Random inspection report
Care homes for older people
Name: Address: Stamford Nursing Centre 21 Watermill Lane Edmonton London N18 1SU two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: David Hastings Date: 0 3 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Stamford Nursing Centre 21 Watermill Lane Edmonton London N18 1SU 02088074111 02088079479 moriarth@bupa.com www.bupacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 90 Number of places (if applicable): Under 65 Over 65 0 43 0 dementia old age, not falling within any other category physical disability Conditions of registration: 33 0 14 The maximum number of service users who can be accommodated is: 90 The registered person may provide the following category 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: Dementia Code DE (of the following age range: 50 years and over) (maximum number of places: 33) Old age, not falling within any other category - Code OP (of the following age range: 65 years and over) (maximum number of places: 43) Physical disablity - Code PD (maximum number of places: 14) Date of last inspection
Care Homes for Older People 1 3 0 1 2 0 1 0 Page 2 of 15 Brief description of the care home Stamford Nursing Centre is a care home registered to provide nursing care for older adults and a specified number of younger adults with physical disabilities. The home was previously owned by ANS Homes Limited. BUPA purchased the home in October 2005. BUPA is a national organisation and owns other care homes across the country. The home aims to provide a high quality of nursing care to adults convalescing after surgery or illness, older people who require nursing care, adults aged over fifty with physical disabilities and those requiring palliative care. The home is a large modern purpose built three storey building. The kitchen, laundry, reception and administrative offices are all located on the ground floor. The bedrooms are located on all three floors. All bedrooms have en-suite facilities. Floors are connected by stairways and a passenger lift. Each floor has a lounge and separate dining room. There are two additional smaller lounges. Fourteen younger adults are accommodated in a separate wing on the first floor. The home is located close to the North Middlesex Hospital and along the North Circular Road. It is within walking distance of shops; restaurants and transport facilities located the High Street in Edmonton. The fees charged by the home range from Seven hundred and thirty five pounds to Nine hundred and twenty nine pounds per week. The provider must make information about the service available (including reports) to service users and other stakeholders. Care Homes for Older People Page 3 of 15 What we found:
The Care Quality Commission carried out this unannounced inspection of Stamford Nursing Centre on Tuesday 3rd August 2010. There have been four recent safeguarding alerts regarding pressure care management at this service. Two of these alerts have been investigated by Enfield Safeguarding team and an outcome of institutional neglect has been found in both investigations. The service has been cooperating with these safeguarding investigations and an action plan has been developed regarding improvements to the management of pressure ulcers. The local authorities have also stopped admissions to the home until the problems with pressure care management have been satisfactorily resolved. Following a more recent pressure care problem identified by the service, five registered nurses have been suspended pending a further investigation. The regional manager told us that these posts are being filled by other nurses in the home and with agency staff. The regional manager told us that this was not having a negative impact on residents in the home. The reason for this inspection was to check that people who have pressure ulcers are being treated and cared for properly. The two inspectors carrying out this inspection focused on pressure care management at the home. We toured the building with the deputy manager, spoke with service users, staff and a visitor to the home. We also examined care plans, clinical notes and other documentation relating to pressure care management. The service sent us a list of residents who were currently being treated for pressure ulcers. A clinical plan was also provided giving details of the treatment of these pressure ulcers. The treatment plan for a number of residents made reference to using tap water to clean wounds. We questioned the regional director about this and asked her to clarify if this was a suitable treatment. We were concerned that staff were using the water from the hot tap rather than water from the mains/drinking water tap. We were later informed that tap water should only be used for the treatment of leg ulcers and not for pressure sores. The regional director confirmed that treatment plans had been revised accordingly and that wounds were now being cleaned with normal saline solution. On the day of the inspection the manager was on annual leave. We were assisted throughout the inspection by the regional manager for BUPA and the deputy manager. We also spoke with the London director of BUPA and the quality manager who is also qualified tissue viability nurse. The management and staff were open and helpful throughout the inspection. What the care home does well:
This inspection focuses on pressure care and as such other unrelated issues were not inspected. For example we were informed that the menus for the home have been revised and this is having a positive effect for residents. We also acknowledge that some care plans we examined were detailed and included clear information about the resident and their needs. We also saw examples of pressure ulcers being treated appropriately and saw records that indicated some pressure ulcers were improving at the home.
Care Homes for Older People Page 4 of 15 However this was not always the case as clinical practices, infection control measures and accurate recording procedures were inconsistent throughout the whole home. What they could do better:
A recent safeguarding investigation highlighted a problem with the pre admission process. It appears that a resident with an existing pressure sore was admitted to the home without all the required equipment first being put in place. This meant that the resident was in the home for a few days without the proper pressure relief mattress being provided. It is vital that all of the assessed needs of a potential resident are able to be met by the service before they are admitted. A new requirement has been issued that pre assessments must be carried out and all of the persons assessed needs must be able to be met before they are admitted to the home. There has been an issue with local tissue viability nurses not being available for advice and support. However as this service is a nursing home the expectation is that pressure care advice should be available within the organisation. The local PCT now has a tissue viability nurse in post and advice has been sought in relation to pressure care management. The organisation has also brought in a quality manager with pressure care experience to assist the nursing staff. The nursing staff told us that prior to this they were assessing the clinical needs of residents with pressure ulcers themselves. Evidence has shown that there have been problems with these assessments and the clinical management at the home. The doctor who visits the home told us he was surprised that he was not notified sooner about some residents with deteriorating pressure ulcers. Although the doctor told us he would not generally advise about pressure ulcers he would expect to be contacted in cases of infection so that a swab could be taken and/or hospital admission advised. We have issued a new requirement that the service develop a contingency plan for pressure care management at the home in the event that an outside tissue viability nurse is unavailable. The regional manager confirmed that all nurses have undertaken recent training in tissue viability. This training was carried out by the quality manager who has experience in pressure care. Given that training has been provided we asked why there have been so many problems with the management of pressure ulcers at the home. We were informed that there have been problems within the staff group including apathy and lack of understanding about clinical accountability. This is evidenced by the recent lack of recording of newly developed pressure ulcers at the home. Some staff we spoke to told us there were other staffing problems between care workers and registered nurses. These problems included a lack of communication, general arguments and a lack of understanding about work objectives and priorities. Care Homes for Older People Page 5 of 15 Records in relation to staff supervision indicated that not all staff receive regular supervision. This could be one reason that staff are unclear about objectives and priorities. A new requirement has been issued relating to staff supervision at the home. There also appears to be a lack of clinical supervision for nursing staff. It is not sufficient to provide training without also monitoring the competencies of staff. A new requirement has been issued that all nursing staff have directly observed clinical supervision and are signed off as competent to ensure that clinical practices reflect their learning and best practice. Evidence has shown that there is problem with a small minority of staff at the home. We were assured by senior management that they were addressing this issue as a matter of urgency. We toured the home and visited all three units with the deputy manager and spoke with staff, residents and a visitor. A requirement was issued at the last inspection that the home be refurbished and redecorated. Although this has not started yet we were told that the refurbishment of the home will be undertaken in September this year. Broomfield Unit We inspected the moving and handling equipment that is used as part of the management of all residents but in particular those with pressure ulcers. We inspected two hoists on this unit and found them to be dirty. The base of the frame had a build up of debris and the frame itself was heavily stained. We witnessed a support worker moving one of these frames. We asked what she was about to do with this and were told she was about to use it. This was addressed at the time of the inspection. We briefly inspected the sluice (dirty utility room) on this floor. The room was foul smelling with an offensive odour. The room was cluttered with a range of items including wash bowls. Clinical waste bags were on the floor. The clinical waste bin appeared broken, there was a box underneath this lined with a bag, with used dressings being discarded in it. This is an unnecessary infection hazard for residents. It was difficult to access the clinical hand wash basin in the room. Woodside Unit We inspected one bathroom that was infrequently used. We asked if there was a flushing programme in place to control the spread of Legionella and were told by the nursing staff and the deputy manager that there wasnt. We inspected two hoists on this floor and found them to be in a similar condition as to Broomfield with heavy staining on the frames. We were informed that the support workers should clean these each night shift. We observed two hoist slings hung over the hoists. We asked about how these were used and decontaminated. We were informed that they didnt have many hoist slings so they used the between residents unless they had a known infection. We were told they were then laundered. We asked about the process for washing mattresses. We were informed that the specialist pressure relieving mattresses are just washed by the care workers as are the static foam mattresses. The mattresses are not unzipped and inspected nor are audits undertaken. The nurse with us did not know that they could be unzipped. This means that mattresses are not being cleaned as they should be and so could increase the risk of
Care Homes for Older People Page 6 of 15 infections spreading. We briefly inspected the sluice (dirty utility room) on this floor. The room was foul smelling with an offensive odour. The room was cluttered with items stored on top of the bed pan washer making access to it difficult. There items on the floor including clinical waste bags and newspapers. It was difficult to access the clinical hand wash basin in the room. Oakwood Unit We inspected two hoists on this floor and found them to be in a similar condition as the other two floors, with heavy staining on the frames. We were again informed that the support workers should clean these each night shift. The sluice area on this floor was much less cluttered although there was still an offensive smell and clinical bags were still found on the floor. The taps in the clinical rooms were hand operated only and non mixer types. This could compromise effective hand washing procedures so other types of taps must be fitted to ensure that infection control measures are being adhered to. We issued an immediate that all equipment in the home must be cleaned and maintained to a satisfactory standard. We have also issued two further requirements relating to cleanliness and infection control and Legionella control in the home. We then examined a sample of clinical records and care plans on all three floors. Broomfield Unit We interviewed a residents relative and reviewed their current nursing records. The records were organised in a file and current charts were on a clipboard. The notes were difficult to review as there were inconsistencies as to where information would be recorded. For example some staff recorded clinical information in the relevant ongoing care section whilst others used the daily care section. The resident reviewed was assessed as being at risk of malnutrition on the MUST tool and had lost 2 kg in weight over a period of time. As a result weekly weights had been ordered. We were shown a weekly weight book which was used for all residents. This had not been completed since 22 June 2010. We were informed that there had been a problem with the weighing scales and therefore they had been waiting for them to be repaired. We then found weights dated 2 July 2010 and 10 July 2010, but recorded in different places within the records. The relative we spoke to said they were generally satisfied with the care provided at the home. They also told us that communication had improved recently, mainly due to the efforts of the deputy manager. Woodside Unit We inspected two sets of residents nursing records on the Woodside unit. We found evidence of risk assessments being undertaken. The records were filed neatly and staff
Care Homes for Older People Page 7 of 15 were updating clinical information in the ongoing record section making information easier to access. We noted that the pain assessment chart used for one resident was not appropriate. The chart was labelled as a pain assessment chart for residents who could communicate. We asked staff if they had a chart for those who couldnt communicate. Staff reported that they did but could not locate one on any floor in the centre, nor could we see evidence of one being used in residents records. We issued an immediate requirement that pain assessments be available for all those residents who have communication difficulties. Oakwood Unit We inspected two sets of nursing records on the Oakwood unit. These records were of clients that had not had their pressure ulcers previously recorded. There was evidence that these have now been recorded in the records. We spoke with some residents who are being treated for pressure ulcers. They told us that staff carrying out these procedures sometimes asked if they require pain control and sometimes told the resident what they were doing during the procedure. It is very important that all staff communicate with residents while such procedures are being carried out. We have made a new requirement relating to this issue. Generally we noted that risk assessments had been undertaken and recorded. The nursing records were not consistently completed in terms of which section they would record clinical care in. We also noted a duplication of recording with some area such as weight and were unable then to confirm if the weekly weights had been undertaken. This lack of consistency in recording could compromise the care of residents and makes reviewing residents progress more difficult. We have issued a new requirement in relation to the recording of clinical notes. In total we have issued ten new requirements as a result of this inspection including two immediate requirements on the day of the inspection. 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 set out on page 2. Care Homes for Older People Page 8 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 15 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person must 13/08/2010 ensure that pain assessment charts are available for all service users who cannot communicate. Regulation 12(1) (a)(b) The registered person shall ensure that the care home is conducted so as - (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. This is to ensure people who use the service have appropriate pain control when clinical procedures are being carried out. 2 26 13 The registered person must 13/08/2010 ensure that all equipment is kept clean and well maintained. Regulation 13(3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This is to ensure that people who use the service are not put at risk from dirty or potentially contaminated equipment. Care Homes for Older People Page 10 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 Regulation 14 (1) The 01/09/2010 registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practical to do so - (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (d) The registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of health and welfare. This is to ensure that no one is admitted to the home without first having everything in place to meet their assessed needs. 2 7 17 Regulation 17 (1) The 01/09/2010 registered person shall - (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. This means that records relating to the treatment of pressure sores or related issues must be stored in a manner that benefits both staff and service users. This is to ensure that records are being maintained in such Care Homes for Older People Page 11 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action a way as to inform staff of the progress or otherwise of an individuals treatment plan. 3 8 12 Regulation 12(1) The 01/09/2010 registered person shall ensure that the care home is conducted so as (b) to make proper provision for the health and welfare of service users. This means that a contingency plan must be developed to ensure that advice on tissue viability is available for all service users at all times. This is to ensure that people who use the service who have pressure ulcers receive current and appropriate treatment. 4 8 12 Regulation 12 (4) The 01/09/2010 registered person shall make suitable arrangements to ensure that the care home is conducted - (a) in a manner which respects the privacy and dignity of service users. This means that staff must communicate with service users when they are providing clinical treatments. This should ensure that service users are aware of what is going on when they receive treatment from nursing staff. 5 26 13 Regulation 13(3).The 01/09/2010
Page 12 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This means that all areas in the home are kept clean with particular reference to sluice rooms and mattresses. This also relates to handwashing procedures for staff. This is to ensure people are not put at risk from dirty or potentially contaminated areas or equipment. 6 36 18 Regulation 18 (2) The 01/09/2010 registered person shall ensure that persons working at the care home are appropriately supervised. This should ensure that all staff working at the home understand their roles and responsibilities at the home. 7 36 18 Regulation 18 (1) The 01/09/2010 registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This means that observed competency assessments must be carried
Page 13 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action out for all nurses who provide pressure care treatment for service users at the home. This is to ensure that there is evidence that nursing staff have understood any pressure care training and are carry out this treatment safely and appropriately. 8 38 13 Regulation 13(3).The 06/09/2010 registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This means that the registered person must review the policies and procedeures in relation to Legionella control. This should ensure that current best practice is being followed at all times in relation to Legionella control. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
