Inspection on 15/11/07 for Stockingate Nursing Home

This inspection was carried out on 15th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stockingate Nursing Home 10/04/08

Stockingate Nursing Home 23/08/07

Stockingate Nursing Home 22/02/07

Stockingate Nursing Home 26/05/06

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stockingate Nursing Home Stockingate South Kirkby Pontefract W Yorks WF9 3QX Lead Inspector Tony Brindle Key Unannounced Inspection 15th November 2007 10:30 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 Stockingate Nursing Home DS0000066612.V355076.R02.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. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stockingate Nursing Home Address Stockingate South Kirkby Pontefract W Yorks WF9 3QX 01977 648683 01977 648683 janet.db@btconnect.com 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) Helpcare Ltd vacant post Care Home 25 Category(ies) of Dementia DE (E)- over 65 years of age (25), registration, with number Mental Disorder, excluding learning disability or of places dementia - over 65 years of age (25) Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2007 Brief Description of the Service: Stockingate Nursing Home is registered to provide nursing and personal care for 25 elderly people who may have a diagnosis of dementia or other mental health problems. HelpCare Ltd bought the home from the previous owner in 2006. Bedrooms are mostly single, although a few double rooms remain. The home does not provide en-suite facilities and, as an existing provider, is exempted from any requirement to do so. However, there are bathroom and toilet facilities on both levels of the building. Other communal facilities consist of two lounges, a dining room and, to the back of the home, there is an enclosed garden where a sensory garden has been developed. Communal TVs are in the two lounges and activities are available. The provider informed the Commission for Social Care Inspection in August 2007 that fees range from £359 to £492 per week. Additional charges include hairdressing, private chiropody and newspapers. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. A copy of the most recent inspection report is available in the entrance hall. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit started at 10.30 am and ended at approximately 4:30 pm. Two inspectors visited the home: a regulation inspector and a pharmacy inspector. The last inspection in August 2007 identified some areas of serious concern. Improvement plans received from the company following this indicated that regulation had been met. Since then, the Commission has again met with the provider and managers, on 7 November 2007. The meeting focused upon the breaches of regulation affecting people’s safe care, outstanding queries relating to the finances of the company and no manager application for registration having been lodged with the Commission. The meeting was held within the Commission for Social Care Inspection (CSCI) improvement and enforcement strategy and sought information from the provider about actions taken to meet regulations and ensure people’s safe care. The provider said, on 7 November 2007, that regulations were now met. It was, therefore, of concern that the visit of 15 November 2007 found some matters have not been resolved, and the Ccommission will formally address these with the company. There has been discussion since the visit with the provider in relation to the inspection findings and outstanding financial information. Additionally, the Commission will directly contact the person managing the home as no progress has been made in relation to an application to seek registration. At the visit of 15 November 2007, there was the opportunity to speak to people living at the home as well as the acting manager, operations manager, care staff, kitchen, office and domestic staff and the handyman. A full check of the medication and the procedures operated by the staff in relation to this was carried out. Five people’s records were seen and included assessments, care plans, daily and medical records and the record of activities. One newly recruited staff record was seen. Other information considered was the information provided by the home through the Annual Quality Assurance Assessment and returned Commission for Social Care Inspection (CSCI) surveys. Surveys were sent out to people living in the home, their relatives and other people associated with Stockingate such as healthcare professionals and social workers. Replies were received from two people living at the home, 3 relatives and 1 healthcare professional. The feedback we received was positive. The inspector would like to take the opportunity to thank the manager and her staff team for their hospitality, and people using the service and their relatives for their patience and co-operation throughout the visit. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: In order to meet people’s need effectively, the registered person must ensure appropriate plans of care are completed, based on comprehensive risk assessments and information about people’s healthcare needs. The registered person must promote and maintain people’s health and ensure access to appropriate health care such as prescribed medication as and when required. A safe system of the handling and administration of medication must be followed by staff at the home. A record should be made in the controlled drugs register and returns book of all controlled drugs disposed of. The medication policy needs to be updated to provide staff with access to up to date information and guidance on the safe management of medication. The systems operated by the home must ensure that people get their own medication at the right time to make sure their healthcare needs are met. The registered person should ensure that appropriate supervision arrangements are put into practice for the person managing the home. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 7 The way that the daily records are completed should be improved to make sure that a full picture is given of the assistance people are given, and the ways people are supported to make day to day decisions. Training should continue until at least 50 of care staff have achieved level 2 NVQ in care. To ensure that all staff training is up to date, all staff should have refresher training as and when required. Also, all staff who deal with medication should receive appropriate training from an accredited source. The registered person should ensure that the records required by regulation for the protection of people living in the home, and for the effective and efficient running of the business are maintained, up to date and accurate. 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. Stockingate Nursing Home DS0000066612.V355076.R02.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 Stockingate Nursing Home DS0000066612.V355076.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People seeking to move into the home are not admitted until they have received satisfactory levels of information about the home and an assessment to ensure that the home is able to meet their needs. The home does not provide intermediate care. EVIDENCE: Feedback from people who completed our survey indicated that they were satisfied with the information they had been given about the home prior to moving in and were happy about the way their move had been carried out. All of the files seen contained completed pre-admission assessments and the acting manager said that, wherever possible, she does the assessments herself. The files included a basic pre-admission assessment based on activities of daily living, which included past medical history as well as current needs. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 10 The acting manager said that that people are welcome to visit the home and have a meal before they make a decision to move in. Two people were spoken to about this but they did not confirm this. Staff on duty said that people are welcome to visit before they make a decision to move in. The home does not provide intermediate care. Stockingate Nursing Home DS0000066612.V355076.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. People’s healthcare needs are being put at risk by the operation of inadequate systems relating to the administration of medication and insufficient care planning. EVIDENCE: The records show that care plans are in place but some require development to ensure there is sufficient information for staff to follow to meet people’s health, personal and social needs. An example of this was where a risk assessment showed that a person was at risk of falling when getting out of chairs and walking around the home. The care plan did not detail how the person should be supported and assisted safely when mobilising. Staff were seen to ask the person to sit back in their chair when they tried to get up, rather than asking them if they wanted to walk, and supporting them accordingly. Another care Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 12 plan talked about how a person with dementia can, from time to time, become verbally aggressive. The care plan did not detail how this person should be supported, what actions the staff should take to assist and reassure this person, or how the needs other people in the room should be supported should they become distressed. None of the care plans that were seen contain information about behaviour management plans and the support people should be given if they become distressed or aggressive, and none of the plans contained information about people to specifically support people with dementia, with particular reference to mental health issues they may experience such as depression or isolation. Whilst initial care plans had been produced with the person living in the home, or their representative, the acting manager said the monthly review was completed only by staff. This did not always contain enough information about current needs and medical condition, which could result in people not getting the care they need. One staff member said that, even though not all people’s care needs are written down in great detail, because the staff know the people well, they know what care they need. When asked what would happen if someone’s needs changed, the staff member said that it would probably get written down. An example given was if someone needed their food to be softened so they could eat it without the risk of choking. The staff member said they would inform the nurse in charge who would usually change the care plan. However, not all the care plans that were looked at included risk assessments. It was pointed out to the manager that this issue, of a lack of risk assessment, had been highlighted at previous inspections, and that she had recently given assurances, at a CSCI management review meeting, that all the care plans and risk assessments were up to date. In five records sampled, there were no risk assessments in place for medication and mobility despite people having mobility problems and people being on medication, which was administered for them by the home. No information could be found within the plans about what people’s pain thresholds were and how to gauge when to give medication prescribed as PRN, which could result in people being in pain. It is expected that the daily records will evidence that people receive the care they need, and can be particularly important to demonstrate care delivered for people with dementia or mental health needs as they not be able to communicate this easily. The daily records seen, written by the staff, were found to contain only very limited information about what had been “done” to a person. It was pointed out to the acting manager that recording did not include the reasons why planned care had not been undertaken by the staff, the choices people had, how decisions had been made with a person, or what activities people had done. No evidence could be found that actions, such as a referral to a dietician, had taken place following a weight loss for one person, despite a record of people’s weight gain or loss, and the guidance stating what Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 13 action needs to be taken depending on either a weight gain or loss. This was discussed with the acting manager. She said that she would be looking into these issues when she looks at reviewing the care plan system. The care plans did contain limited information on how the care staff maintain the personal and oral hygiene of each person. There were risk assessments in place in relation to moving and handling and the prevention of falls. The records show that people who have developed, or are at risk of developing, pressure sores have appropriate intervention and this is recorded in the plan of care. Nutritional screening records were seen, and the acting manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this and that people are registered with a GP and that people have access to hearing and sight tests according to their needs and one person living at the home confirmed that they had recently had an eye test. The acting manager said that the activities co-ordinator does provide opportunities for people to take part in appropriate exercise and physical activity, however, no evidence could be found to show that people had been assessed to make sure that they were able to take part in activities. A discussion with the acting manager centred on the issue of poor medication practices. As the system is not robust enough, it is clear that the medication/healthcare needs of people, and thus their privacy and dignity, is not respected at all times. The acting manager agreed that this is an issue and said that she will be auditing the medication as soon as possible and will take the action necessary to rectify any problems. The medication policy was looked at and found to be in need of review as there are no details on correct storage including taking fridge temperatures or on self administration of medicines. The current Medication Administration Record (MAR) charts were looked at. A number of people do not have a current photograph attached to their MAR chart. This means there is a risk that a person may be wrongly identified and given incorrect medication. The recording of medicine administration is good; this means there is a record to demonstrate that people are getting their medication as prescribed. The controlled drugs cabinet and register are suitable for use. It was pointed out to the acting manager that records had not been made in the register for the disposal of two controlled drugs. It is important that an accurate record is made of receipt, administration and disposal of controlled drugs to make sure that they are being handled safely and securely. The ordering of prescriptions is good, prescriptions are checked before sending them to the pharmacy. This is an example of good practice in the management of people’s medication as it provides an opportunity to check if any new medicines or dose changes are included. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 14 The quantity of medication from one monthly cycle to another is not recorded on the new MAR. This means it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. The amount of medication remaining after each administration is recorded. However, it was pointed out to the acting manager that the information on stock remaining was not always used to make sure prescriptions are ordered in time. It is important that staff understand and follow good practice systems to make sure people are not without their medication. Inconsistencies were found in handwritten entries and changes made to medication. It was explained to the acting manager that accurate and detailed records of any changes or new medicines must be made to make sure the medication is given correctly. It was pointed put that the code ‘N’ was used on a number of occasions to record no administration. However, there was no definition on the chart to explain why the person had not received their medication. It was explained to the acting manager that it is important a clear reason is given so there is accurate information on how a person is taking their medication. There is a record of disposed medication. However it was noted that this does not detail the name of the person who had been taking the medication. This information is required to provide an accurate record of medication leaving the home. An audit of current stock and records showed that some medication had been signed for but not given. For example, one person had twelve methotrexate supplied at a dose of three tablets once a week. Nine tablets had been recorded as administered but six tablets remained in the bottle. This means there is a risk that people are not receiving their medication as prescribed, which may affect their medical condition. The storage facilities are good; medication is kept securely. A number of out of date medicines were found. It was pointed out to the acting manager that out of date medicine must be disposed of. This reduces the risk of people receiving medication that may be unsafe. It was noted that there was medication for people no longer at the home. It was explained to the manager that medication no longer required must be separated from medication in use and disposed of safely to prevent incorrect administration. Inconsistency was noted in relation to the recording of the date of opening on medication with limited use once opened. It was pointed out to the manager that there is a risk that people may receive medication that was no longer safe to use. A bottle of Gaviscon was found in the cupboard with the word ‘staff’ written on. Medication used by staff should be kept separately to reduce the Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 15 risk of administration errors. There were a number of medicines that did not have a pharmacy label. Medication must only be administered from stock supplied and labelled by the pharmacy for that person. The pharmacy inspector looked at four care plans. The information held within them was of a good standard. However, some needed to contain an updated list of current medication. One care plan had a good detailed record of the person’s medical condition. Information such as test results and hospital visits were recorded. This means staff have up to date information. The acting manager explained that care and comfort is given to people who are close to death, and appropriate medical interventions are made such as visits by GPs or admission into hospital. The records confirmed this. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The way in which people’s social and recreational needs are identified mean that people are supported well in this area. People could be better supported to make choices and decisions about their daily lives. EVIDENCE: People’s individual files showed that the work on developing life histories of people continues, this looks into their interests, hobbies and social preferences. The staff rota shows that an activities organiser is employed at the home and a programme of activities is available. The activities organiser was on duty during the visit and was seen to engage a small number of people in an activity which was a table top activity looking at photos. Photographs of recent events held at the home were on display. The records of the various activities that people had been involved in was seen, and contained some good information. People living at the home said that they enjoy the activities that are on offer, and that they enjoy spending time with other people doing arts and crafts, and “remembering the good old days”. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 17 Staff were seen to interact with people positively and seen to talk to people in pleasant ways, offering them drinks and talking to them about their day. People living at the home said that the meals are nice. The mealtime observed showed that meals are presented in an attractive manner and that people living at the home were enjoying their food, and being supported appropriately. One person living at the home said that there is a good choice of meals. The menus confirmed this. One staff member said that there is always enough food on the premises and a look at the pantry confirmed this. The staff member said that food and supplies are usually ordered online via a local supermarket, and delivered twice a week. There has been some rearrangement of the use of rooms, a lounge is now being used as the dining room, and vice versa. People living and working in the home said that this was a change for the better as the rooms are better suited to their respective activities. People working at the home said that they have a noticed a positive change in the way people engage with each other, both during meal times and while sitting in the new lounge. Stockingate Nursing Home DS0000066612.V355076.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are safeguarded by complaints being managed appropriately and staff are trained on adult abuse and protection. EVIDENCE: Feedback from people who completed our survey indicated that they were satisfied that the staff at the home knew how to respond to incidents or complaints. The records relating to complaints were seen and found to be in good order. The records show that complaints are usually responded to, and dealt with, within the appropriate timescales. People living at the home said that they felt safe and comfortable and knew who to speak to if they were unsure about a situation or the way someone was behaving. The training records show that staff have had satisfactory training in the area of safeguarding vulnerable people. The records show that there are appropriate procedures for responding to the suspicion, or evidence of, abuse or neglect. One member of staff said that, if allegations of abuse are made or incidents take place, they are followed up promptly and the action taken by the staff is recorded. The records confirmed this. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 19 The acting manager said that the court case, which is to be held against a suspended staff member who it is alleged abused a person living in the home, has not yet taken place. She said that she would keep the Commission informed of the progress of the case. Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean and comfortable home. EVIDENCE: The acting manager said that various areas of the home have been refurbished such as the dining room and lounge. She added that the sensory garden is almost complete. A tour of the home confirmed this. The maintenance of the home, and the levels of hygiene, were found to be of an acceptable level. The Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 20 lounges were clean and tidy. The sensory garden was seen to be an excellent addition to the home. People living at the home said that the garden looks lovely, adding that they find it is easy to get round the home. Feedback from people who completed our survey indicated they believed the home to be kept clean and tidy. The acting manager said that soiled articles of clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten. This was confirmed by a look around the home. Appropriate hand washing facilities are available; the records show that there is an appropriate infection control policy and procedure in place. Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further training for both nursing and non-nursing staff, and the achievement of NVQ awards, would ensure that a well trained and competent staff team supports people living in the home. EVIDENCE: Staff rotas showed that staffing levels are appropriate to meet the needs of the people living at Stockingate. People living at the home said that they think there are enough staff on duty to “help us and care for us”. Observations on the day found that there were sufficient numbers of staff on duty who were able to meet the needs of the people living in the home. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 21 A programme for staff training is in place. The staff training records confirmed that staff receive training in areas such as health and safety, fire safety, movement and handling, safeguarding, and food hygiene. However, some staff who work nights are in need of refresher training in relation to movement and handling and health and safety training. The acting manager explained that training has been organised for people in need of refresher training. The records confirmed this. A discussion took place with the acting manager regarding the issue of medication and the fact that a number of issues and errors been found during the visit. The records show that the medication is operated by the acting manager and other trained nursing staff and the point was made that, despite this, a number of errors had been found which did bring into question the competency of those operating the system. The acting manager said that full audits of the medication, along with both disciplinary action and further training, is being considered in order to tackle this longstanding issue. Feedback from people who completed our survey indicated that they believed that the staff were well trained. The records show that induction procedures are in place and that new staff receive the new induction in common standards in line with the Skills for Care Council. One staff member discussed the induction process and was able to talk at length about topics such as understanding principles of care, maintaining safety at work and recognising and responding to abuse and neglect. The records show that National Vocational Qualification (NVQ) training has been arranged for care staff but the target of 50 of staff holding the level 2 award is yet to be achieved. The records show that recruitment policies and procedures are being followed. The manager explained that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. The records confirmed this, and show that new staff are confirmed in post only following completion of a satisfactory police check and Protection of Vulnerable Adults register and Nursing register. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 34 35 36 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some good management systems are now in place at the home but this judgement is particularly affected by the potential risk to people’s safety caused by poor care planning, inadequate medication systems, and an ineffective quality assurance system within the home. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 23 EVIDENCE: There has been no registered manager at the home since the company achieved registration in April 2006. CSCI records show that the owner of Stockingate and the acting manager have been informed that people managing a home must be registered. No application has been submitted despite agreement that this would occur, and this matter will be addressed. There is evidence to show that the home has a quality assurance and quality monitoring system which is based on the views of people living in the home. Feedback from relatives and visiting healthcare professionals gathered during January 2007 was seen but the acting manager said that she has not yet compiled a report detailing the outcomes of the survey. The acting manager said that she is not aware of an annual development plan for the home. The records show that there is suitable insurance cover put in place and the certificates are displayed in the office of the home. During the visit, a number of unpaid bills were seen. These related to a number of different things such as the utility supply, phone bill, stationery, wipes, training etc. A discussion with the operations manager over the telephone following the inspection indicated that these bills had been paid, and that the paperwork seen at the inspection was ready for filing. However, the operations manager could not account for the fact that all the bills were overdue. The acting manager said that there is always plenty of food and stock in the home. However, she did say that, on two occasions, the company credit card had been turned down when food was being ordered over the Internet, and that another means of payment had to be found. The CSCI records show that, in August 2007 the company, HELPCARE (LTD), that runs Stockingate, was subject to a Winding Up Order, which was later rescinded. As a result of the winding up proceedings, the owner of the home was asked to supply the Commission with information relating to the financial viability of the company. He has supplied the Commission with a set of accounts. The Commission is currently having further discussions with the owner of the home with reference to the finances of the company. The acting manager said that she is not aware of a business and/or a financial plan for the home. The acting manager explained that, where the money of individuals is handled at the home, she makes sure that the personal allowances are not pooled and that appropriate records and receipts are kept. The records confirmed this. The acting manager said that she is not appointed as agent for any of the people living at the home. The acting manager said that the monies are now kept in a securely locked cabinet, this followed the last inspection when it was noted that the money tin was in a cabinet which had been left unlocked and, at times, unattended. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 24 The records show that, on the whole, care staff receive formal supervision at least 6 times a year. One staff member said that supervision usually involves talking about the care people need, how the home should operate and their own training needs. The acting manager said that her supervision is hit and miss, and no records of her supervision could be found to show whether the acting manager receives the support she needs to manage the home. The records show that the staff have had training in health and safety, fire, movement and handling, food hygiene, safeguarding, infection control and First Aid. The records show that the home has had checks completed in relation to: • risk of Legionella, • risks from hot water/surfaces • Gas and electric • Fire safety • Maintaining equipment, eg hoists As previously mentioned, of concern is that the medication records were not accurate. In addition to this, nor were some of the care plans, and risk assessments have not always been carried out to ensure safe working practices. Risk assessments within care plans were found to be incomplete. The acting manager does notify the Commission of significant incidents within the home such as falls, deaths or admissions to hospital. Feedback from people who completed our survey indicated that they feel safe living in the home, and that they believe it is well run. Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 3 3 X X 1 Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 26 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 OP38 Regulation 15 13 Requirement In order to meet people’s need effectively, the registered person must completed appropriate plans of care based on properly completed risk assessments and information about people’s healthcare needs. Previous timescale 01/10/07. The registered person must promote and maintain people’s health and ensure access to appropriate health care service as and when required, to ensure peoples healthcare needs are met. A safe system of the handling and administration of medication must be followed by staff at the home. Previous timescale for compliance 1/10/07 and 22/02/07. Timescale for action 07/01/08 2 OP8 12 07/01/08 3 OP9 13(2) 07/01/08 Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations The way that the daily records are completed should be improved to make sure that a full picture is given of the support people are given, and the ways people are supported to make day to day decisions. A record should be made in the controlled drugs register and returns book of all controlled drugs disposed of. The medication policy needs to be updated. This means that staff have access to up to date information and guidance on the safe management of medication. The systems operated by the home should ensure that people get their own medication at the right time, thus affording them respect and dignity. Training should continue until at least 50 of care staff have achieved level 2 NVQ in care. To ensure that all staff training is up to date, all staff should have refresher training as and when required To ensure that all staff training is up to date, all staff who deal with medication should receive appropriate training from an accredited source. The registered person should ensure that appropriate supervision arrangements are put into practice for the person managing the home. The registered person should ensure that the records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 2. 3. 4. 5. OP9 OP9 OP10 OP30 6 7 OP36 OP37 Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stockingate Nursing Home DS0000066612.V355076.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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