Inspection on 12/06/07 for Stubby Leas Nursing Home

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Stubby Leas Nursing Home 10/06/09

Stubby Leas Nursing Home 07/01/09

Stubby Leas Nursing Home 13/02/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT Lead Inspector Mr Keith Jones Key Unannounced Inspection 12th June 2007 09:00 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 Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stubby Leas Nursing Home Address Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT 01827 383496 01827 383086 abbeydale@abbeydale.plus.uk 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) First Care Ltd Vacant post Care Home 48 Category(ies) of Dementia (48), Dementia - over 65 years of age registration, with number (48) of places Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 Dementia (DE) - Minimum age 55 years on admission. 48 DE (Dementia) - Minimum age 60 years on admission. Date of last inspection 29th November 2006 Brief Description of the Service: 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. Accommodation is provided on three levels, which are accessed, by stairs or a passenger lift. 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 service users have the opportunity to maintain their skills and hobbies or to enjoy new interests. The grounds are spacious and there are pleasant country views all round, with space for several cars to park. The current range of fees are from £400 to £500 per week. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out with the Registered Provider. The Operations Director and the Care Manager (designate), with assistance of Nurses and members of staff on duty. The Annual Quality Assurance Assessment (AQAA) self-assessment and Dataset questionnaire had been completed prior to the inspection, although there had not been an opportunity to receive survey forms from residents, families or associated professionals. The last inspection report was discussed to which it was noted that a number of requirements had not been dealt with, although scheduled for early attention. It was recognised that a highly significant attention has been focused in complying with meeting regulation, including those recommendations made at recent key and random inspections. A tour of the Home permitted free access to all areas, residents, relatives and staff. A full case tracking of four residents, and discussions with five members of staff, yielded a valuable insight of policies in action. An inspection of administrative procedures and documentation preceded a detailed follow-up report with the Provider and senior nurse managers, and all were thanked for their cooperation and open willingness to contribute to the inspection process. There were 34 Service Users in residence on the day of inspection. This was representative of a low average occupancy over the past 6 months, to allow consolidation in meeting Regulation standards. What the service does well: What has improved since the last inspection? It was evident throughout the inspection that attention to a broad area of standards has improved the overall performance in delivery of care. Care planning and monitoring has improved in meeting the physical, social and psychological needs of residents. The environment has had significant investment into upgrading services and refurbishment. Staffing had been unsettled with the rapid changes in managers, but has responded to a more Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 6 ‘client-based’ package of care, meeting physical, personal and mental health needs. Creation of two person staff teams have enhanced care standards and communication, reinforcing the named nurse and carer concept. Training and supervision has improved with an established foundation of plans and programmes geared to meeting both specific and mandatory training needs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 7 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 Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 8 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): 1,2,3,4,and 5 The quality in this outcome area is good. The Statement of Purpose has been, and continues to be reviewed, in addressing the major issues and reflecting changes. The Home ensures that the admission process is a recognition of a joint understanding that residents are aware, and that staff are able to meet expectations, to realise a comfortable transition. The Home ensures that prospective residents have the necessary information to enable an informed choice to be made. All residents have suitable contracts of terms and conditions of residence at the home a copy of which is on resident’s files. EVIDENCE: The revised draft Statement of Purpose, and Service User’s guide represent an improved description of the Home’s aims and objectives, philosophy of care and terms and conditions. It offers residents, and their relatives the Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 9 opportunity to make an informed choice about where to live. A continuing attention to the issues raised in Schedule 1 of the Care Standards Regulations, in addressing contemporary changes, would improve the depth of information the prospective residents and their family require. A review of the Service User Guide in presenting a more easily read information package would enhance the process. It is stated in the Statement of Purpose that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of service users. The Statement of Purpose also indicates the terms and conditions, which are discussed with service users and relatives prior to admission. Following the last inspection, a policy has established that a pre-admission assessment, carried out by the Care Manager or deputy, appreciated any special needs of the individual including cultural, social or personal needs, are fully discussed and documented. In a recent admission case file examined showed that this assessment initiates the process of care, the individual having a plan of care based on personal needs and a daily living process. The Home demonstrated through case tracking, that the assessor explained this information in respect of each individual to ensure a clear understanding is established. The assessor also makes a judgement as to the suitability of each prospective service user using the same criteria. This process is planned to continue with a ‘partnership’ approach to care as an ongoing basis, founded on the assessment. There is sufficient evidence that the family is kept informed of the situation, offering service users and their relatives the opportunity to make an informed choice about where to live. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 10 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 and 11 The quality in this outcome area is adequate. The service users’ assessment provides the base, from which care planning is formulated. It is recognised that this reflects an individual profile of needs, discussed fully with family. The Home has access to GPs that visits the Home frequently, and the majority of service users are registered within 48 hours. The Service User Guide, admission assessment and care plans are geared to engender a sense of individuality and privacy. The inspector observed the free, courteous interaction between service users and staff based on a level of confidence of essential mutual trust and respect. Medicines administration and management is basically secure, although there are areas of practice and procedure that need a thorough review. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 11 EVIDENCE: There was evidence to show that a review of the care process has produced a much-improved standard of meeting a broad area of care needs. The preadmission assessment represents the foundation for an informative care planning process. Four residents’ care files were tracked, and demonstrated a system of collecting valid information on individuals, their life style and needs, events and contacts, procedures and actions measured on a daily basis and reviewed monthly. Risk screening on an individual basis was seen to be effective. The policy of the Home is to maintain service users own GP support wherever practical; otherwise residents are registered with the local surgery. The main practice servicing Stubby Leas has recently declined to continue to offer a professional advisory service, although maintaining its weekly, and ad hoc visits. It is expected that a review of this position will be considered following the positive changes achieved. District nursing services, CPN and Clinical Nurse Specialist consultation are also received, offering valuable care assets within an established and positive professional rapport. Discussions with service users confirmed their acceptance and confidence in the overall standard of care and service given. “ The staff are brilliant”, ”I saw the doctor last week, it was really nice”, and “ when I asked for a change, the matron was very kind and helpful”, were some of the comments offered by residents. There was evidence that suitable equipment was deployed effectively, and carers were seen to interact with residents with purpose and compassion. Activities are an important element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style. Consideration should be given to increase these resources with an employed activity coordinator to further the aims of effective care. The facilities and bedrooms were presented to facilitate privacy for the individual, which included medical examinations and personal care procedures, being performed in private. The administration of medicines process has an elementary security and administration standard to promote protection to service users. The storage was essentially secure, with added security space for controlled drugs. There was poor control of Schedule 3 drugs, recognised as requiring controlled drug security. A controlled drug register was examined and found to be poorly maintained to handle both CDA and Schedule 3 drugs. The Care Manager was advised to close off records of CDA when a resident leaves or discontinues the drug. There were several instances of failing to complete the MAR record appropriately. There was a list of drugs approved for stock use, including antibiotics and night sedations, and it was noted that stock bottles had not been approved by the Care Manager (designate), who is required to review Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 12 policies with the supplying pharmacist. There were no residents self-medicating at the time of inspection. Each service user has the opportunity of their own lockable facility in their bedrooms on request. These ‘boxes’ are to be secured in each bedroom. The procedure for handling accidents and incidents was inspected and found to be appropriate. The Care Manager (designate) was advised to analyse accidents on a 3 monthly basis. Family and friends have relative freedom of visiting, those spoken to remarking on the importance of maintaining social contact. There was also an observed knowledgeable, and positive attitude by staff towards residents, and feedback from the residents: “I am very well looked after here, and “ nice home, very friendly” “good staff, very helpful”. The spiritual needs of service users were respected, recorded and observed by the staff. Staff were advised to desist placing institutional notices and sticky labels on furniture. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 13 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 and 14 The quality in this outcome area is adequate Generally service users’ life-styles and interests are recognised, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Those who wish to bring in personal possessions are encouraged to do so. That routine is seen as flexible; to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Service users were able to see their relatives and friends in private and decide whom they see and do not see. Service users were offered a varied and nutritious choice of meals from a 4week rotating menu. Special diets were accommodated with the cook making every effort to engage with service users to discuss personal preferences. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 14 EVIDENCE: The daily routine was discussed with staff and several residents, and was agreed that there have been significant improvements in ensuring a more sensitive approach, and to be seen to be flexible to acknowledge individuality, without dictating a regime, yet present a focal point for residents to offer the security of consistency. Through case tracking, resident’s life-styles and interests were recognised, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. This will be enhanced by a closer application of a social record to match regular care plans. Those who wish to bring in personal possessions are encouraged to do so; there was ample evidence to show that has been followed through, presenting a warmth and familiarity. Family and friends have freedom of visiting, those spoken to remarking on the importance of maintaining social contact. One resident who had been admitted recently to Stubby Leas had the case file examined, and it was found to provide a sound plan of care, although the resident was frail and requiring full physical and mental care and attention. It is the intention that relatives are engaged at all levels in the progress of care and its ongoing review. Staff are organised into 2-person teams, identifying named nurses and carers. This has had a profound effect on the provision of personal care, and reduced any anxiety over effective communications. Residents spoken to were generally complementary with the relaxed environment, and the standards of care. During the inspection several residents and staff were seen to be engaged in social activities and discourse. Staff were observed to hold a friendly and sympathetic interaction with service users in several lounge areas, and at mealtime in helping those who required assistance. There is a large activity room used spasmodically with care staff involved. A senior carer is presently engaged in facilitating activities, a role that needs active consideration to be formalised in a more structured activity coordinator role. It is advised that a weekly activity programme be drawn up and actioned. It was noted that a User Forum, including relatives, has been set up. Service users were offered a varied and nutritious choice of meals from a 4week rotating menu. It was pleasing to discuss with the cook the degree of involvement she had in the daily nutritional affairs of the residents, including accommodation of special diets and regimes. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 15 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, 17 and 18 The quality in this outcome area is adequate The home had a meaningful complaints policy in place to ensure the protection of resident’s legal rights, identifying the CSCI as a resource to approach with a complaint or grievance. On discussions it was evident that small matters were handled immediately, discretely and to the satisfaction of all concerned. The home has systems and procedures and to protect residents from abuse. EVIDENCE: Residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the ongoing assessment of care planning and policies in place i.e. the complaints procedure. The complaints policy was seen and records examined. There had been one formal complaint handled by CSCI since the last inspection, in which Regulation had been met, in an atmosphere of improving standards. There were few recent ‘minor’ complaints, which would be better dealt with through a formal ‘record of concerns’, to record residents and families concerns in a meaningful and effective manner. A three monthly analysis of all complaints, concerns and allegations is to be reinforced by the Care Manager (designate). On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned, by direct Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 16 intervention of the care management. The overall policy of openness and transparency was acknowledged to have been a major improvement, requiring continual address. Discussion confirmed that there is a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes clarified and reinforce the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. The practical training requires a formal annual approach for all staff. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 17 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. The location of Stubby Leas is conducive for a care home, situated in a country setting with reasonable access to road links for Tamworth and Lichfield. The building has received a significant attention to maintenance over the past four to six months, and to internal refurbishment, and an ongoing upgrading programme. The interior state of repair is at an improving, adequate standard; bedrooms are well appointed, of a satisfactory size. Communal areas are furnished and decorated to a much improving standard to present a more comfortable environment. Service users live in a safer, and better managed environment, with a planned programme drawn up to sustain the recovering standards. Each of the bedrooms provided differing levels of furnishing and facilities, across a broad band of quality, but to which each resident has been encouraged to add their personal belongings, furniture and décor as wished. The standard and presentation of all the toilets and bathrooms were of a poor quality, although clean, uncluttered and odour-free. The standard of cleanliness has had extensive and thorough reorganisation throughout, resulting as an important factor in evidencing improving standards. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 18 EVIDENCE: There is evidence that the Home’s staff and management have systematically addressed the many problems identified in recent reports. There remain many challenges but there has been a meaningful focus on establishing a safe environment, and evidence of meeting personal care standards. External car parking is adequate, and gardens are spacious, but poorly maintained, with some dilapidated equipment. Patio areas available are of a good quality, popular, well equipped and safe. It was recognised that the Home has employed a permanent maintenance operative. Internal access was facilitated with adequate, well-lit and airy corridors, which are in need of decoration and repair. The refurbishment and re-decoration programme is a constant feature, with recent up-grades inspected and found to be of an adequate standard. Overall bedrooms were seen to be well appointed, some with improved maintenance to meet service user’s personal preferences. It is the policy that on bedrooms becoming vacant, that each room is reappraised for redecoration. There has been a substantial improvement in the purchasing of bedroom and communal furniture, although there remains some furniture looking worn and in need of reassessment. The Provider indicated that the remaining needs would be shortly met through the development programme. A complete replacement of the fire alarm system was underway at the time. New curtains were been fitted on the day. The 2007/08/09 development programme is to be drawn up and presented to CSCI as a requirement, following a risk assessment by the management. Communal areas were much improved, pleasantly furnished with facilities to accommodate social or reflective needs, in a homely setting. The building complied with local fire service, Environmental Health, and Health and Safety requirements. Stubby Leas provides a range of communal areas for service users to sit, with four lounge areas available. On the day of inspection staff were seen to be deployed in lounges with residents, and actively engaged in interactions. Service users risk assessed have virtual free access to safe and comfortable surroundings throughout the home. There are well provided-for dining rooms, suitably light and bright to allow service users to take enjoy a meal. Social, cultural and religious activities tend to take place in the lounges, although a spacious activity room is available, and service users are able to access any lounge. The call alarm system was satisfactorily tested and service record checked. The standard and presentation of all the toilets and bathrooms were of a poor quality of decoration and barely furnished, although clean, uncluttered and Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 19 odour-free. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. Toilets are accessible to all and within close proximity to all communal areas. Notices regarding chemical handling in the areas that store chemicals displayed appropriate COSHH posters and information charts. The general standards of cleanliness and infection control have made significant progress following the visit by the Health Protection Nurse specialist. There were no areas with malodours found; a stained mattress and divan were identified for removal. There are two variable height beds available, even though there were a number of physically ill residents. It was agreed that the Provider would ensure a minimum of five beds be made available. The heating arrangements throughout the home are by central heating with guarded radiator convection. There have been major problems with the systems over the past year, with an almost continual presence of plumbers. It was acknowledged that much remedial action has taken place, with substantial improvements, which has inevitably led to an increased need to redecorate areas previously affected. The laundry area was clean and well organised; procedures were in place for coping with soiled/infected linen with a provision to minimise handling, and cross-infection. A drawer of unnamed items was identified for removal. COSHH signs were evident, although in need of renewal with laminate posters. Vinyl flooring was ‘sticky’ underfoot following cleaning. Chemical cleaners were used appropriately throughout the home, and were seen to be secure and under COSHH recommended practices. The kitchen was inspected with the cook, and found to present a well equipped and organised area. All fridges and freezers were seen to be used in the appropriate manner, well maintained, and checked daily by the kitchen staff. A cleaning schedule was in place and found to be accurate, up to date and comprehensive. Staff were advised to sign and date all records. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 20 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 The quality in this outcome area is adequate. Staffing levels were seen to be good to meet an expected demand, the daily care staffing rota showed adequate balance between skills and qualifications. Staff turnover had settled down following a period of some unrest. A newly appointed Care Manager (designate) has swiftly consolidated the stability of deployment, contributing approximately 10 hours a week to the staff rota. The Provider and Care Management have established a procedure for interview, selection and appointment of staff, which requires reinforcement in ensuring the protection of service users. Staff training records also need review to complement the effort placed into staff training. EVIDENCE: Three weeks of off-duty were examined, and showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. Staffing levels exceed the expected number to meet the needs of 34 residents, a level which has been kept low during the past months to allow for consolidation and reorganisation. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 21 The Care Manager works 30 hours supernumerary, and 10 hours to shifts, supported by an able team of Registered Nurse (RMN and RGN), led by an experienced Deputy. Bank coverage has been used occasionally to support shortages of care staff, in tandem with overtime and flexible rostering to meet shortfalls. Agency staff have not been used recently. There is a 30 contribution of overseas staff to the overall establishment. At the time of inspection the duty rotas confirmed a staff coverage as thus: 0700 - 1430 - 1 Trained Nurse 6 Carers 1430 - 2130 - 1 Trained Nurse 5 Carers 2130 - 0700 - 1 Trained Nurse 3 Carers There are 140 hours for housekeeping services led by an experienced supervisor who also works as a part time Senior Carer. There is a satisfactory complement of support staff in catering, laundry, maintenance, and administration. A Senior Carer is responsible for activities and facilitating training. The Provider and Care Management have established a procedure for interview, selection and appointment of staff. Five staff files were sampled and found to be generally well organised. Each staff file would be more informative with a copy of interview record, letter of appointment, and a suitable photograph of each staff member. Clarity on offering CRB clearance would be helpful in maintaining a register. Four members of staff were spoken with, each being pleased and satisfied with the improving foundation of care, services and training offered to them through a responsive management. All staff have a statement of terms and conditions. Service users are supported and protected by these practises and all new staff goes through the Common Induction process that will ensure that they are going to be the right person for the home, paving the way to a formal training and supervision process. The Care Manager is committed to a learning environment. Overall the evidence shows a satisfactory account of a training programme, although the process would be better handled with a formal programme to a full understanding of training needs. Dementia training was geared to person centred care, and welcomed by staff. A plan of staff training for 2007/08/09 will be forwarded for CSCI inspection. Supervision is inconsistent, and conducted by the Care Manager, which would be better maintained with delegated responsibilities, cascaded throughout the staff, to include all staff, on a two-monthly basis. Stubby Leas Nursing Home DS0000022378.V343480.R01.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): 31,32,33,35,36,37,38 Quality in this outcome area is adequate The Care Manager (designate), Karon Roberts is a very experience qualified General Nurse with a track record of good standards and professionalism. Arrangements are in hand to ensure early Registration with CSCI. Until this process is complete the Home is routinely placed at a higher risk status (Level 2 – adequate). The registered Provider confirmed commitment to Stubby Leas, and it’s future financial viability, demonstrated by the level of investment deployed over the past 6 months. She is supported with an Operational Director who is a qualified Mental Health Nurse. There is a renewed confidence apparent in the interaction of staff and the Home’s management that demonstrated an increasingly positive relationship that pervades throughout the Home. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 23 EVIDENCE: Over the past 6 months there have been severe disruption to the management process due to lack of effective care leadership and management. The Care Manager (designate) has been appointed with a background in General Nursing, at clinical and managerial levels. She has, in the short time since starting in April 2007, demonstrated good standards of practice, communication and organisation. The inspector observed at first hand the confident interrelationship that exist between management, staff, residents and relatives. The tangible expression of an easy and relaxed atmosphere created by a responsive care staff enabled that confidence. She is to be supported by a senior RMN as deputy, and an establishment of four other Registered Nurses. The Provider has taken extensive measures to comply with recent severe inspection reports. There has been a demonstrable commitment of resources in meeting requirements to ensure a safe environment and improved infrastructure of services. She continues, with the assistance of a qualified professional Operations Director, to hold a high profile presence, on a daily basis, in supportive administration and direction. Evidence was secured to confirm that a quality monitoring system has been introduced, based upon audit of standards, care plans, general audits and feed back from service users and relatives, and risk assessment. Care planning review has significantly enhanced the resident’s daily living, ensuring that individual requirements are maintained. This has been complemented with an effective, inclusive review process, meaningful observations and a solid daily monitoring report. Complaints and accident management are recognised as valuable resources of quality assurance. Standards are discussed at staff meetings, daily handovers, direct observation and involvement and one to one staff meetings. Social Workers’ review meetings are often a vehicle for assessing quality. Staff meetings are held regularly. Regular audits and on-site inspections by the provider’s offers evidence of a management more committed to the improvement of care standards. Examination of staff records showed that employment policies are effective. A sample examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. A sample of administrative, maintenance and care records were examined, and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. These included procedures on managing abuse, challenging behaviour, First aid and pressure area care. Service records for gas supplies, water and hoists were examined. All records and medical notes are kept confidential and secure. There is a willingness to create a training environment. A staff supervision policy and procedure is in place in the home, and will be reinforced to form an established Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 24 routine alongside a training programme, cascaded throughout the staff establishment. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training sessions. The accident books for staff and service users were checked and found to be accurate, up to date and Riddor sensitive. This was crosschecked and confirmed with case tracking. These issues and routines ensured the health, safety and welfare of service users and staff. The administration and management of the home is increasingly effective and sensitive to the needs of service users. Stubby Leas Nursing Home DS0000022378.V343480.R01.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 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 3 2 2 2 2 2 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 2 2 2 2 3 Stubby Leas Nursing Home DS0000022378.V343480.R01.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 OP9 Regulation 13.2 Requirement That Nursing staff maintain the register of Controlled Drugs, and store CDAs appropriately. Timescale for action 20/06/07 2 OP19 23(2)(b) The registered person must 01/09/07 ensure that all areas of the home have good quality décor. The registered person shall ensure that all identified outstanding work is fully completed. The registered person shall ensure that the garden area of the home is kept in a good state of repair. Nurses complete MAR charts as instructed. 01/09/07 3 OP19 23(2)(b)1 3(4)(a) 4 OP19 23(2)(b) (o) 01/09/07 5 13.2 20/06/07 Stubby Leas Nursing Home DS0000022378.V343480.R01.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 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 OP33 OP9 OP26 OP10 OP24 OP19 Refer to Standard OP19 OP26 OP24 OP33 OP24 OP29 OP27 OP36 OP1 Good Practice Recommendations That a full unit risk assessment programme be updated. Corridors needs an appraisal of the décor and fittings. Provide a further 3 variable height beds for nursing cases. Provide CSCI with a development plan for 2007/08/09 Continue the review of bedroom and communal furniture for repair/replacement You must demonstrate robust recruitment, application and interview procedures within the home. That consideration be given to the provision of activity coordination. All staff to receive adequate supervision, 6 times a year Service users Guide will need to be updated As a course of good practice COSHH posters should be located in areas where chemicals are stored Provide CSCI with a staff training development plan for 2007/08/09 Discontinue the use of medicine stocks, and stock supplies Review the cleaning chemical used on Vinyl flooring. Discontinue the use of notices and sticky labels in Residents’ bedrooms. All lockable facility ‘boxes’ be kept secure. All bathrooms and toilets be upgraded. Stubby Leas Nursing Home DS0000022378.V343480.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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 Stubby Leas Nursing Home DS0000022378.V343480.R01.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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