Inspection on 29/11/06 for Stubby Leas Nursing Home

This inspection was carried out on 29th November 2006.

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 12/06/07

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 Mrs Sue Mullin Key Announced Inspection 29 November 2006 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.V319635.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.V319635.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 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 Position vacant 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.V319635.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 25th June 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. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced “key” inspection took place over one day; this was the third visit to this service since April 2006. One inspector undertook the inspection process whilst a second was investigating complaints made to the home by a relative and the local District Nursing services. The preparation work for the inspection was hampered as the Commission only received the current year’s pre-inspection questionnaire from the home the day before the inspection and not in the timescale required. Two service user surveys were completed and one of those was handed to the inspector during the visit. Five CSCI Comments Cards had been received from relatives and one received from a Social Worker. Discussions took place with several service users, the registered provider, operations manager, the acting care manager and other members of staff. Case tracking of two service users was undertaken which included discussions and checking of their records. Observations were made of staff and service user interaction. A new member of care staff was also engaged in conversation regarding her induction programme. A random selection of records was checked and a tour of the environment was undertaken. A new acting care manager was in post having started in June 2006 but had not yet formally applied for registration at the Commission. It was disappointing, however, to find that there had been little progress since the last report. Indeed, several requirements from the last report had not been addressed or only partly addressed and these are identified in the body of this report. The home has a history of not sustaining improvements for any length of time and this is a serious concern to the CSCI. Issues of concern were identified in all of the outcome areas; Choice of home, Health and personal care, Daily life and social activities, Complaints and protection, Environment, Staffing and Management and administration. A serious concerns letter was sent to the proprietor on the day following the inspection and it is an expectation that the proprietor will introduce an action plan in order to meet shortfalls, within an agreed timescale and the Commission will monitor this. What the service does well: Some of the care staff who have worked at the home for many years strive to ensure that service users lives are made as comfortable as possible. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The proprietor needs to introduce a continuing programme of repairs and maintenance both internally and externally, that include all service user areas throughout the home. All pre admission assessments must be translated into comprehensive individual care plans so that all staff have the information they need to meet identified service user needs on a daily basis. Each long-term problem in the care plans must be reviewed monthly. When short-term problems such as chest infections or dressings etc. are identified these plans should be reviewed weekly or more regularly if changes are noted. There were gaps seen in the care plans examined. There should be a meaningful entry written in the daily records at least every 24 hours. Service users (where possible) and their representatives should be encouraged to take part in the implementation of the care plans and in the monthly review process. Care staffing levels must be increased promptly to ensure there are sufficient staff on duty to meet the needs of service users throughout the 24-hour day. A review of the domestic staff team is required to ensure that there are sufficient hours allocated, to maintain acceptable levels of cleanliness throughout the home. All disciplines of staff must receive mandatory training. The home has been without a registered care manager for the past 6 months. The standard of care provided by the home is indicative of poor management arrangements. The registered person must inform CSCI of the intended arrangements for the application for registration of the care manager for the home. The CSCI records show that the home has not informed the inspector of incidents occurring at the home an example of this was when Police recently attended a service user due to disruptive behaviour. The home must ensure that the CSCI is notified under regulation 37 of incidents occurring at the home. Further details of the homes shortfalls are contained in the body of this report. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 7 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.V319635.R01.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 Stubby Leas Nursing Home DS0000022378.V319635.R01.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): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers potential service users and their representatives information about their service and service users receive a pre admission assessment. EVIDENCE: The management confirmed that there had been no change to the Statement of Purpose and Service User Guide. These documents were not, therefore inspected again on this occasion as they met the criteria in Schedule 1 and Regulation 5 at the last inspection. The home is registered for dementia care and unfortunately; as such most of the service users are unable to make meaningful comments. Care staff guided the inspector to the service users most able to comment on this standard. Three service users were asked if they had been given a copy of the Service Users guide following their admission in to the home. Both ladies spoken to Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 10 stated they had not received anything in writing but that, they had been in the home for some time. A newly admitted gentleman when asked the same question stated that he had not been given any information regarding Stubby Leas care home either prior to admission or following admission. Both ladies were self-funding and when asked if they knew how much the weekly fees were in the home, they both stated that they did not know. The homes administrator explained to the inspector that there had been a rise in fees from the beginning of November 2006 but she did not know if the two ladies had been made aware of or agreed to this. When asked, both ladies stated that they did not know if or when fees were raised and that they had relatives ‘ who dealt with that side of things’. Both relatives in this case had been made aware of the increase in fees in writing. The gentleman stated that he was funded by Social services and he did not know what the charges were in care homes. It was identified on the service users files seen, that contracts were in place. However, they did not specify the number/name of the room to be occupied. A recommendation has been made to ensure that this information is routinely included in the document to ensure clarity regarding terms and conditions of residency. The acting care manager stated that pre admission assessments are always undertaken before a service user is admitted to the home. These were seen on the files and did meet the criteria in standard 3.3. It was felt that these could be developed further to ensure that all service users admitted are compatible with the service users already in the home and that staff have the skills and experience to meet their needs. A new gentleman admitted the week prior to the inspection was proving to be very difficult to manage, in particular lashing out and physically injuring staff. There was no written confirmation on the files seen that following the pre admission assessment that the care home was able to meet their needs as required by regulation. A requirement was made as part of this report to address this issue. The home did not provide intermediate care. Stubby Leas Nursing Home DS0000022378.V319635.R01.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): 7,8,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was a lack of a comprehensive individual plan of care for the service users used during the case tracking exercise. Health needs were not clearly monitored or addressed. Communication between nursing staff and relatives was at best sporadic. EVIDENCE: Evidence secured by examination of care records, plans and assessments, and discussion with senior care staff confirmed that there was no established practice of involving family in the process of care, beyond the occasional reported communication at times of incident or concern. The records showed that care plans and a risk assessment process was in place but the review process was inconsistent. Reviews should be held monthly, short-term problems should be reviewed weekly or more frequently if the service users physical or mental condition changes. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 12 Two relatives reported on the comment cards that they were not always informed by the nursing staff when their were changes in the well being of their loved ones or when incidences had occurred. Both were contacted and spoke to the inspector; one stated that she had not been informed that her mother had a pressure sore until over a month of the home treating it. The other stated that although she felt her mother generally received good care, when incidents occurred such as loss of property she was not informed. She quoted an incident when her mothers lead crystal cut glass fruit bowl went missing. She stated that she had found it was missing and no one had informed her, her mother had been in the home for at least three years and the staff would have known the presence of the bowl. When she took this up with the acting care manager he stated he would have a look for it but did not get in touch with her. When she went to speak to him again he stated that the home would reimburse her, to date she had received no further communication in this regard. The registered person must ensure that relatives/representatives are kept informed of important matters affecting their relative/friend. This is a requirement of the report. Risk assessments on falls management, movement and handling and overall dependency was documented, which underpinned the implementation of care required on an individual basis. However, it was noted that there was lack of written daily entries in to the care plan. The home must enter a meaningful report at least every 24 hours. There was scant information recorded information of visiting professionals or communication to relatives. One residential service user complained to the inspector that a member of the nursing team had tried to take some blood from her hand without success. This left the service with extensive bruising to her hand and forearm. As this lady was only resident in the home on a residential basis and was being seen regularly by the district nursing services, the home were asked to inform the CSCI as to why they had attempted to take blood from this service user and for what medical reason. The CSCI were provided with very limited information that the taking of blood was unsuccessful on that occasion. This is currently under investigation. Nursing staff should not undertake nursing procedures on residential service users. The Registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. There was no primary nurse or key worker system in place. No one person took responsibility for individual service users. There was little evidence of service users clothing or toiletry requirements noted. Some service users did not have the benefit of relatives to keep their personal stocks and supplies replenished. There was evidence of service users wearing other service users clothes and the home operated a ‘pool’ of unclaimed items. Inspection of the laundry facility, several resident’s wardrobes and discussion with the acting Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 13 care manager confirmed that there was a routine of storing unmarked clothing, for either communal use or for relative’s perusal. The practice of ensuring a nametag on all clothing was at times substituted with indelible ink marking on labels, which proved ineffective, with inevitable results in clothing being misdirected or lost. This was discussed at the inspection and this practice was stopped. A requirement has been made to that effect. In one shared room inspected there was no adequate privacy screening to promote privacy and dignity. This is a requirement in this report. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 14 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): 12,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Visitors were made welcome and service users were offered varied in-house activities. Food provision is generally reported by service users to be satisfactory but it was felt that this could be improved upon. EVIDENCE: An appointed activity organiser led daily activities in a large purpose art and craft room. The home has a good programme of activities and a plentiful supply of materials. This standard was not checked in full on this visit. However, a recommendation was made to provide more hairdressing hours to maintain better levels of hair care. Four out of five relatives who completed a comment card stated that there were “ always welcomed into the Home when visiting’. No relatives were seen on the inspection. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 15 Service users spoken to gave a mixed response regarding the quality of food serviced in the home. Two stated that it had deteriorated recently. One stated ‘ it depends whose cooking! If Sally is cooking it will be really nice’. One gentleman stated ‘it is poor quality, cheap stuff’. Staff stated the food was ‘usually good’. When working a long day, which several did regularly, they ate from the same menu as the service users. The inspector joined three ladies at lunchtime and sampled the choice of food. There was chicken pie, with mashed potatoes, fresh cabbage, frozen mixed vegetables or cheese and potato pie with the same vegetables. Two ladies stated that it was a ‘poor choice of food ‘ on that day. The cheese and potato pie was very dry and stodgy and the kitchen staff confirmed it was made from ‘packet mash’. Fresh produce should be used as often as possible. The dessert choice was better, although one service user stated she did not know that ‘you could ask for fresh fruit’. Fresh fruit was available in the kitchen staff need to remind service users of a fresh fruit choice. One service user informed the inspector that she had not received any food or drink from 11.30am- 9.30pm on the 28/11/06. This service user stated that because she spends a lot of her time in her room, the staff have to bring food and drink up to her. She felt she was forgotten due to shortages of staff and the pressures of work they are under. This matter was brought to the attention of the management on the day of the inspection to investigate this issue immediately and report back to the CSCI. The home must take account of service users comments that they are not provided with sufficient and suitable food during the day. Management should make arrangements to consult with service users about the adequacy of the food provision. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards relating to complaints were not met and as a result service users were not fully protected from abuse. Formal processes need to be further developed so that the home’s procedures are understood and consistently applied Not all staff had received training in line with the Protection of Vulnerable Adults.. EVIDENCE: The home has a complaints procedure that is published in their Statement of Purpose/Service Users Guide and displayed in the home. The Commission have received 2 formal complaints about the home since the last inspection. One made by a relative relates to poor nursing care provision in the home, poor communication and generally poor standards. The second was made by the local District nursing services, which states that they are constantly being asked to ‘see’ service users who are receiving nursing care from nurses working in the home, for their advice and guidance. The district nursing services are only expected to attend to service users in care homes who are receiving personal care only. The District nurses have complained to the CSCI alleging that nursing staff working in the home are not attending to service users medical needs promptly or properly. This is currently being investigated. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 17 A further informal complaint was made by a local hospital who have stated that the home are sending in service users with advanced pressure sores and they are concerned that the service users may not have received appropriate or swift attention when their skin integrity was compromised. The CSCI are awaiting a formal complaint in this respect and will investigate all issues raised. One service user spoken with on the day stated that she made a complaint to son of the registered provider some months ago following an incident in the home. This lady explained to the inspector that she had been called a ‘Pig’ by one of the care workers, which had upset her. After she informed the son the care worker was sacked. This incident was not reported to the CSCI under Regulation 37 as required by Law and does not instil confidence in the management or conduct of the home. A requirement has been made in relation to this. The CSCI received 5 comment cards from relatives and 3 of those stated that they had to make a complaint to management about the care of their loved ones. One lady in particular, who was contacted prior to the inspection, stated that she had on several occasions raised concerns with the home. When the acting care manager was asked about this he stated that he had not received any complaints from that particular family. This disparity between management and relatives causes concern for the CSCI and further investigations into this issue will ensue. The CSCI are currently investigation an allegation of abuse the outcome of which will be included in the next inspection report. The home must ensure that all staff receive training in the Protection of Vulnerable Adults from Abuse from a reputable source. This should be updated regularly. The home had policies in place regarding service users money and financial affairs. The administrator confirmed to the inspector that at present there were no service users receiving any assistance via the home for their personal monies. This area will be monitored fully at the next inspection. Two ladies and one gentleman were asked if they had been provided with a copy of the homes complaint procedure, two stated that they had not and one lady could not remember. Management of the home must provide all service users/representatives with this information. A requirement was left to this effect. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Not all areas of the home seen on the inspection were clean and hygienic. The lack of maintenance and renewal of equipment and facilities mean that service users could be potentially at risk from equipment that may be unsafe. The poor condition of the décor and fixtures and fittings means that service users live in an inadequate environment. EVIDENCE: On arrival at the home a large pothole had to be negotiated in the driveway. The proprietor had carried out some work on the building following the last inspection but a programme of routine maintenance and renewal of the fabric of the premises needs to be implemented. The inspector was shown a ‘risk assessment of building’ list, which was compiled by the homes maintenance man two days before the announced Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 19 inspection. This list highlighted an excessive amount of remedial work required to bring the standard of the home up to an acceptable safe level. The work identified related to most arrears of the home and arrears of concern are listed below: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • No window latches No lamp shades Carpet needing gripper rod to secure Head board to secure No hot water Door handle loose Shower not working Leaking tap Loose radiator guard Dirty top window Hole in fire door Door frame needs repair Hole in ceiling Commode needs a cover No covers on nurse call Chairs required Light bulbs out Carpet trip hazard leading to conservatory Chairs to throw out Bathroom in main building not hot or cold water Toilet seat loose Ceiling light needs cleaning Loose rail in toilet Shared room no privacy screen Damp damage to wall Curtains do not fit the window Wiring on floor not safe No matching handles on drawers Bathroom uneven flooring Bathroom salon no soap Odour, plumbing job outstanding Table needed Sink needs securing Pipe work not covered Poor lighting No nurse call cord No toilet paper A requirement has been made to ensure all remedial work identified is completed. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 20 During the tour of the premises it was noted that wallpaper had been stripped off the wall in one dining room and there were service user areas where only a bare bulb was seen. A review of all furniture in the home is required to ensure that fixtures and fittings are in good order and the home is fit for purpose. One service user spoken with stated that their room was “It’s alright but a little small” and a second considered their room to be “poor, when I first saw it I thought it was a police cell”. Two clocks in two lounges both showed the wrong time of day. This is confusing especially to those people who suffer with dementia related illnesses. This is indicative of poor practice with little thought for the service users wellbeing. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were not sufficient levels of care staff on duty at the time of the inspection. The deployment of ancillary staff needs to be reviewed, as much of the home was unclean. Not all staff were appropriately trained in line with their responsibilities and duties and this could have a detrimental effect of the safety of service users. EVIDENCE: This care home with nursing was previously registered under South Staffs Health Authority and the levels and skill mix of staff required at 31 March 2002 must be maintained. There were 22 service users requiring nursing care and 20 requiring residential care on the day of the inspection. However, there were a further three people who had all arrived on the same day the previous week who could not be identified by management as requiring nursing or residential care. One some of the early shifts there is between one and two qualified nurses on duty. Supernumerary time for the acting care manager was not determined. Generally, over the 24 hours a day there is one qualified nurse on duty. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 22 On the day of the inspection there was the acting care manager in a supernumerary role, the deputy manager a qualified nurse and: • • • Early shift (7.00 – 2.30) there were 6 care staff Late shift (2.30 – 9.30) there were 6 care staff Night shift (9.30 – 7.00) there were 3 care staff On the day of the inspection it was determined that there were not appropriate staffing levels on duty. The staff complement and their deployment were discussed with some of the service users, and each said that they considered that there was not always sufficient staff available to meet their needs. At the time of the inspection there were 7 care staff on duty including a qualified staff member for the care of 45 service users in the morning. This is below what has been previously agreed with the home as the staffing level needed to meet the assessed needs of the service users at the home There were concerns that in view of the geography of the building and the increased dependency levels of present service users staffing levels were not adequate. From observations made on the day it was clear that the staff were under pressure to provide for the care needs of the present service users. The inspection found that some rooms had cobwebs, dust and debris i.e. pieces of torn aprons and paper and unfinished food. Several windows and cills were dirty. There were some dirty skirting boards and carpets that need vacuuming. Some of the doors were dirty and generally marked. Concerns were expressed regarding the domestic staffing arrangements. Staffing levels were at best minimal and possibly inadequate. Concerns included the deployment of staffing i.e. that some staff felt a cleaner was needed in the afternoon / evening. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 23 There was no agency use at present. The home state that there is a full time Care and Training coordinator who mentors new staff and organises training sessions and induction programmes, however this member of staff was involved in providing hands on care to try and meet the needs of the service users. It was determined that there was allocated on a daily basis; Two domestics from 7am – 2.30pm (including breaks) One Laundry staff from either 7am – 2.30pm or 8am – 2.30pm (including breaks) One cook per day with a kitchen assistant. The home has an in house administrator. The inspector was informed that Handymen/gardeners were employed as needed. Recruitment procedures were checked and one member staff recently in post did not have proof of suitable POVA and CRB checks, prior to employment being offered. The home must ensure that evidence of CRB checks are kept on the premises and available for inspection. Two written references have been obtained, contracts of employment offered. The staff training programme was cross checked with individual plans and records, and failed to demonstrate an effective routine to ensure that statutory training, or specific issues had been addressed. It was acknowledged that a senior member of care staff had been recognised for staff training coordination and facilitation. However, the staff programme showed very significant gaps in staff attendance at essential events. The registered person must ensure all staff are appropriately trained in line with the duties they are expected to undertake, which includes; Moving and handling, Basic Food hygiene, COSHH, First Aid and instruction on reporting issues under POVA procedures. Concerns were expressed that one staff member’s induction record had shown that induction had been completed in one day. This covered a range of duties and area of professional practice. The senior who had competed the induction record thought that it was acceptable to provide induction training in such a short time and expect that staff would be competent in these areas. Care staff must be deemed proficient to complete documents in relation to staff Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 24 induction. Staff must receive training appropriate to the work they are to perform. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 25 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 poor. This judgement has been made using available evidence including a visit to this service. The home is not run in the best interests of the service users. There was an acting care manager in post who had not yet applied to the CSCI registration. Not all care staff have been supervised every two months. Some health and safety aspects need addressing. EVIDENCE: It was understood that the acting care manager had been in post since June2006. He was employed on a full time basis but had not applied to the CSCI for registration. Discussions with staff indicated that he was approachable and helpful. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 26 It was stated by staff that team meetings are held very infrequently. A relative confirmed that residents/relatives meetings had been mentioned but to date she had not be invited to one. Care staff have not been receiving formal supervision to meet requirements and National Minimum Standards. The acting care manager must be allowed sufficient time to manage the care home and to keep up to date with mandatory administration, staff training, supervision, assessment and reviews of service users and liaison with relatives and professionals. A requirement has been made regarding the need to introduce formal staff supervision. It was identified that there were shortfalls in mandatory training earlier in the report. A requirement has been made in relation to this issue. It was noticed that one bedroom door was propped open with a safety cone and a requirement is made for the proprietor to meet with the fire officer to ensure that appropriate equipment is fitted to the door to meet fire regulations. The tour of the premises with the care manager found a number of items that presented health and safety issues and needed to be repaired/replaced to meet regulations and presented a health and safety hazard. (These have been detailed earlier in the report) A requirement has been made to ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The home has been without a registered care manager for the past 6 months. The standard of care provided by the home is indicative of poor management arrangements. The registered person must inform CSCI of the intended arrangements for the application for registration of the care manager for the home. The CSCI records show that the home has not informed the inspector of incidents occurring at the home an example of this was when Police recently attended a service user due to disruptive behaviour. The home must ensure that the CSCI is notified under regulation 37 of incidents occurring at the home. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 27 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 3 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 1 18 2 1 3 X 3 3 1 2 1 STAFFING Standard No Score 27 1 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 3 1 2 1 Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 28 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 OP4 Regulation 14(d) Requirement Timescale for action 12/12/06 2 OP7 12(1)(a) 15(2)(b) 3 OP7 15(1) 4 OP7 15(2)(c) The registered person shall in all instances prior to admission confirm in writing to the service user/representative that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of their health and welfare. The registered person must 12/12/06 ensure that care planning be more comprehensive and contain all relevant information to meet the identified needs of the service users. Previous requirement 18/05/05, 25/06/06 and 06/09/06 The registered person shall 12/12/06 ensure that in consultation with the service user/ representative a written service user plan as to how the service user’s needs in respect of his health and welfare are to be met is in place. The registered person must 29/11/06 ensure that relatives/representatives are kept informed of important DS0000022378.V319635.R01.S.doc Version 5.2 Stubby Leas Nursing Home Page 29 5 OP8 12(1)(a) 6 OP10 16(2)(c) 7 OP10 12(4)(a) 8 OP15 16(2)(i) 9 OP16 22(5) 10 OP18 18(1)(a) (i) 13(6) 11 OP19 23(2)(b) matters affecting their relative/friend. The registered person must ensure the service users have access to health care services to meet assessed needs. Nursing staff should not undertake nursing procedures on residential service users. The registered person shall ensure that appropriate privacy screening is provided in shared rooms to promote privacy and dignity for service users. The Registered person shall ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. Service users should only wear their own clothing at all times. The registered person must take account of service users comments that they are not provided with sufficient and suitable food during the day. In doing this, the registered person should make arrangements to consult with service users about the adequacy of the food provision. Previous requirement 06/01/06 and 25/06/06 Management of the home must provide all service users/representatives with a copy of the complaints procedure. The registered person must ensure that all staff employed receives training in regard to the Protection of Vulnerable adults. Previous requirement 25/06/06 and 06/09/06 The registered person must ensure that all areas of the home have good quality décor. Previous requirement DS0000022378.V319635.R01.S.doc 29/11/06 02/12/06 29/11/06 01/12/06 08/12/06 06/01/07 06/01/07 Stubby Leas Nursing Home Version 5.2 Page 30 12 OP19 23(2)(b) 13(4)(a) 13 OP19 23(2)(b) (o) 14 OP24 13(4)(c), 16(2)(c), 23(2)(b) 15 OP25 13(4)(a) 16 OP26 16(2)(j) 23(d) 17 OP27 18(1)(a) 25/06/06 and 06/09/06 The registered person shall ensure that all identified outstanding work is fully completed. Work should be prioritised where there is a hazard to service users safety. Previous requirement 06/01/06, 25/05/06 and 06/09/06 The registered person shall ensure that the external area of the home is kept in a good state of repair. There was a large pothole in the driveway. The registered person shall ensure that service users are not accommodated in bedrooms that are not suitably decorated and furnished. Suitable, good quality furniture that is fit for purpose and sufficient for service users needs should be provided in bedrooms. Previous requirement 25/06/06 and 06/09/06 The registered person must rectify the deficient hot water supply. Some areas are too hot and some too cool. Previous requirement 18/05/05, 06/01/06, 25/05/06 and 06/09/06 The registered person shall ensure that all areas of the home be maintained in a clean and hygienic condition. Previous requirement 18/05/05, 06/01/06, 25/05/06 and 06/09/06 The registered person shall ensure that there are sufficient care staff on duty at all times taking into account the dependency needs of service users and the geography of the building. Previous requirement DS0000022378.V319635.R01.S.doc 06/01/07 06/01/07 06/02/07 06/01/07 06/12/06 01/12/06 Stubby Leas Nursing Home Version 5.2 Page 31 18 OP29 19 OP30 19(1)(a) (b)(c) Schedule 2 18(1)(a), 18(1)(c) 20 OP30 18(1)(c) (i) 21 OP30 18(1)(c) (i) 22 OP31 8(1)(a) 23 OP36 18 (2) 24 OP38 23(4)(a) 25 OP38 37 (1)(e) 18/05/05 and 06/09/06 The registered person must ensure that evidence of CRB checks are kept on the premises and available for inspection. The registered person shall, having regard to the size of the home and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are deployed and that they have training appropriate to the work they are to perform. Staff induction should be pertinent to the specific job roles within the home and be completed in a realistic and meaningful timescale. Care staff must be deemed proficient to complete documents in relation to staff induction. You must ensure that staff receive training appropriate to the work they are to perform. The registered person must inform CSCI of the intended arrangements for the application for registration of the care manager for the home. Care staff must receive formal supervision 6 times per year and this must be documented. Previous requirement 18/05/05, 06/01/06, 25/05/06 and 06/09/06 The registered person shall, following consultation with the fire officer, fit appropriate equipment to bedroom doors to meet fire regulations rather than propping the door open with a safety cone. The registered person must ensure that the CSCI is notified under regulation 37 of incidents occurring at the home. DS0000022378.V319635.R01.S.doc 06/12/06 06/01/07 12/12/06 06/12/06 15/12/06 06/01/07 06/01/07 01/12/06 Stubby Leas Nursing Home Version 5.2 Page 32 26 OP38 24A (1)(2) 27 OP38 24(1)(2) (a)(b)(c) (3)(4)(5) The registered person must provide a written copy of the improvement plan to the CSCI, which outlines the remedial action required to meet all the above requirements. The registered person must provide a written copy to the CSCI, of an established system for evaluating and maintaining the quality of the services provided at the care home. 15/01/07 15/01/07 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. Refer to Standard OP2 OP12 Good Practice Recommendations Contracts were in place but need to specify the number/name of the room to be occupied. More hairdressing hours would be beneficial, to ensure adequate hair care. Stubby Leas Nursing Home DS0000022378.V319635.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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.V319635.R01.S.doc Version 5.2 Page 34 - 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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