Inspection on 10/06/09 for Stubby Leas Nursing Home

This inspection was carried out on 10th June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stubby Leas Nursing Home 07/01/09

Stubby Leas Nursing Home 13/02/08

Stubby Leas Nursing Home 12/06/07

Stubby Leas Nursing Home 29/11/06

Stubby Leas Nursing Home 25/06/06

Stubby Leas Nursing Home 06/01/06

Stubby Leas Nursing Home 18/05/05

Stubby Leas Nursing Home 15/03/05

Stubby Leas Nursing Home 14/07/04

Stubby Leas Nursing Home 15/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Random inspection report Care homes for older people Name: Address: Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT one star adequate service 07/01/2009 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: Keith Jones Date: 1 0 0 6 2 0 0 9 Information about the care home Name of care home: Address: Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT 01827383496 01827383086 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : 1st Care Limited care home 48 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: Age: Dementia (DE) age 55 and above. 48 The maximum number of service users who can be accommodated is: 48 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 (DE) 48 Date of last inspection Brief description of the care home Stubby Leas Care home provides personal and nursing care for up to 48 people suffering with forms of dementia related illnesses. The home is situated in its own grounds on the edge of Fisherwick, a rural hamlet fairly close to the city of Tamworth, with accommodation provided on three levels, which are accessed, by stairs or a passenger lift. We found the grounds spacious, and there are pleasant country views Care Homes for Older People Page 2 of 13 0 7 0 1 2 0 0 9 Brief description of the care home all round, although with a limited car park. The attractive garden and patio areas are well maintained and secure. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. Rooms are provided on all levels of the home with a mixture of single or double rooms, some with en suite facilities. Communal areas are on the ground floor and there is a separate smoking area. The home has a purpose built activity room where people have the opportunity to maintain their skills and hobbies or to enjoy new interests. The full range of fees were not detailed in the service Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 3 of 13 What we found: Two Regulation Inspectors carried out this unannounced random inspection to monitor outcomes of an action plan, submitted to us by the Registered Provider of Stubby Leas, on the 26/05/09. This was made in response to concerns raised following a large scale review report of care, following a conference convened in accordance with the Staffordshire Safeguarding Vulnerable Adults Procedures, held on the 05/05/09. We found a number of areas that needed to be addressed and improved upon to increase peoples safety. This random inspection was to look at what the Registered Provider had done to make sure that the required outcomes of standards had been met. We conducted the random inspection with the Acting Care Manager and senior nursing and care staff on duty. We were joined at a later stage by the Registered Provider, Mrs. J Patel, and Mr. P Hetherington, Operations Director to assist in the inspection. The assessment process. The home has been subject to a cessation of admissions from the 30.02.09. From that date there has been an ongoing inquiry into events in accordance with the Staffordshire Safeguarding Vulnerable Adults Procedure. There are presently 32 people in the residence, registered for 48 people. We had conducted an unannounced key inspection on the 07/01/09, and concluded that the service offered a one star (adequate) quality rating outcome. We examined the policies and procedures that have been reviewed, to ensure that people who may use the service are appropriately assessed, to take into consideration their personal and specialist needs, and to ensure that those needs can be fully met before offering a placement. We also discussed with the Registered Provider and care managers the admission process, and were satisfied that there is a satisfactory procedure in place to ensure compliance to this requirement in practice. Care planning. We looked at how care is being arranged and supported for a range of people with health care needs who are presently using the service. We undertook an examination of five peoples care records (case tracked) from the last key inspection to the present time. We also interviewed care staff on duty and looked at other information such as complaints, incidents, accidents and other professional reports, including the review assessments submitted to the Staffordshire and Stoke on Trent Safeguarding of Vulnerable Adults strategy group. Our examination of care records and case tracking showed an improved consistency of quality of assessment, personal risk screening, care planning and review since the last inspection. We acknowledge that there have been no admissions to the home for the past five months, during the current review programme. Five care plans were examined, four having been recently modified in accordance to the acting Care Managers instructions. It is expected that the process will be completed by the end of July 2009. Those outstanding care files were seen to have an adequate care plan structure. We found that a comprehensive personal risk screening process is recognised as the foundation for a competent care planning process. Each persons health, personal and social care needs were found to be presented in an individual plan of care that is diligently reviewed monthly, to reflect changing needs and adapting care profiles, supported with a Care Homes for Older People Page 4 of 13 substantial and informative daily progress report. Each profile was seen to be supported by a dependency screening, including falls, movement and handling, nutritional, and a Waterlow pressure sore risk assessment. It was also noted from evidence provided from weighing people on a regular basis, has shown overall improvements in weight gains, where previously they had experienced weight loss in some people being reviewed. We found that appropriate monitoring of physical health observations were consistent and meaningful, and that we confirmed that those people who use the service, families and friends are invited to participate in the care planning process, and established reviews. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person using the service having access to a local Doctor, Dentist, Optician, Chiropodist, and Community Psychiatric Nurse as required. We consider that the strength of planned care lies within the frequency of the review process in monitoring and adapting care profiles, now established as a monthly routine by the acting Care Manager and Registered Nurses. A purposeful daily report is maintained to support and control monitoring, and offer an full account of care and service given during the day and night, updated with events and incidents, as and when necessary. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving at Stubby Leas Comments we received from people using the service and visiting relatives were: Ive been coming to Stubby Leas since my husbands admission last October, and I have been very impressed with every aspect of his care. The home is always clean and fresh smelling, and the nurses and carers are brilliant, Im very happy with the way that X is looked after here. I come every other day and find everyone to be so kind and very attentive, with everyone caring, understanding and respecting everyones privacy. Staff are very, very helpful. The Acting Care Manager informed us that there remains a number of care plans still to be organized under the revised system, although the one outstanding file we examined showed a competent assessment, risk analysis, plan and review process, supported by a detailed daily report, and associated monitoring arrangements. Medication. The administration of medicines adhered to procedures, with no observed inconsistencies. We reviewed the policy and procedure and found them appropriate to meet the demands for an elderly mentally ill nursing home. We saw that the receipt, storage, security and administration were of a good standard, including Controlled drugs management. We checked the medicines regimes for those people being case tracked and a random checks of Medicines Administration Record (MAR) sheets, which confirmed a consistent administration with an adequate audit trail for medicines received, administered and disposed of. Care Homes for Older People Page 5 of 13 Self medication and risk assessment policies were seen to be satisfactory, with no one in at the time who was able or wished to participate in the scheme. We confirmed that only nursing staff administer medication, have received updated training in the Safe Handling of Medications. We checked those case tracked individuals medication charts, and found all to receive appropriate medication regimes. A recorded incident regarding staff failing to confirm that a person has taken a prescribed medication was examined. We found that appropriate action has taken place to ensure future compliance with regulation. Social stimulation and recreation. We found daily life to be flexible to accommodate peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We are informed that two activity coordinators has been appointed, working from a large activities room, which had displays of art and craft work. We were informed that the Home is planning extended activities to add to those already in place, including a mix of individual and group activities, whilst recognising that normal daily routines, such as personal care procedures, should be a social interaction. On the day of inspection we spoke with one of the activity coordinators, who informed us that the following week she will be working full time at Stubby Leas. She was seen to be reading to a lady in the day room. We were informed by the Acting Care Manager that the two coordinators were having a significant influence on the daily lives of people, and would be presenting a plan of objectives to include a person centred support plan for each individual. We discussed their roles in relation with the objectives in reaching a quality environment for people with dementia care needs. We recognize that dementia needs are now being considered in relation to stimulation and occupation, and that no one was seen on the day to be isolated. Staff were seen to be actively involved in the programme and generally chatting with people throughout the inspection. Several people were asked about activities at the home, one would like to have entertainers brought in on a regular basis, and the other would like to spend more time talking and going out on day trips. One comment we received from a person using the service was: I dont like to mix with the others, but its nice to have the attention of the girls (activity coordinators) to talk with and do some exercises. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Staff were seen to supervise people in the dining and lounge areas. Those individuals rooms inspected showed a positive influence of personalisation in the inclusion of belongings, some furniture and general decor. Our inspection of the home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Environmental issues. Stubby Leas Care home is situated in its own, extensive grounds, with accommodation Care Homes for Older People Page 6 of 13 provided on three levels, which are accessed, by stairs or a passenger lift. We found the grounds spacious, and there are pleasant country views all round, although with a limited car park. The attractive garden and patio areas are well maintained and secure. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. The new reception area was found to be secure and the general state of exterior repair and maintenance was found to be satisfactory. It is recognized that there have been no admissions to the home since February 2009. We were informed that the procedure on admission the Acting Care Manager would assess each individuals needs for equipment and necessary adaptations. We confirmed that those facilities are available throughout the home, with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors; wheelchair access was satisfactory throughout the home. We observed that people had access to all communal areas, allowing relative freedom, including wheelchair access, in an improved, maintained, clean and safe environment. The Fire Officer report for the 05/01/09 had been received, with no major concerns. Our inspection showed us that fire doors were secure, equipment recently maintained and staff training to be in progress. Communal areas present much improved, pleasantly furnished areas to accommodate social or reflective needs, in a homely setting. There are four main lounges, each providing a comfortable seating area, with a satisfactory standard of furnishings. On the day of inspection staff were seen to be deployed in lounges with people, and actively engaged in interactions. The dining areas are well furnished, and presented to provide a good quality, conducive environment, to enjoy a good meal. We observed that staff supervision is available throughout the day. Efforts had been made to provide a homely atmosphere and the decor throughout was found to be of a steadily improving standard. Recent redecoration of bedrooms, new carpets and upgrades to bathrooms were satisfactory. The lounge spaces allow activities to be presented in pleasant areas of the home, with furniture and fittings of a good quality. We found sufficient evidence to confirm a progressive refurbishment programme. Bedroom areas were seen to be generally better maintained, decorated and furnished; some were seen to have been personalised with peoples possessions, and some personal furniture brought in with them. The ongoing re-decoration and maintenance are continuing, evidencing the Providers commitment to the future development of the home. We inspected a number of bedrooms throughout the home, and four of the bedrooms were identified as those of the people being case tracked. All had been subject to upgrading of the central heating system, with temperature monitoring, with each having a room thermometer. The atmosphere was found to be pleasantly ambient on a warm day. Bedrooms were individually and naturally ventilated, and windows were provided with restrainers for safety and security reasons. Radiators and hot water temperatures were regulated to reduce the risks of accidents from scalds, and all personal electrical equipment were seen to be tested. The Provider had stated that all maintenance worked highlighted in the reviews have been addressed, which we found to be true. Of the rooms inspected only one had a slight malodour due to an unwillingness in allowing regular cleaning to take place. People we spoke to during the course of the inspection expressed their general approval of their accommodation standards. We noted the action taken to replace insecure bedrails, and pressure relieving mattresses; and that wheelchairs were seen to be appropriately equipped with footrests. Care Homes for Older People Page 7 of 13 The standard and presentation of all the toilets and bathrooms continued to be an improving quality of decoration, having been recently refurbished. They were seen to be clean, uncluttered and odour free. Toilets are accessible to all, and within close proximity to all communal areas. The domestic services in the Home were seen to be of a good standard. The home presented to us a clean and pleasant atmosphere. To complement the presentation there were a number of floral and decorative displays. Those people we spoke to remarked, that they found the environment very clean, and fresh. We recognised the improvements made to provide an environment conducive to meeting the needs of individuals with dementia, with a programme of bedrooms being redecorated to meet individual wants and needs, with easier recognition and personalisation being introduced, for example, clear identification on their bedroom doors, and peoples artwork on display. We were informed that work will be going ahead on collages and murals for reminiscence, and pathway findings made easy with landmark items, to facilitate easily recognized routes in the home. Staffing levels There were 32 people using the service on the day of the random inspection, which included 25 people requiring nursing care. Three weeks of duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. We recognised that the Acting Care Manager is supernumerary to the staffing rota. Flexible rostering, with agreed overtime, are used to accommodate shortfalls due to sickness and absence; agency staff are infrequently employed. The staffing establishments were examined and found to be satisfactory in meeting the staffing standards. An average coverage was seen to be: 0700 to 1430 2 Trained Nurse and 6 Carers 1430 to 2130 1 Trained Nurse and 6 Carers 2130 to 0700 1 Trained Nurse and 3 Carers The manager is supported by a team of Registered Nurses and experienced senior carers. The administrative, catering, domestic and laundry staff were found to be appropriate for the size of the home and the needs of the people who use the service. We were informed that two more Registered Nurses would be joining the complement in the next three weeks. We have noted through our examination of staff records, and discussions with staff that a training programme is drawn up, although the records have not been kept up to date to evidence the effort. It is recognised that staff received a meaningful induction programme to meet their level of experience, and that mandatory training is given, and we confirmed that fire training is arranged, and movement and handling is presently underway. There has been a significant improvement in the numbers of staff undertaking Safeguarding awareness and Dementia training for the past 6 months. A training matrix was presented to us to evidence the degree of training undertaken in 2009, although failing to identify Registered Nurses training arrangements. Discussion with a senior nurse confirmed she had had a clear induction, and all mandatory training since commencing. It was agreed Care Homes for Older People Page 8 of 13 that a Registered Nurse would take up the responsibility for ensuring that training took place at the appropriate times, and that staff records be kept up to date. We received a number of comments regarding the staff at Stubby Leas, from visitors and people using the service, all being very complimentary. Policy and procedures. The acting Care Manager present at the last inspection has resigned his post, and a new Acting Care Manager has been in post since March 2009. He is a Registered Mental Nurse with extensive experience, working in a variety of care setting, including that of Quality assurance nurse and Deputy Care Manager, in two homes in the Staffordshire area over the past four years. He has yet to submit an application form for registration with us at the time of inspection, but stated that it was in the process of being addressed. We recognise that he has been appointed to head a team of Registered Nurses with a mandate to manage the service at Stubby Leas, with direct accountability to the Registered Provider. We have found a willingness to demonstrate an assertive commitment to the management task in hand, in addressing assessments, care planning and risk assessments for review, and ensure that practice is applied at a high standard throughout. We acknowledged the commitment and level of achievement, evidenced to show that a good standard of care practice has been observed, addressing clinical competence, and a very caring attitude and environment. Through the inspection process we found appropriate personal risk assessments in place for people using the service, through care planning, review and monitoring, and of the general environment. The Acting Care Manager offered evidence of procedure reviews, and safe working practices. We examined the accident records and found them to be in order, with a regular, and effective follow through of action taken, including a review of care plans and risk assessments when considered appropriate. We discussed with the Acting Care Manager, Operations Director, and the Registered Provider the issue of reporting Safeguarding matters to Social Services and the Care Quality Commission (CQC). We reminded the team present of the importance to report and refer all issues of safeguarding concerns speedily, to allow a strategy to be organised to deal with the issues. We reinforced the commitment of CQC in the safeguarding procedure, which was acknowledged by the team. We discussed the issue of medical authorisation for resuscitation instructions, and have been informed that a satisfactory outcome and policy have been agreed with the medical staff supporting Stubby Leas. What the care home does well: We are assured that requirements that we made following our 07/01/09 key inspection have been met. Under the direction of the Acting Care Manager and Registered Provider we acknowledged that the home has responded positively to the issues raised by the review of care commissioned by the Staffordshire and Stoke on Trent Safeguarding of Vulnerable Adults strategy group, and to our request for an action plan to address those issues, We found that the management has re-established a genuine commitment to Care Homes for Older People Page 9 of 13 care, with an open, confident and personable approach, which reflects a sound relationship between carer and people who use the service. We found that this has enhanced the involvement of families in the process of care, providing an individual approach to meeting personal and health care needs. We confirmed that a review of assessment procedures and care planning has presented a good standard, offering essential information on each persons progress in the meeting of objectives. We have recognised improved deployment of staffing resources, and that staff training and supervision are re-established in safeguarding the interests of people who use the service. No additional requirements were made as a result of this inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 13 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 11 of 13 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 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 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 12 of 13 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. Copyright © (2009) Care Quality Commission (CQC). 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