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Inspection on 06/01/06 for Stubby Leas Nursing Home

Also see our care home review for Stubby Leas Nursing Home for more information

This inspection was carried out on 6th January 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The activity co-ordinator was on annual leave at the time of the inspection. The activity room was inspected along with records and documentation. The home is to be commended on the programme of therapeutic activities and entertainment it provides for the residents. The activity room itself contained many examples of on going art and craft projects, which portrayed the changing seasons throughout the year. There were many examples of individual resident participation and records had been maintained to support this. There had been a recent show put on by staff and residents over the Christmas period.Assessments of individual needs, preferences and abilities had been taken into account when planning activities, especially in relation to the needs of residents with dementia. Staff complete a "getting to know you better" form when residents come into the home, with the help of families, and this helps to find out what individual residents are interested in and are able to participate in, as well as any particular hobbies they might have.

What has improved since the last inspection?

A newly appointed registered care manager is now in post.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT Lead Inspector Mrs Sue Mullin additional inspector Mrs Yvonne Allen Unannounced Inspection 6th January 2006 10:45 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.V275764.R01.S.doc Version 5.1 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.V275764.R01.S.doc Version 5.1 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 Mr Kevin Campbell 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.V275764.R01.S.doc Version 5.1 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 18th May 2005 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 residents 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.V275764.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspection officers made this statutory unannounced visit on the 6th January 2006. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including preparation amounted to 10.45 hrs. The inspection included the following elements; a sample tour of the building, inspection of records relating to provision of care, discussions with several residents and relatives and also staff members, observation and sampling of other services provided such as catering, housekeeping and laundry, and an inspection of the managerial aspects such as staffing and health & safety. Not all of the National Minimum standards were checked, as these have been verified previously during this inspection year. The registered care manager, who is a first level nurse, was on a day off at the time of the visit and the home was in the charge of the deputy manager, a first level nurse. The owner and the operations manager arrived soon after the inspection started and assisted throughout the inspection process. The total of 44 residents included - 23 receiving nursing care and 21 receiving personal care. Privacy, dignity and choice aspects for residents were being upheld. Health, personal and social care needs had been met and documented. A selection of care plans were examined at the time of the inspection and the care of the residents were tracked. Care staffing levels were in line with those agreed prior to April 2002 by South Staffs Health Authority. However, there were concerns over the level of ancillary staff employed in the home. All areas were checked and duty rotas seen and it was determined that ancillary staff on duty at the time of the inspection included; 1 cook and 1 catering assistant, no domestic staff, 1 laundry worker, 1 maintenance/ gardener, and an administrator. These staffing levels were not deemed adequate to meet the needs of current 44 residents in the home. Many parts of the home were not clean or hygienic enough. The staffing of the entire home continues to be undertaken on a very sporadic basis. This is a serious situation, which needs to be rectified forthwith. The registered provider must recruit more catering/domestic and laundry staff to supply an adequate workforce, to meet the needs of the residents and to keep the home clean and well maintained. Currently, ancillary staff continue to be moved off their assigned duties to cover care staff shortfalls. The home was generally in need of a good clean throughout. The inspector was not able to speak with any of the domestic staff, as there were none on duty. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 6 Catering services and facilities fell below acceptable national minimum standards. There was some evidence of choices being made in relation to the meals, albeit choice was limited. Quantities of meals were reported to be minimal at times and residents requiring soft diets had a repetitive diet provided to them at teatime and this was discussed during feedback of the inspection. Confirmation was given that this would be reviewed. The kitchen door must be locked when not in use as the hot water still, just inside the door poses a real hazard to wandering residents suffering from dementia. Several members of staff were engaged in conversation and stated that ‘ there are not enough staff on duty, we have to do long days and usually there is not enough food cooked by the kitchen staff to enable us to have a cooked meal in a 12.5 hour shift’. ‘ Staff are constantly taken off domestic and laundry work to go on to care or catering duties’. ‘ We are not allowed to have agency staff and there are no bank staff on the files’. Staff went on to confirm that although plenty of notice was given when staff could not cover extra shifts agency was not contacted to cover the shortfall. When asked about conditions at work staff stated ‘ we are never listened to, we do not feel valued, we are put on and taken for granted’. Staff stated that they ‘ liked looking after elderly people and that they (the carers) were a good hard working team, that support and look out for each other’. Laundry staff were consulted and confirmed that no ironing was undertaken in the home, as there were not enough staff to cover laundry requirements. Overall the visit was quite disappointing and further unannounced visits will now be undertaken until all the national minimum standards have been met. What the service does well: The activity co-ordinator was on annual leave at the time of the inspection. The activity room was inspected along with records and documentation. The home is to be commended on the programme of therapeutic activities and entertainment it provides for the residents. The activity room itself contained many examples of on going art and craft projects, which portrayed the changing seasons throughout the year. There were many examples of individual resident participation and records had been maintained to support this. There had been a recent show put on by staff and residents over the Christmas period. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 7 Assessments of individual needs, preferences and abilities had been taken into account when planning activities, especially in relation to the needs of residents with dementia. Staff complete a “getting to know you better” form when residents come into the home, with the help of families, and this helps to find out what individual residents are interested in and are able to participate in, as well as any particular hobbies they might have. What has improved since the last inspection? What they could do better: Once again staffing levels were not deemed appropriate or sufficient to meet the needs of the residents or the demands of running the home. This has been brought to the attention of the owner on a previous inspection and was at that time rectified. Sufficient skill mix and levels of staff must be maintained at all times. The home is not clean or hygienic enough and this will be monitored on follow-up unannounced inspections. Resident contracts must clearly identify the level of fees to be paid including charges made during absences. The complaints procedure was displayed on the wall and was accessible. This contained the details of the local CSCI office at Stafford. This procedure was somewhat complicated and not easy to follow. It is recommended that this process is made clearer. The complaints procedure contained within the contract must refer complainants to the Stafford Area Office and not Birmingham. The recruitment process needs to be tightened up somewhat in order to ensure that residents are protected. A written reference from the last employer must be obtained when recruiting new staff. Gaps in employment history must be explored and the reasons for these discussed and documented. All staff must receive regular updates in Moving and handling training and these must be documented. All new staff must receive fire safety training, as part of their induction and staff induction should be geared to the specific job roles within the home. Care staff must receive formal supervision 6 times per year and this must be documented. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 8 The maintenance man works 3 days hours a week for Stubby leas care home, as he is also responsible for the owners other care homes - Abidale in particular. However to continue redecoration and upgrading of the home the registered person should increase maintenance hours as discussed during the inspection. Décor was generally suitable but in need of attention in some areas. Some of the bedroom furniture was in need of repair or replacement and it is recommended that an audit of all furniture be undertaken. Regulation 26 reports had not been received by the CSCI and will need to be sent in monthly by the provider. The home must ensure that all dietary requirements identified in the home are met. A choice of two hot meals must be provided at the main meal of the day and quantities must be sufficient. Residents requiring liquidised diets must be provided with more choice. A varied and more suitable and a more appealing menu, must be available to them at all mealtimes. A window in the conservatory needs repairing as it was almost falling off. A bath in the home is awaiting a new hoist to enable it to be used. With this out of action staff have only one bathroom to use between two buildings. Several windows were reported by staff as not closing properly. Night staff must not undertake laundering of resident’s personal clothing during the night shift. The registered person must employ sufficient laundry staff to ensure that washing and ironing is undertaken in line with the resident’s personal requirements and the homes routine. Rooms 2 and 12 are still delivering cold water only. There are no thermometers available in the bathrooms for testing the hot water temperatures. There are no foot operated waste bins in the kitchen inline with environmental health requirements. 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. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 9 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.V275764.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, the home do not provide intermediate care (6) Contacts of residency still do not contain sufficient information to meet the national minimum standards. EVIDENCE: All residents in the home are issued with a Statement of Terms and Conditions. Those residents who are funded by Social Services or other funding bodies have a standard contract. Residents who are self funding are also issued with a contract and these were examined. The previous requirement to ensure that fees are clearly identified had not been addressed. This had been a requirement twice previously. Also, it was not identified what the charges would be should the resident be away from the home for a period of time, such as in hospital. The complaints procedure contained within the contract directed the resident/complainant to the CSCI area office in Birmingham whereas this home is registered with the CSCI office in Stafford. This will need to be changed. All these issues were discussed at the time with the provider and the administrator. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Care planning was maintained at a reasonable standard. The health and personal care needs of residents were being met appropriately. The home had policies and procedures in place for the management and administration of resident’s medication. Residents were treated with respect and their right to privacy was being up held. EVIDENCE: A sample of care plans were examined during this inspection and the inspector was satisfied that a reasonable standard of care planning was being maintained. All care plans were written legibly in black ink, dated and signed in line with NMC requirements. All risk assessments were in place along with long and short-term problems, which were reviewed monthly or more frequently if required. The staff maintain care planning notes, up to date, reflecting the current condition of each resident. Discussions with staff and residents confirmed that good standards of health and personal care were provided. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 12 An examination of daily entries into the care plan also confirmed a thorough approach. All NHS entitlements were available and made through the referral process where necessary. The medication process was observed and the storage, administration, disposal and documentation relating to this procedure were examined with the cooperation of the nurse on duty. All were found to be in order at the time of the inspection. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Stubby Leas provides a wide range of social, religious and recreational activities and opportunities. Contact with families is promoted. Residents are encouraged to make choices that determine personal routines and activities for daily life. The quality of meals needs to improve further to meet the nutritional requirements of all residents. EVIDENCE: The activity co-ordinator was on annual leave at the time of the inspection. The activity room was inspected along with records and documentation. The home is to be commended on the programme of therapeutic activities and entertainment it provides for the residents. The activity room itself contained many examples of on going art and craft projects, which portrayed the changing seasons throughout the year. There were many examples of individual resident participation and records had been maintained to support this. There had been a recent show put on by staff and residents over the Christmas period. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 14 Assessments of individual needs, preferences and abilities had been taken into account when planning activities, especially in relation to the needs of residents with dementia. Staff complete a “getting to know you better” form when residents come into the home, with the help of families, and this helps to find out what individual residents are interested in and are able to participate in, as well as any particular hobbies they might have. In relation to meals offered and provided, these need to be improved upon. There were some negative comments received from residents and staff in relation to the choice of meals available. Portion sizes of hot meal alternatives were observed as being very conservative in size on the day of the inspection. Staff confirmed that there was very little food left over at mealtimes. Catering services and facilities fell below acceptable national minimum standards. There was some evidence of choices being made in relation to the meals, albeit choice was limited. Menus provided at inspection were generally being followed but staff thought that most of the vegetables served in the home were frozen with the exception of mashed potatoes, which were served very frequently. Although there was evidence of available fresh vegetables, the kitchen assistant informed the inspector that he did not like preparing some fresh vegetables, as they were ‘too hard to cut’. The owner is currently dealing with this issue through the disciplinary procedures in the home. Quantities of meals were reported to be minimal at times and residents requiring soft diets had a repetitive diet provided to them at teatime and this was discussed during feedback of the inspection. Residents requiring liquidised diets must be provided with more choice. A varied and more suitable and a more appealing menu, must be available to them at all mealtimes. Catering staff explained to the inspector that not enough food supplies were ordered and this had an effect when trying to meet the menu plans. Some lipped beakers were stained and there was a shortage of cups at meal and drink times. The cook reported a shortage of dishcloths. The fridge in the kitchen needs a good clean and temperatures of fridge and freezers must be maintained. The freezer in the storeroom needs replacing, as it is not working properly. There are no foot operated waste bins in the kitchen inline with environmental health requirements. The home must ensure that all dietary requirements identified in the home are met. Menus should be displayed in the dining room so residents can be reminded of the choices on offer each day. Confirmation was given that this would be reviewed. This will be thoroughly checked on the next unannounced inspection. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Residents and their families can be assured that any concerns they have will be listened to, taken seriously and acted upon. The legal rights of residents are maintained and they are protected from harm and abuse by the systems in the home. EVIDENCE: The complaints procedure was displayed on the wall and was accessible. This contained the details of the local CSCI office at Stafford. This procedure was somewhat complicated and not easy to follow. It is recommended that this process is made clearer. The inspector was informed that all in-house complaints are logged with records of investigations and these were seen at the time of the inspection. Legal rights are upheld for the residents with the help of families, solicitors and advocates. Some of the staff had started to receive training in POVA and this is outlined in the induction procedure. The inspector was informed that all staff have been handed a booklet containing the Vulnerable Adult protection procedure. When questioned about this the nurse on duty stated that she had received this as well as the training. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 The grounds enable residents to benefit from countryside living. The standard of the environment within this home is in need of some improvement in order to ensure that residents are provided with an attractive, comfortable and safe place to live. The interior was untidy, dirty in parts and in need of routine cleaning in all areas. EVIDENCE: Décor was generally suitable but in need of attention in some areas. Some of the bedroom furniture was in need of repair or replacement and it is recommended that an audit of all furniture be undertaken. The home had been adapted with grab rails, ramps, a passenger lift, various mobile hoists, fixed bath hoists, moving and handling equipment and aids to help residents maintain mobility. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 17 The home was generally in need of a good clean throughout. The inspector was not able to speak with any of the domestic staff, as there were none on duty. The organisation of the cleaning schedules could not be determined. (Staffing requirements has been referred to in the relevant section of the report). A window in the conservatory needs repairing as it was almost falling off. A bath in the home is awaiting a new hoist to enable it to be used. With this out of action staff have only one bathroom to use between two buildings. Some windows were unable to be closed properly and need remedial attention. Rooms 2 and 12 are still delivering cold water only. There are no thermometers available in the bathrooms for testing the hot water temperatures. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Staffing levels were not deemed appropriate or sufficient to meet the needs of the residents and the demands of running the home. Staff are trained and given the necessary skills to care for the residents in the home. The recruitment process needs to be tightened up somewhat in order to ensure that residents are protected. EVIDENCE: As the home has been registered under South Staffs Health Authority prior to 31st March 2002, the levels and skill mix implemented and agreed at that at that time must be maintained. On the day of the inspection the home did not have appropriate ancillary staff to meet the requirements of the residents or the administration of the home. There is a qualified nurse on duty during the twenty-four hour period. To support this compliment of qualified staff there are currently 7 care staff on the early shift and 6 on the late shift and 3 care staff over the night shift. The home is split into two sides - The main house and the cottage. Following a discussion with the staff the two inspectors were told that there are 21 residents cared for in the main house, with 4 carers on in the morning and 3 on the late shift. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 19 On the cottage side it was determined that there were 23 residents with 3 care staff on in the morning and 3 in the afternoon. These numbers when maintained are acceptable for the 44 residents in the home on the day of the inspection. 23 were receiving nursing care and 21 receiving residential care. However, the staffing of the entire home continues to be undertaken on a very sporadic basis. This is a serious situation, which needs to be rectified forthwith. The registered provider must recruit more catering/domestic and laundry staff to supply an adequate workforce, to meet the needs of the residents and to keep the home clean and well maintained. Currently, ancillary staff continue to be moved off their assigned duties to cover care staff shortfalls. The registered care manager Mr Kevin Campbell now has some supernumerary hours to complete his management duties. There is an administrator employed by the home and a training coordinator. The maintenance man works 3 days hours a week for Stubby leas care home, as he is also responsible for the owners other care homes - Abidale in particular. However to continue redecoration and upgrading of the home the registered person should increase maintenance hours as discussed during the inspection. There was a programme of staff training in place at the home and there was an appointed training supervisor to oversee this. NVQ training had commenced with 3 care assistants trained to NVQ level 3 and 2 to level 2 in direct care. 6 care staff were working toward the NVQ level 2 qualifications. The manager was undertaking the Registered Manager’s Award. A selection of staff files was examined in relation to the recruitment procedure. These were found to contain the required information and staff had undergone the required checks. One of the staff files identified that a nurse had been employed without a reference from her last employer having been obtained and there had been a gap of two years on her employment history with no written record of the reason for this having been explored. There is a requirement for this information to be contained within employee files. Records of staff training were examined and these included evidence of staff induction. There was a very good example of staff induction in relation to a care assistant but the records relating to the induction of the maintenance person were poor. There was a statement in place to say that he had received some instructions but he had not received fire safety training despite being employed for three months at the home. Staff inductions must be geared to job descriptions and varying roles to ensure that all staff have the knowledge to carry out their jobs. Most of the staff had been updated in fire safety training but moving and handling updates had not been delivered to staff as required. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 20 The reason given for this was that there had been no authorised trainer within the home until recently where two staff members (one being the training supervisor), had undergone a “Training the Trainer” programme. The supervisor explained that the remainder of staff would now be updated. Further staff training included food hygiene, understanding challenging behaviour, dementia care awareness and infection control. Staff are trained and given the necessary skills to care for the residents in the home. The recruitment process needs to be tightened up somewhat in order to ensure that residents are protected. Night staff must not undertake laundering of resident’s personal clothing during the night shift. The registered person must employ sufficient laundry staff to ensure that washing and ironing is undertaken in line with the resident’s personal requirements and the homes routine. Laundry staff were consulted and confirmed that no ironing was undertaken in the home as there were not enough staff to cover laundry requirements. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, 36, 37,38 Generally, the home is run in the best interests of the residents and records were maintained. Formal staff supervision must be implemented without delay to ensure that all staff receives the necessary support. Some health and safety issues need addressing. EVIDENCE: Discussions with the operations manager identified that quality assurance had commenced in the home. The inspector was shown a file containing audits that had been carried out in the home. These included audits of the environment, care plans and a quality survey completed by relatives. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 22 Some of the audits were not dated and these were brought to the attention of the operations manager. Regulation 26 reports had not been received by the CSCI and will need to be sent in monthly by the provider. The provider, who was present throughout most of the inspection, confirmed that the home was financially viable. The responsibility for the administration of residents’ finances was in the process of being transferred from the activities co-coordinator to the new administrator who had only been in place for a few months. Not all of the records relating to this were available for inspection at the time. Records relating to pocket monies of two residents were inspected and these were found to be in order. The administrator kept very good records allowing audit trails to be easily carried out if required. She was developing some very good systems in order to ensure that residents’ finances are protected. All records and documentation were kept securely and in accordance with the data protection act. Formal staff supervision had not taken place and this will need to be implemented. Care staff must receive formal supervision 6 times per year and this must be documented. Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X 2 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 1 3 2 Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 24 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 OP27 Regulation 18(1)(a) Requirement There were insufficient staffing levels identified in the kitchen, domestic and laundry areas. Sufficient staff must be employed to ensure full cover is maintained in all areas over a seven-day period. Staff must not be taken off ancillary duties to cover care shifts. Agency and bank staff must be used where shortfalls cannot be covered. The kitchen door must be locked when not in use as the hot water still, just inside the door poses a real hazard to wandering residents suffering from dementia. All areas of the home must be maintained in a clean and hygienic condition. Previous immediate timescale has not been sustained. Resident contracts must clearly identify the level of fees to be paid including charges made during absences. Previous requirement of 15/04/05 not met. The complaints procedure DS0000022378.V275764.R01.S.doc Timescale for action 06/01/06 2. OP38 13(4)(c) 06/01/06 3. OP26 16(2)(j) 06/01/06 4. OP2 17(2) schedule 4 (8) 06/02/06 5. OP2 22(7) 06/02/06 Page 25 Stubby Leas Nursing Home Version 5.1 6. OP29 19 Schedule 2 7. OP30 18(1)(c) 8. OP30 23(4)(d) 9 10 11 OP36 OP38 OP15 18 (2) 26(5) 16(2)(i) contained within the contract must refer complainants to the Stafford Area Office and not Birmingham. • A written reference from the last employer must be obtained when recruiting new staff. • Gaps in employment history must be explored and the reasons for these discussed and documented All staff must receive regular updates in Moving and handling training and these must be documented and available for inspection when requested. All new staff must receive fire safety training as part of their induction; these must be documented and available for inspection when requested. Care staff must receive formal supervision 6 times per year and this must be documented. The owner must send in monthly regulation 26 reports to the CSCI. • The registered person must ensure that all dietary requirements identified in the home are met. A choice of two hot meals must be provided at the main meal of the day and quantities must be sufficient. • Residents requiring liquidised diets must be provided with more choice. • A varied and more suitable and a more appealing menu, must be available at all mealtimes. • Temperatures of fridge and freezers must be maintained. • Foot operated waste bins DS0000022378.V275764.R01.S.doc 06/01/06 06/02/06 06/01/06 06/02/06 06/02/06 06/01/06 Stubby Leas Nursing Home Version 5.1 Page 26 must be provided in the kitchen inline with environmental health requirements 12 OP19 23(2)(b) (c) A window in the 06/02/01 conservatory needs repairing as it was almost falling off. • Several windows could not be closed properly and need remedial action. • A bath in the home is awaiting a new hoist to enable it to be used. With this out of action staff have only one bathroom to use between two buildings. The registered person must 06/01/06 employ sufficient laundry staff to ensure that washing and ironing is undertaken in line with the resident’s personal requirements and the homes routine. Night staff must not undertake laundering of resident’s personal clothing during the night shift. Rooms 2 and 12 are still 06/01/06 delivering cold water only. There are no thermometers available in the bathrooms for testing the hot water temperatures. • 13 OP27 18(1)(a) 14 Op38 23(2)(j) Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 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 Refer to Standard OP21 OP30 OP16 Good Practice Recommendations The ground floor bathroom would be better turned into a shower area which is power assisted that heats water as it is drawn. Staff induction should be geared to the specific job roles within the home The complaints procedure was displayed on the wall and was accessible. This contained the details of the local CSCI office at Stafford. This procedure was somewhat complicated and not easy to follow. It is recommended that this process is made clearer. The maintenance man works 3 days hours a week for Stubby leas care home, as he is also responsible for the owners other care homes - Abidale in particular. However to continue redecoration and upgrading of the home the registered person should increase maintenance hours as discussed during the inspection. Décor was generally attractive but in need of attention in some areas. Some of the bedroom furniture was in need of repair or replacement and it is recommended that an audit of all furniture be undertaken. 4 OP27 5 OP19 Stubby Leas Nursing Home DS0000022378.V275764.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 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.V275764.R01.S.doc Version 5.1 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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