia (97), Old age, not falling within any registration, with number other category (71) of places Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N To service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - OP 71 Dementia - DE 97 The maximum number of service users to be accommodated is 168. 2. Date of last inspection 18th July 2006 Brief Description of the Service: Stadium Court Care Home is owned by BUPA Care Homes. The Registered Manager is Sandy Bradbury and she is supported by her Deputy, Mrs Judith Pearson. The home offers twenty-four hour nursing care. The home has been extended since the last inspection, to include a further 18 beds. These have been incorporated into three of the existing purpose built bungalows. One of the Units (Wedgwood) has a number of beds contracted for “Assessment” needs, taking individuals directly from the hospital and assessing their needs for future placements. There are two units offering care to older people including nursing care and physical needs. These units have aids and adaptations to help individuals with physical limitations. All areas of the home and gardens are accessible to individuals who use wheelchairs. The other three units are adapted to meet the needs of older persons with varying degrees of mental health needs including dementia care. A senior sister/manager is responsible for managing each unit. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 5 Stadium Court is situated close to Hanley town centre, and it is on the main road, close to public transport. The home has ample parking facilities. All bedrooms are single occupancy and have en-suite facilities. Each one of the units has two lounge areas along with a dining area and a separate conservatory. Each of the units also has its own secure garden, which is accessible to individuals using wheelchairs. The amount of fees charged by the home is available on request from the manager and contained in the Service User Guide. The home accepts individuals who are funded by Social Services and other purchasers of care as well as those who are self-funding. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Overall quality rating for this service is 1 star. This means that the people using the service experience adequate quality outcomes. We, the commission, carried out an unannounced Key inspection visit on 16/04/08. This inspection took a full day and three inspectors were involved. However, the inspection process commenced several weeks prior to the visit and was not fully completed until 06/06/08. This was because we were still receiving information about the home from people using the service, their relatives, some health professionals and purchasers of care. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. It was completed to a good standard and gave detailed information about the services offered. Information from this AQAA was used to plan the inspection visit and references to it have been included in this report. The ways in which we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any compliments, complaints and Safeguarding referrals we had received. We spoke with the people who live in the home We spoke with the staff who work at the home Discussions were held with the Registered Manager of the home We spoke with professionals who are involved with the home. This included a General Practitioner, a Social Worker, an Occupational Therapist and a nurse specialist. We examined relevant paperwork and documentation at the home. We walked around the home and we visited all the units. We looked at how staff interact with and care for the people who live at the home. We did this on all the units but on Stafford unit we used what is called a Short Observational Framework Inspection (SOFI). This is where an inspector Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 7 sits for a period of time in one of the lounges and observes care practices and staff interaction. At the end of the inspection visit we discussed our findings with the Registered Manager. There were no immediate requirements made. There were three requirements and six recommendations made as a result of this inspection. What the service does well: The following are extracts from a letter received by us directly from the relative of an individual who resides at this home – “This has been a very difficult time for all the family, not least Mum, when she was ready to visit the home her words were, “There is nothing better that could have been done for Dad”, she was sure that he was in the best place possible, everyone in the home showed care in their eyes and words couldnt express her relief.” “From a simple families point of view thank god for people like them and a large faceless company (BUPA) that obviously does what it says on the Box, it cares for our relatives! How do you put a price on happiness, give them the things it doesnt say in the brochure and then find new things to give.... I think you and I would call that a caring home, in fact their home.” Some of the comments received from residents and their representatives “Its like the Grand here”, “ I am well looked after by all the staff”, “ The staff are very kind.” “I could not wish for a better place”, “ My husband is settling well he is always clean and tidy”, and “ the staff are very good to dad.” “Staff are very caring and there is a good atmosphere. Today is the same as any other day, not different because of an inspection.” The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is a very pleasant, safe place to live and all bedrooms have en-suite facilities. In their AQAA the Providers state that they do well in the following area – “Focus on person centred care.” Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? General nursing needs are met well at the home with lots of support from health care professionals. Since the last inspection this has been developed further, especially encouraging is the introduction of more effective Tissue Viability support. The team will now come out to the home to give advice and treatment on the prevention and treatment of pressure ulcers, whereas before this was a telephone service. The introduction of the “Nite Bite” menu has helped to ensure that individual choices and preferences are upheld in respect of meals and mealtimes. Individual care plans have been redesigned and are now more person – centred. These are referred to as QUEST. The home has also done the following since the last inspection as a result of listening to the people who live thereReviewed times of meal provision, (main meal in the evening, as opposed to lunchtime). Reviewed the Laundry opening hours. Reviewed the varieties of food available, (flavours of yoghurt, mouse). Revised the activity programme. The home has improved in the following areas in order to ensure that equality and diversity are met. Providing special diets, respecting different religions and respecting last wishes. Providing specialist equipment to enable i.e. special cutlery, new baths in our house extensions. In their AQAA the Providers state that they have improved in the following areas – The Home has been expanded (18 beds) to offer more choice for local people or people wishing to transfer to Stoke-on-Trent. Specialist skilled staff and support staff have been recruited to manage this expansion. One of the units has been changed so that it can now support people with dementia. This has been done to facilitate the increased number of people requiring this specialist service. BUPA Care Homes has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts. Introduced the Menu Manager and the Night bite menu. One Unit has been refurbished and there has been partial refurbishment of other units. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 9 New beds, mattresses, sensor mats, hoist, washing machine, dryer and freezer have been purchased. Staff training has been developed further, including Mental Capacity, Management of Violence and Aggression, Hand washing techniques with purchased light box. What they could do better: 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. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 10 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 Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 11 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): We looked at Standards 1, 3, 4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides clear information, in its Statement of Purpose and Service User Guide, about the services offered and the nursing and personal care provided. People coming into the home can be assured that their needs will be assessed. EVIDENCE: In their AQAA the Providers tell us – “We provide comprehensive written information for prospective clients. No prospective resident is admitted to the Home until a pre-admission assessment is undertaken by an experienced Registered Nurse (RMN or RGN) to ensure the Home can meet any identified need and that the placement would be appropriate.” Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 12 They say that their evidence for this is – “The relevant information is available both in the Home and by request. QUEST is a personal plan which includes a pre-admission assessment which then evolves into a set of care plans with the involvement of the resident / representative.” Information that we have received in the form of complaints and Safeguarding meetings held prior to and during the inspection process suggests that not all individual needs are being met as planned at the home. Therefore we looked at all of the relevant evidence and records in the home and spoke to people using the service, relatives and some health professionals: On visiting the home and talking to the people who live there, including visitors, it was evident that they felt that their individual needs were being met. Examination of relevant records and documentation identified that assessed needs are being monitored and met. A number of people who live on Wade and Spode units including some of their Representatives were spoken with and the following comments were received “Its like the Grand here” “ I am well looked after by all the staff” “ The staff are very kind.” “I could not wish for a better place”, “ My husband is settling well he is always clean and tidy”, and “ The staff are very good to Dad.” The following is an extract from a letter of compliments received by us from a relative of a service user “I initially contacted the home manager, Sandy Bradbury, late on a Friday afternoon to visit the next day. Special arrangements were made to show us around the next day. Once we had decided we wanted Dad to move to them I was offered a choice of a couple of rooms, again at very short notice I was shown around that night to choose. The staff were extremely patient as I checked around, including my quirks of a compass to check for south facing rooms, thermometer etc, nothing was too much trouble. The whole process of moving Dad was very worrying, but I was totally wrong to worry, the newly appointed unit manager visited the hospital to sort out everything, Dad was moved within a few days. I was kept informed at every stage by calls to my mobile. We are now approaching 6 weeks and the level of care just continues, Dad is receiving not just care but love, respect and his individual needs both physical and emotional.” 4 service users were spoken to on Wedgwood Unit and all were happy with the care and services provided to them. One lady said, “Its marvellous here I don’t want to go home”. One visitor was spoken to on this unit. She was also satisfied with the care her relative was receiving at the home and had no concerns. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 13 Discussions with the GP and Social Worker who were overseeing the care of individuals admitted for “assessment” both stated that they had no concerns about the care in the home and that individual needs were being met in respect of the above. The GP did say that some of the individuals coming into the home requiring an assessment bed had somewhat different needs to what he had first anticipated. Dementia care is an area, which the Providers have developed since the last inspection, and there are now more dementia care beds at the home. The meeting of individual choices and preferences on these units is adequate but there is room for improvement and development to ensure that personal choices are upheld and autonomy promoted. The senior staff spoken to have some good ideas for further development and improvement In light of complaints received since the last Key inspection, discussions were held with the Registered Manager about admissions to the home of people with challenging behaviours and the ability of the staff at the home to be able to manage these episodes and meet individual needs. The manager stated that she only admits people to the home whose needs she feels the staff are able to meet. She said that the initial assessment might not always give a true picture of what an individual’s needs are and that is why there is a trial period of stay in place. The manager also confirmed that all care and nursing staff working on the dementia care units have now received training in understanding dementia care and managing challenging behaviours. We saw records to confirm this. A total of 8 care plans were examined and all contained an assessment of needs. There is an initial assessment of needs carried out which is done by a senior nurse either in the individual’s home or hospital. There is then a further, more detailed assessment carried out together with the resident and/or their representative. There was evidence contained in the care plans of signatures of agreement from representatives. These assessments and subsequent care plans are known as “QUEST” and cover all aspects of care and daily life in the home. Individual care plans have become more person centred. The home does not provide intermediate care so standard 6 was not applicable in this case. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 14 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): We looked at standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receiving services are happy with the way that most staff deliver their care and respect their dignity and rights. However, decisions on how personal care is delivered might not be consistently recorded. There are not always enough staff available, with the up to date clinical expertise necessary to fully meet the needs of the people using the service. EVIDENCE: In their AQAA the Providers tell us – “All residents have comprehensive personal care individual to their identified needs. We have a comprehensive suite of Policies and Procedures and the Royal Marsden Manual of Clinical Procedures. There are company specialists both regionally and nationally who can be consulted for advice and support at anytime. Self-care is encouraged. Any pressure ulcers are recorded. The information is collated within BUPA Care Homes and the information is used to identify trends and inform the Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 15 purchase of appropriate equipment. All residents have a nutritional screen using the MUST screening tool. Every resident is registered with a General Practitioner of his or her choice (within the constraints of access to GPs). The BUPA updated Medication policy meets the criteria National Minimum Standards and the guidance from the Nursing and Midwifery Council and the Royal Pharmaceutical Society. There is regular audit of the management of medications. Privacy and Dignity feature highly in BUPA Care Homes customer service programme, Personal Best. The Liverpool Care Pathway to meet the needs of our dying residents is well developed within the Home preventing the need to transfer residents to Hospital / Hospice for terminal care.” They say that the evidence for this is contained in – “Personal plans, risk assessments, Named Nurse and Key Worker role development, Clinical supervision files. Policy and Procedure Manuals are available for inspection. Pressure sore recording forms / audits. Feedback from deceased resident’s relatives.” Staff on Wade and Spode Units demonstrated their ability to respect individual dignity, listening to different people who use the service. There was a slight concern observed when two staff attempted to transfer a resident to a different chair, using a green sling. The sling was not positioned correctly and lifted when they attempted to move the person. The unit manager demonstrated and advised the staff that this particular resident could transfer with the support of an arm. The observed interaction between the people who use the service and staff was excellent. Each unit had a relaxed atmosphere; staff addressed the needs of individuals with respect and warmth. There was obviously an abundance of knowledge used to ensure that the people who use the service were well cared for. On Stafford unit an assessment called a Short Observational Framework Inspection (SOFI) was carried out during the afternoon for one hour. This is where the inspector sits in one of the communal lounges and observes the interaction between staff and residents. It was observed that most individuals were having an afternoon sleep. People who were awake were receiving the care and attention they required from staff. A staff member supervised the lounge at all times. No residents were being verbally or physically aggressive towards one another but one lady was somewhat perturbed by another resident shouting. Staff were reassuring to this individual. Afternoon drinks were served including tea and coffee. Residents were helped to consume their drinks by the staff. Staff members attempted to communicate with the residents who were awake and one of the resident’s eyes lit up when the staff member began to reminisce with her. One of the residents was trying to engage with another resident during the SOFI. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 16 4 service users were spoken to on Wedgwood Unit and all were happy with the care and services provided to them. One lady said, “Its marvellous here I don’t want to go home”. One visitor was spoken to on this unit as she was visiting her relative. She was also satisfied with the care her relative was receiving at the home and had no concerns. On Aynsley Unit 3 relatives were spoken to at length. These were all happy with the care and attention provided to their loved ones. They spoke highly of the staff and felt that individual needs were being met well. One relative who visits every day said – “staff are very caring and there is a good atmosphere. Today is the same as any other day, not different because of an inspection.” 2 care plans were examined on this unit: In one plan it was documented – “staff to spend time talking to (individual). She frequently talks and repeats things, which have happened in the past. She can be quite demanding and likes a lot of attention.” We were concerned about the words used to describe an individual as to refer to someone as being ‘demanding’ is considered to be derogatory and lacking in understanding that this person enjoys the company of others. The map of life and lifestyle profiles with routines and rituals were not fully completed. There were risk assessments in place including tissue viability and nutrition. The care plan had been reviewed by the local authority on 02/04/07 and had been signed by the individual’s son. In the other care plan – of an individual nursed in bed. There was a document in place entitled “Do Not Attempt Resuscitation”(DNAR). These procedures have been agreed with the Primary Care Trust and other relevant professionals and there are clear and concise guidelines designed to protect all the people involved. They should give people choice as to whether they wish to be resuscitated. However, it is vital that due to the seriousness and sensitivity of this issue, procedures are followed precisely. In this instance, the form had been signed by the GP. However, the proforma to this document states that the DNAR order and reviews must be written prominently in the medical records explaining the decision with date, time, clinical justification and those people consulted with their views and the resident’s documented assessment if applicable. The notes must then be signed and the name and job title must be printed on the external professional visits form. The DNAR form in place for this individual did not fully comply with the proforma and was therefore not safe. This was discussed with the manager during the feedback at the end of the inspection visit. The Home must ensure that any decision not to attempt resuscitation is carefully considered, with the people themselves, wherever possible and protocols strictly adhered to, to protect the people using the service and the staff involved. The Home should Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 17 consider the Mental Capacity Act where a person is no longer able to express their views or make a decision. The same individual is receiving covert medication. In this case, correct procedures have been followed. The BUPA procedure for this is in place and there is documentation of the discussions held with the granddaughter and husband and deputy manager and a fax had been sent to the GP, which was dated and signed. During the visit on 21/04/08, we looked at another care plan because of a complaint we had received. During examination of the care plan, it was identified that one piece of documentation was incomplete-this was the “history of falls” and the care plan evaluations in general were 2 months behind schedule. We also felt that the care plan did not show how the person’s care or pain had been monitored. Night staff had expressed concerns about the person’s medical condition, which, from the day shifts notes did not appear to have been followed through. We believe that this demonstrates the importance of detailed and informative record keeping and the negative outcomes for people using the service if their records are not kept up to date. 2 care plans were examined on Wedgwood Unit in respect of individuals admitted for assessment of needs. These were thorough and comprehensive but these also were falling behind on evaluations. There was evidence of involvement from different health and social care professionals into the plan of care. The home receives support from health care professionals. Since the last inspection this has been developed further, especially encouraging is the introduction of more effective Tissue Viability support. We were told that the team will now come out to the home to give advice and treatment on the prevention and treatment of pressure ulcers, whereas before this was a telephone service. During our discussions with healthcare professionals who visit the home it was highlighted that not all nursing staff possess the required up to date clinical knowledge and expertise. One way in which the Providers are trying to improve this is by involving the Community Matron and the Primary Care Trust, (PCT), who offer free training and guidance. A nurse employed by the PCT visits the home to offer this training on a regular basis. We spoke to the nurse and she confirmed that she gives staff training and support in many areas including palliative care and wound treatment. The Unit Manager on Wedgwood confirmed that there is a good GP service for the home. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 18 One of the GPs was observed visiting individuals at the time of the inspection visit. We spoke with him and he confirmed that he had no concerns with the care afforded to the people who live at the home. The same GP was discussing a resident who was a recent admission. He spoke with the unit manager about ensuring that the lady was made to feel comfortable and that her environment was adapted to suit her needs as she is registered blind. We spoke with 3 professionals who are involved with the care and placement of individuals coming into the home for “assessment” needs. This included a GP, a Social Worker, an Occupational Therapist, and a nurse who works for the PCT and has been very involved with the care of these individuals. On the whole the feelings were that needs were being met but the following thoughts and concerns were raised – That there is insufficient staffing on this unit to allow time to “assess” these individuals and to allow time for care to be carried out as per their care plan. Also that some individuals are being admitted to the home with differing needs as to what was first anticipated and are falling more into the “continuing care category”. The manager does make sure that all of the people referred to the assessment unit are assessed and has at times refused to take people whose needs the Home cannot meet. There are examples of inappropriate referrals from the PCT. We have received a number of complaints in the last eight months and most of them related to concerns about health and personal care. There is a weekly meeting of health and social care professionals in the Wedgwood Unit. This was taking place at the beginning of our inspection. We were informed that this is held in order to discuss the needs and progress of individuals admitted for assessment needs. We observed that because of the above meeting having taken place, the nurse in charge (unit manager) was very late administering the 9am medication with the last few individuals receiving theirs around 12 midday. This resulted in people having to wait for their medication including analgesia. The nurse recognised this and commented that there should have been 2 nurses on duty but one was off sick. It was also observed that the nurse was very busy and kept being interrupted as she was attempting to administer the medication. Discussions with the registered manager and examination of the duty rota for this unit identified that there are normally 2 nurses on duty 3 mornings out of 5, from Monday to Friday. The manager stated that the weekends are not as busy as other health and social care professionals are not there usually. However additional staffing needs to be provided spontaneously as and when needs occur. Lack of staff should not mean that people do not get their medication when they need it. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 19 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): We looked at all the standards for this outcome. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life in the home is geared around individual preferences and abilities. Residents are generally consulted or listened to regarding the choice of daily activity but this process could be improved and autonomy better promoted for individuals with reduced mental capacity. EVIDENCE: In their AQAA the Providers tell us – “We offer an activity programme identifying individual needs and choice including relatives and other professionals in encouraging service users to exercise choice. The Home has an open visiting policy taking account of residents’ wishes. We encourage the personalisation of residents individual space with their personal belongings. A full and varied menu is available in the Home. The BUPA Menu Master helps us to ensure the menu meets the nutritional needs of the residents. A night bite menu is available and provided.” Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 20 They say that the evidence for this is contained in –“BUPA and local press coverage of some activities in 2007, in the Night Bite menu and in Letters of complements / thanks from grateful relatives.” The Random Inspection done by us in November 2007 confirmed that the “Nite Bite” menu is being used. We were told that various churches of different denominations visit the home regularly. Spiritual needs and preferences are documented in care plans. 3 people were receiving Holy Communion at the time of the visit. There is a policy in place on how to meet the needs of individuals with differing spiritual and religious persuasion. One of the activity co-ordinators was spoken to on Aynsley Unit and she explained how she encourages individuals to take part in activities. She was working with a number of residents making posters for St George’s Day. She said that the home celebrates most of the celebrations throughout the year. There was a notice displayed on the wall in this unit which contained all the planned activities and entertainment. The activities co-ordinator said that she tries to encourage all individuals to participate in the activities and come along to the entertainment and that she records this on a regular basis. Visitors were observed coming and going during the inspection visit on all the Units and visitors commented that they were made to feel very welcome. The activities person spoken to on Wedgwood unit explained how friends and family are encouraged to join in activities and events held at the home. On Aynsley Unit the lunchtime trolley was brought to the unit. The soft diets were pureed into separate portions – i.e.–separate portions of meat, vegetables and potatoes. It was noted that a number of residents on this unit required assistance with eating and this was provided on a one-to–one basis by the staff. Staff were interacting well with the residents as they were assisting them with their meal. The lunchtime meal was observed on Wedgwood Unit and some individuals were having one of the alternative choices on offer. There was also a notice displayed on the wall in the lounge, which documented the daily choices on offer as well as the main menu. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 21 4 individuals were asked about the meals in the home and all of them were said that they were generally satisfied. One lady said that the meals were “really lovely.” Individuals are able to order snacks and light meals at any time of the day and night. Since the last Key Inspection the home has introduced a “Nite Bite” menu. Evidence was seen of foodstuffs kept in kitchenettes on the various units. At a random nighttime inspection visit held in January of this year, individual residents were seen participating in this “nite bite” menu at 10pm. We saw lunch being served in Spode Unit. The food was presented in an acceptable manner, however none of the individuals had the choice of an alternative to the main meal. One gentleman refused his meal, which was then put in the waste. The staff told the inspector that he would eat his pudding. On speaking with the catering staff about this issue it seems that the staff in the Spode unit had not requested an alternative, (salad or jacket potatoes). This needs to be addressed in order to ensure that people who use the service receive a nutritious diet, based on choice and awareness and likes and dislikes. In the Aynsley Unit, the senior care assistant was unable to demonstrate that choices are offered to individual residents in relation to meals and in connection with the choices on offer on the menus. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 22 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): Standards 16 and 18 were assessed. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The Home has structured procedures in place for dealing with complaints and says that it encourages people to raise any concerns. Some people tell us that their complaints were not dealt with effectively leaving them dissatisfied with the service. EVIDENCE: In their AQAA the Providers tell us – “We have a clearly defined company complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the Home. BUPA Care Homes has robust policies for dealing with allegations of abuse or neglect. Protection of Vulnerable Adults is discussed at interview, induction and ongoing supervision sessions”. They say that their evidence for this is contained in: appropriate complaints recording in the Home, statutory training of all staff in Manual Handling, Fire awareness, Health and Safety, POVA awareness and a whistle blowing policy in practice. There is a complaints procedure displayed in each unit. This outlines the procedure to follow in the event of an individual or their representative having concerns about the home. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 23 The manager confirmed that she deals with complaints and these are recorded in the complaints file. We saw this during the visit. There is a timescale of 28 days during which the manager investigates the complaint and she sends the complainant a written response. The organisation has a structured complaints procedure in place, which enables them to investigate complaints at a higher management level, if necessary. We have received 9 complaints directly from people using this service and/or their representatives since the last Key inspection. These have mainly been as a result of the complainants being dissatisfied with the response from the Providers. There is a concern that the Home is not investigating complaints as thoroughly as they should and missing some elements of concern. Some families are frustrated that their main concerns are not addressed properly. We have also attended 2 Safeguarding referral meetings. One of these meetings was in reference to three vulnerable adults. Common issues of concern which have arisen on more than one occasion from complaints and Vulnerable Adult meetings are – Concerns about care practices, including a lack of attention to individual nutritional needs. Lack of staff communication – not informing relatives of accidents/incidents. Concerns about the attitude of some staff – especially senior staff. Concerns about the levels of cleanliness throughout the units. Lack of awareness of relatives as to who was the “named nurse”. Failure of staff to be able to manage challenging behaviours. Discussions with the Deputy Manager identified that the above concerns had all been addressed. We saw evidence of amended accident forms, which ensures that relatives are contacted and a revised notice displaying the name of the “named nurse” in individual bedrooms. We also saw that staff have received instructions and training in the management of challenging behaviours and that the home was clean and hygienic at the time of this unannounced inspection visit. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 24 We received a letter during the inspection process, from the relative of an individual who had been a resident on Aynsley Unit. She had made a complaint to the Providers about care on the unit including concerns about a fall during which the individual had sustained a fractured hip. The complainant was not satisfied with the investigation and had requested that we investigate the issues as part of our inspection process. As a result, we decided to visit the home again on 22/04/08 to look at this further. On examination of the care plan documentation it became apparent that, although the Provider had investigated many of the issues, there were still some unanswered questions. We asked that the manager of the home refer this complaint as a stage 2 – to be investigated by the organisation at a Regional level. We have not yet been notified of the outcome of this investigation. 2 members of staff on Wedgwood unit confirmed that they had received instructions on the recognition and reporting of abuse. The manager of the home stated that all staff received instruction in the Protection Of Vulnerable Adults during their induction training. She said that each unit manager was familiar with the local policies and procedures. We have attended 3 separate Safeguarding referral meetings since the last Key inspection. One meeting alone was in reference to three vulnerable adults. One of these safeguarding meetings was held very recently after the inspection visit and raised the following concerns – A lack of staff supervision, A lack of personal care, A lack of communication by the staff on the unit. We have asked the Providers to carry out an investigation into the above concerns. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 25 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): We looked at standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service have the benefit of a well-maintained, pleasant and safe place to live, with specialist aids and equipment available to meet their needs. EVIDENCE: In their AQAA the Providers tell us – “Stadium Court provides a clean, safe, well maintained environment with facilities that meet the needs of the service users. A specialist micro fibre cleaning system has been introduced and a housekeeping programme to ensure the Home is clean and odour free. The Home is supported in maintaining the environment by a central team of experts within BUPA Care Homes. We have a specialist property and a estates department as well as a hotel services department.” Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 26 They say that –“This can be evidenced by visiting the Home. Maintenance records relating to Health and Safety and environmental requirements.” Complaints received since the last inspection raised concerns of dirty windows and bedrooms/ensuite rooms, which, “are not cleaned as thoroughly or as often as they should be.” A sample tour of the two units Wade and Spode was made, it was obvious that the housekeeping staff took a pride in their role. Each area was clean and well presented and free from malodours. Staff confirmed that they had received training in the use of the products used. Each of the bedrooms seen had been personalised to suit individuals taste. A number of the bedrooms had personal possessions. One person on Wade confirmed to the inspector, “ I have brought in my things and it makes my room nicer”. This person asked the inspector to view her room. The communal areas are warm and homely. Wedgwood Unit is clean and well presented and has benefited from new carpets throughout the corridors. Communal areas are bright and welcoming. Bedrooms have been personalised and adapted to individual needs. It was noted that the roofs of all the conservatories had been boarded up with wood. We were informed that this was due to the conservatory roof exploding and shattering on Wedgwood Unit. We had been informed of this incident at the time. We were told that plans were in place to replace the roofs of all the conservatories. We visited the kitchen and laundry and found these to be well presented and maintained in accordance with environmental health guidelines. We complimented the laundry staff on the clean bed linen. The home is clean and hygienic throughout and is maintained in accordance with infection control guidelines. There is written evidence that staff have received training in infection control. This includes ancillary staff as well as care staff. The outdoor sitting areas and gardens are well maintained on each unit and provide a pleasant outdoor space for residents and their visitors to enjoy. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 27 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): We looked at all the standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole staff are provided in adequate numbers but there is a need to review the nursing hours provided on Wedgwood Unit. EVIDENCE: In their AQAA the Providers tell us – “There are comprehensive Human Resource policies to aid effective recruitment and staff management. We maintain the correct numbers of staff agreed with the inspectorate and take account of the individual needs of the residents. All staff have appropriate CRB, POVA, NMC Pin checks and references. There is a training matrix specific to each Unit that identifies the training requirements of the staff.” They say that their evidence for this is – “BUPA Care Homes has achieved Investors In People (IIP) accreditation. We received a complaint that not enough staff were on duty during the night. As a result we went to the Home during the night shift on the 8th January 2008 and we had no concerns at the time that people were not being supported by enough staff. This was confirmed by the amount of staff on duty and in the staff rotas. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 28 Wade unit provides care and accommodation to 38 people. The people using the service are supported by 2 trained nurses and 7 carers in the mornings, 2 trained nurses and 5 carers afternoon/evenings and 1 trained nurse plus 3 carers during the night. These staff are supported by 2 housekeepers. From observation of the activity on the unit during the morning of the inspection visit these numbers appear satisfactory. Spode unit provides accommodation to 28 people. During this inspection the normal staffing levels for this unit were reduced and there was 1 trained nurse instead of 2. Wedgwood unit was also not adequately staffed during the morning shift, meaning that people using the service had to wait far too long for their medication. On Aynsley Unit there were 8 care staff and the Deputy Manager and 3 staff on nights. They care for 30 residents in total. We and other health professionals have expressed concerns about the staffing levels on the Wedgewood assessment unit. We were particularly concerned that on the day of this visit, people had to wait for three hours for their medication. Staff also told us that this was a regular occurrence. Cover and contingency plans need to be in place when staff are sick or in emergency situations. One of the housekeeping staff on Wade was very enthusiastic and proud of her role; she had received the relevant training and had requested training to further her knowledge for dementia. The housekeeper on Spode told us that she had achieved NVQ level 1 in housekeeping. When asked, staff in general said that they had received relevant training or were aware that more training for them had been planned. The company use a collection of booklets for distance learning covering Infection Control, Fire Safety, and Health and Safety. Staff confirmed that they have received training in recognising and dealing with violence and aggression, which includes challenging behaviour. Each one asked confirmed they know how to protect vulnerable people from abuse because they have received training and know how to activate concerns. All the staff spoken to know how to complain, and who to speak to in the event they felt anything was not acceptable. The training records were seen; there were a small number of short falls where the training matrix for Wade & Spode units did not correspond with the office records but this was a paper exercise. The staff that we spoke to told us that they felt very supported by their unit managers. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 29 Three staff files were examined in respect of the recruitment procedure. These were found to contain the required checks and references. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 30 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): We looked at standards 31, 33, 34, 35 and 38. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The management systems keep the people using the service safe, but the monitoring systems do not always focus on the issues important to them or address their concerns effectively. EVIDENCE: In their AQAA the Providers say – “The Manager ensures that the approach within the Home creates an open and positive atmosphere. The Manager ensures where possible the health, safety and welfare of service users and staff. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 31 The Manager ensures compliance with relevant legislation. There are Regional and National experts available within BUPA for advice and guidance if required. There is dedicated Health and Safety staff within the Quality and Compliance directorate.” They say that their evidence for this is – BUPA Care Homes has achieved Investors in People (IIP), their customer satisfaction survey; the records of all financial transactions available in the Home and the minutes of quarterly Health and Safety meetings held within the Home. The manager completed the AQAA in time and this was detailed and informative. The home has had the same Manager for several years. She possesses the required qualifications and experience to run the home and is registered with us. A Deputy Manager is available both on days and nights and a Regional Manager also supports the Registered Manager. Each of the five Units has its own manager. We met with the managers on Wedgwood and Spode Units. The Deputy Manager took us around the home and it was evident that she had a good rapport with both staff and residents on the units. She is knowledgeable and has enthusiasm for the job. She explained how some improvements have been made as a result of concerns received. Staff members spoken to during the visit confirmed that managers are supportive and approachable. There is an organisational tool, designed to monitor the service provided and make sure that people using the service are happy and receiving the support they need. This is completed monthly. The number of complaints received by us since the last inspection suggests that this monitoring tool is not always as effective as it should be and that issues important to the people using the service are being missed. We were told that regular meetings are held with staff and residents/relatives and we saw evidence of this in the form of records and minutes. When we spoke with some of the people who live at the home they told us that they felt that they are listened to and that any suggestions they had are taken seriously. The staff also confirmed that regular meetings are held and that they felt included in decision-making. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 32 The following is an extract from a letter received by us from a relative of a service user “Tonight I have visited a well attended relatives meeting where my comments were echoed by others. The home manager, unit manager and senior care assistant were present and actively and enthusiastically listened and discussed everything with openness and compassion. These meetings happen quarterly, I cant wait for the next. Everything is not perfect but I left my meeting knowing that anything said by relatives would be dealt with efficiently and quickly.” There was a “financial viability assessment carried out by BUPA’s accountants and received by us on 28/6/07. This showed us that, as a Company, BUPA are financially viable. We also spent time with one of the Home’s administrators and checked the arrangements for keeping people’s monies safe. There is a computerised system and the home can produce individual accounts on request. All transactions are recorded and all monies are accounted for properly. Many of the policies and procedures were last reviewed in February 2006. This includes, the ‘management of violence and aggression’ policy, which in practice has caused enough concerns that Safe Guarding Procedures have been initiated. These will need reviewing and bringing up to date. Records and documentation were examined in respect of the maintenance of Health and Safety. The maintenance person is responsible for completion of these checks and it was identified that these had all been carried out very thoroughly and in compliance with BUPA’s own policy. Health and Safety is audited monthly – this includes a review of the fire log, a review of the maintenance plan and a review of the accident and incident reports. Personal individual risk assessments are carried out and these are contained in individual care plans, these include personal environmental risks. Other general risk assessments are carried out and reviewed regularly. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 x x 2 3 Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No 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. OP27 Standard Regulation 18(1)(a) Requirement Timescale for action 20/07/08 2. OP16 22(1,2,3) 3. OP9 13(2) There are insufficient nurse hours supplied to Wedgwood Unit in particular which means that not all individual needs are being met as per care plan. It is therefore a requirement that a review be carried out to ensure that individual needs are met at all times. The increased number of 20/07/08 complaints received by us over the last 12 months indicates that the Providers are not always dealing with individual concerns satisfactorily. Therefore the way that they investigate complaints should be improved to make sure that people’s concerns are investigated properly. The 9am medication was being 20/07/08 administered late on Wedgwood Unit. It is required that medication be administered at the time prescribed so that individuals receive their medication on time. Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP14 Good Practice Recommendations Residents are generally consulted or listened to regarding the choice of daily activity but this process could be improved and autonomy better promoted for individuals with reduced mental capacity. Better consistency of recording and more regular evaluations would help to improve the standard of care planning. The meeting of health and nursing care needs could be further improved by ensuring up to date clinical expertise of the nurses who work at the home. Although the home has adopted a new Quality Assurance system, the number of concerns received by us since the last inspection indicate that this system is not always as effective as it is designed to be. Therefore a review of this system should be undertaken with a view to improvement. The last review for many of the policies and procedures was February 2006. This includes “the management of violence and aggression”. These will need reviewing and bringing up to date in order to ensure that staff are provided with up to date guidance. “Do Not Attempt Resuscitation” forms used by the home should be made more robust in order to protect the individuals to whom they refer. 2 3 4 OP7 OP30 OP33 5 OP37 6 OP14 Stadium Court Nursing Home DS0000026967.V362434.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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