Inspection on 24/10/06 for The Adelaide Nursing Home

This inspection was carried out on 24th October 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

The Adelaide Nursing Home 27/06/07

The Adelaide Nursing Home 31/05/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Adelaide Nursing Home 203 - 205 New Church Road Hove East Sussex BN3 4ED Lead Inspector Elizabeth Dudley Key Unannounced Inspection 24th October 2006 10:00 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 The Adelaide Nursing Home DS0000065729.V316968.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. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Adelaide Nursing Home Address 203 - 205 New Church Road Hove East Sussex BN3 4ED 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) 01273-410530 01273 423413 Adelidenh@btconnect.com Seaway Nursing Home Limited Mrs Kusumawattee Heard Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That service users should be aged sixty-five (65) years or over on admission The maximum number of service users to be accommodated is thirtyfive (35) Only older people requiring nursing are admitted to the home. Date of last inspection Brief Description of the Service: Adelaide Nursing Home is a care home providing care for up to thirty-five (35) residents over the age of sixty-five (65) and requiring nursing care. Rooms are located over two floors and are accessible by stairs. A passenger shaft lift is available for those residents unable to independently mobilise. Communal areas consist of a lounge/dining area and access to garden. Assisted bathing facilities are in place. It is located in a quiet residential area of Hove. Local amenities and the seafront are within walking distance of the home. There is nearby access to public bus routes and rail links to Brighton. The home provides parking for approximately four cars and further car parking is available in adjacent roads, which is unrestricted. Weekly fees range between £471 and £700. There are additional charges for hairdressing ,Chiropody, newspapers/magazines, and personal toiletries. This is based on information given by the provider on 12th May 2006. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 24th October 2006 over a period of seven and a half hours. The inspection was facilitated by Mrs K Heard, registered manager and Dr R Sumooreah, registered provider. In the course of the inspection a tour of the home was undertaken, and records including care plans, personnel files, medication records, catering records and health and safety documentation were examined. During the day, eleven residents at the home, two visitors and seven members of staff were spoken with. Comments received from the residents were variable, the majority stating that the home provided them with a satisfactory standard of care and catering, these comments included the following: ‘The staff are nice, very nice, the food is quite good and we get a choice, and my visitors are made welcome’, ‘Everything is alright really, it’s not the same as home, most of the time my bell gets answered fairly quickly’, ‘Some of the staff are not too good at times, the food is fair, staff sometimes come quickly when I ring my bell’, ‘Staff give you the question and then provide the answer they want to hear — the food is alright on the whole’, ‘They look after me alright, but I don’t think I have much choice over when I go to bed or get up, I go to bed early now or I have to wait too long’, ‘Wonderful place, I’ve put on two stone, the staff are lovely’, ‘I wish staff had longer to talk to me, there is not much going on here, the staff are nice though’ and ‘The food is good, they give you choices, its very nice here’. Staff stated that there was not much time to spend on activities for residents or just sitting and talking to them as they had to duties such as laundry, as there are no laundry staff employed at present, and that staffing in the afternoons had been reduced. Both visitors spoken with were very pleased with the progress their relative had made since coming into the home, they said she had put on weight and was always cheerful, and that they were informed of any changes in her condition or if there were any concerns. What the service does well: The home provides nursing care for residents living in the home, with evidence that the home consults with other health care professionals as required by the needs of the residents. This enables residents to benefit from up to date knowledge from staff who are specialists in their field. Staff are encouraged to undertake further training, most of which is provided in the home by the Nursing Home Support Team, with registered nurses being encouraged to attend study at the hospital and other study centres. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 6 The menu offered to residents is varied and residents are made aware of choice of menu by the staff on a daily basis. Most of the menu is homemade with little reliance on tinned or pre prepared food. The Malnutrition Universal Screening Tool is used, to ensure that residents are well nourished, and all residents are weighed monthly with appropriate action being taken if there are any concerns. Retention of staff is good with some staff having worked at the home for a number of years. What has improved since the last inspection? What they could do better: The provider must ensure that all staff receive regular formal supervision, undergo a full induction course and receive all mandatory training. There is no current fire risk assessment and the provider must liaise with the fire authority for their advice on this. The home is in need of redecoration and the standard of cleanliness in some areas is poor and must be addressed. New carpets are required in many areas of the home and institutional style lockers in bedrooms are in need of replacement and all furnishings should be in a style that promotes a domestic and homely setting. The home provides few activities for residents, and residents also said that staff do not have time to talk to them, this can lead to feelings of isolation. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 7 Many residents described the home as ‘alright’ in most aspects but few stated that they were fully satisfied with any aspects of the home. Some residents referred to some staff attitudes as ‘not good’ all the time and the manager and provider must address this and residents’ morale and satisfaction with the service provided appeared low. The provider must address this through relevant quality monitoring measures. Registered nurses must ensure that their individual practice of medication administration is in line with the Nursing and Midwifery Council guidelines and recommendations. The provision of an easy to read daily menu in the dining/lounge area would act as an ‘aide memoire’ for those residents who have difficulty in remembering what they have been offered from the menu. Requirements not complied with from the last inspection have been brought forward and the provider must ensure that these are met. An improvement plan has not yet been received from the last inspection although the provider gave assurances that this would be supplied to the CSCI. The provider must ensure that the monthly monitoring visits take place and that these are forwarded to the CSCI. 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. The Adelaide Nursing Home DS0000065729.V316968.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 The Adelaide Nursing Home DS0000065729.V316968.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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents receive the information that they require to ensure them that the home can meet their needs prior to making the decision to live there. The Statement of Purpose and Service User Guide do not currently reflect current practice in the home. The provider has not provided residents with a statement of terms and conditions relevant to the present ownership of the home. EVIDENCE: There is a statement of purpose and service user guide, which contain the information required to comply with both the regulation and the standards. Some information included in the statement of purpose and service user guide, relating to activities provided, siting of vulnerable residents on the ground floor and residents or representatives being consulted about their care plan, does not accurately reflect current practice in the home. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 10 The service user guide must be in a format that can be easily read by residents. A statement of terms and conditions relevant to the current ownership of the home is being produced. The new document must include the length of the trial period currently in place in the home and a breakdown of the fees in order that residents are aware of the proportion of the fee they are responsible to pay. The majority of residents in the home at the present time have a statement of terms and conditions, which relates to previous ownership. All residents must be given a copy of the new document. Evidence that this has been addressed must be in place. There is a thorough pre-admission assessment of residents by the manager or another registered nurse. This forms the basis of the care plan and ensures that both the prospective resident and the home are aware of the needs of the resident and their ability to meet these. The manager takes a pack of information, which includes a service user guide and statement of purpose to prospective residents. One resident said ‘she (the manager) brought a full pack of information when she came to see me’. Prospective residents and their representatives can visit the home prior to their admission. The home currently offers a trial period of one month. At present residents are informed verbally that the home can admit them and meet their needs, this must be confirmed in writing to the resident or their representative. Registered nurses, the majority of whom have several years experience in the nursing care of the older person, provide nursing cover twenty-four hours a day and lead the shifts. Some care assistants have attained their National Vocational Qualification level 2 in care, whilst others have experience in the care of the older person. Staff undertake training in subjects relevant to the care of the residents. Residents are not admitted for intermediate care and therefore this standard is non applicable to this home. The Adelaide Nursing Home DS0000065729.V316968.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): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide sufficient information to enable staff to give the care required for each resident. There is little evidence to show that residents are consulted about the initial plan of care or reviews of care. The administration of medication goes part way to ensuring safety of the resident but improved practice in ensuring the accuracy of handwritten medication records would further safeguard residents. EVIDENCE: During the visit to the home six care plans (12 ) were examined. Care plans seen were comprehensive with the majority containing sufficient detail to inform staff of the care that the resident requires. However one care plan required greater detail of the care and observation required for a post operative wound. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 12 All care plans had been reviewed on a monthly basis, but there was not always evidence that residents were aware of the content of the care plan or that they or their representatives had been consulted at its formation or review. Most residents spoken with had no knowledge of the care planning process, ‘I have never seen my care plan, what does that involve?’ and ‘No, I don’t know anything about that’. A relative of a resident confirmed that she had been consulted about the residents care plan and its review, and had signed the care plan. It is appreciated that some residents would forget that they had been consulted and the staff must ensure that they have evidence of this having been undertaken. Although most care plans included nutritional and mobility care plans, there was evidence that one care plan did not identify that the resident also had a soft diet in addition to his Percutaneous endogastric feed (tube feed). There was no mobility care plan in place for one resident and there was no risk assessment or consent for the use of bedrails for another resident for whom these were being used. There was evidence of wound care plans and consultation with the Wound Care Nurse Specialist. There was evidence of advice having being sought from the Continence Advisor Specialist Nurse, the Parkinson’s Disease Specialist Nurse and the Nursing Home Support Team. Advice about the nutrition of the older person has been gained, with all residents being weighed on a monthly basis and the implementation of the ‘Malnutrition Universal Screening Tool’ (M.U.S.T). Both care plans and residents evidenced that a chiropodist, optician and audiologist visit the home, and the home also retains a physiotherapist who is available to all residents. The physiotherapist from the Primary Care Trust visits the home as required. Although the manager stated that residents are accompanied on hospital appointments by a member of staff, if relatives are unable to so, one resident stated that this had not occurred in their case. Many of the residents within the home have high nursing and dependency needs, those seen to be nursed in bed looked comfortable. Other residents around the home looked clean and well cared for. Medication records were examined, and these showed that the majority of charts, with four exceptions, had been signed following administration of the medication. All medications and dressings were within their expiry date and medication was being disposed of using the correct disposal system with records kept. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 13 However the medication policies and procedures do not reflect the current method of disposal of medication and there was no evidence of a policy to address self-medication. Although no residents self medicate at present there is no policy to guide staff in the event of this occurring. Medication policies require reviewing to reflect current practice within the home and give guidelines for staff who administer medication. There have been ongoing concerns raised by one resident about the administration of his individual medication and his social worker is liaising with the home to address this. Handwritten additions to medication charts should be signed by the nurse taking the order for change, and it is good practice for two registered nurses to confirm the dosage and medication of these, with signatures. The clinic room was clean with records kept of the checking of equipment and sufficient information in place to inform the nursing staff of current medication and new practice. All residents receive medical and nursing interventions in the privacy of their own rooms. Some residents have their own telephones and a cordless phone is available for resident’s use. Generally, residents spoken with, said that their privacy and their dignity was upheld and respected. The majority stated that their bells were answered within a reasonable amount of time and that they were able to stay in their rooms if they wished to do so. The resident’s preferred term of address is clarified in the care plan. The Adelaide Nursing Home DS0000065729.V316968.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): 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from social interaction or leisure activities within the home. Menus are varied but do not fully address some dietary needs of the older person. EVIDENCE: Activities provided by the home are few, the statement of purpose identifies that suitable activities will be provided, but at present this is not in place. The manager and provider stated that an activities person attends the home twice a month, and musical entertainment and a painting session once a month. Staff are expected to undertake activities with residents, but the staff spoken with said that other duties leave them little time to do this, although occasionally they can play Bingo or board games with residents. Staff said that few residents go out of the home unless with relatives and that few residents are encouraged go into the garden in the summer. There is no activities programme in place. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 15 Residents spoken to said that ‘Staff do not come in and talk’, ‘occasionally there is something going on but not often and staff are too busy to talk to me’ and ‘Sometimes staff come and talk to us, but they are so busy’. On the day of the visit to the home the lift had broken down resulting in most residents being unable to go into the lounge. No staff were seen to be talking to or visiting these residents in their rooms. The provider and manager must be aware of the importance of social interaction and provide activities to suit the abilities of those in their care. Visitors may visit most times of the day, but visitors are asked to avoid early mornings and late evenings in order to ensure residents’ dignity is maintained whilst essential care is being given. Many residents said that they had the choice of when they get up and go to bed, however one resident stated that ‘I have to wait until 10.30-11am until they come in to wash me’, another, who was dressed in night clothes and in bed by 4pm said ‘If I don’t come to bed now I will have to wait until very late’, and a further one saying ‘I don’t think I choose, they just come and tell me when its time’. However staff said that they do give the residents choices over these matters. Most residents said that their clothes were well ironed and laundry came back promptly with the correct clothes coming back to them. Care assistants said that they have to do the ironing as well as the care duties and ‘You want to take a lot of care over the ironing because I don’t like creased clothes and I wouldn’t want the residents to have clothes that were not ironed’. The provider stated that he is in the process of employing a specific person for laundry and ironing, thus enabling staff to spend more time with residents. Residents said that their visitors are made welcome and usually offered a cup of tea, with two visitors to the home stating that ‘We are made welcome and are always kept informed of mothers progress’. Ministers of religion visit the home and residents are able to see these and all other visitors in their rooms. There is a varied menu, which offers two choices of food at lunch and suppertime. The meals were well presented, including the liquidised meals and there was evidence of fresh vegetables in the home. However there was little evidence of fresh fruit in the kitchen or around the home with only a few desserts incorporating this. The provider should consider training for catering staff which incorporates the dietary needs of the older person with information on the nutrients important for health. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 16 The supper menu was seen to include items such as baked potatoes, or homemade quiche. Most of the cakes and puddings in the home were home made. Residents had varying comments about the food, some saying it was very good, whilst some said it was ‘alright’, ‘some of the time its good sometimes bad’ and ‘we always get a choice and they give you anything you want, its all very nice’. All residents stated that the staff bring the menu around in the morning and in the afternoons and they could choose what they wished to have. It is recommended that the day’s menu be displayed in the lounge as an aide memoire for those residents who come down into the lounge, to ensure that those residents who have difficulty of recall are informed of the days meals. There was a good supply of fresh, frozen and dried food with records being kept of fridge, freezer and cooked food temperatures. There is a cleaning schedule in place and the kitchen appeared clean. The gas oven had broken the previous day but residents said that they had been given meals such as salad or microwave meals, ‘they still managed to provide a nice meal without an oven’. It was in the process of being fixed on this visit. Most residents said that they could have a cup of tea or snacks at any time they wished although most stated that they did not ask for this. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents stated that they were able to make complaints and that these were addressed in a fair manner. Policies relating to adult protection do not fully protect the resident, but staff have attended training in this area. EVIDENCE: The complaints procedure is displayed in the main entrance hall and included in the service user guide. Most residents spoken with were confident about making a complaint and the provider would treat that this in a fair and transparent manner. There is no central complaints file, complaints being kept in individual residents files. It is recommended that all correspondence and matters relating to complaints must be kept in a confidential file with the content known only to senior management. This would also increase ease of access, as at present in order to access this documentation, the provider has to look through all residents’ files. There have been three complaints in the last twelve months, these have been investigated by the provider and social services, these have related to concerns over the care of the residents and two were upheld and one partially substantiated. The provider has demonstrated that he deals with complaints The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 18 in a transparent manner and takes action to ensure that any faults are not repeated. The adult protection policy was forwarded to the CSCI as requested during the last inspection, however the flow chart for the notification of adult protection was six years out of date and did not reflect the current reporting protocol, a new one was obtained during this inspection and it is recommended that this is kept in the nursing office. The relevant policy within the home requires updating to reflect these changes. Some staff have now attended adult protection training and this must be extended to all staff. Staff spoken with were given an adult protection scenario and were able to address this correctly. There has been one adult protection investigation in the past six months and this was found not to be substantiated, the home was co-operative throughout the investigation. However there were concerns over a member of staff working in charge of a shift without a current Criminal Records Bureau check and discussions around this were held with the provider. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ rooms are comfortable and are made homely by the addition of resident’s own possessions. However the standard of décor and cleanliness does not enhance resident’s quality of life. EVIDENCE: The standard of decoration and maintenance in the home requires attention. Although the entrance hall carpet has been replaced with wood flooring, the carpets in other areas including the lounge, some residents’ rooms and corridors need either repairing or replacing. The garden is well maintained but an accumulation of unused items is starting to build up in the patio area. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 20 The lift was out of order on the day of the visit and had been out of order the previous day, however this was in the process of being repaired. There is a need for redecoration in most areas of the home. However the present owner has owned the home for only seven months and during this time has replaced mattresses, linen and hoists within the home. The lounge/dining room area leads onto the garden. Although it is small for the number of residents in the home it did not appear crowded on the day of the visit, however it is in need of redecoration and some replacement furniture. There are four bathrooms in the home, but staff stated that only the one could be used easily as there was not sufficient room in the others to get wheelchairs and hoists in them. The owner is proposing to change one of the bathrooms into an assisted shower room. The bathrooms are not inviting and could benefit from redecoration or refurbishment and this was discussed with the provider. Staff stated that the water outflow from one bathroom was very slow and by the time the bath was full the water was cold. There was evidence of the need for recoating of this bath and the bottom of the bath seat required cleaning. Twenty-two of the twenty-four single rooms, and all three double bedrooms, have an ensuite facility of wc and washbasin. All residents rooms show evidence of being personalised with residents own possessions and are comfortable. Some of the furniture in the bedrooms, i.e. bedside lockers are institutional, and some rooms do not have a lockable drawer. All rooms have lockable doors and the manager must produce evidence that residents have been assessed for possession of a room key. All rooms are in need of redecoration and some attention to the carpets, although the curtains are fit for purpose. New linen has recently been purchased although staff raised concerns about that the quality of this will not enhance residents’ comfort. The size of the rooms in the home meets the amended National Minimum Standards. The water temperatures of resident’s hot water outlets were recorded and were within recommended parameters, all window restrictors on windows above first floor were in place. The home has a good selection of both pressure relieving mattresses, cushions, and moving and handling equipment, with a new full body hoist having recently being purchased. A device to aid hair washing of bed bound residents has been purchased. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 21 Although odours have been reduced in the hallway, there was evidence of odours in some rooms and this must be addressed. Additional attention to cleanliness is required in most areas, specifically bathrooms and laundry area, although both clinic room and kitchen were clean. Staff stated that at present they have to undertake laundry duties and were concerned that they did not always have time to iron resident’s clothing and voiced their concern over the staining of the new sheets, although they stated the washing machines were efficient. The home has infection control policies and staff said they were aware of infection control issues, although they have received no formal training in this. Staff stated that there were always plenty of gloves and aprons available and staff were seen to be wearing protective clothing on entering the kitchen. The kitchen assistant does not have a food handler or food hygiene certificate; most care assistants and registered nurses have undertaken this training. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff undertake an induction course to ensure that they know the foundations of caring for older persons with some staff commencing training in the National Vocational Qualification level 2 in care. The majority of personnel files contain all documentation as required by the regulations to ensure the protection of the residents. EVIDENCE: Staffing has been reduced by one member of care staff in the afternoon and staff spoken with stated that although there were sufficient staff on duty in the mornings that the afternoons and evenings were difficult, with having to do the laundry and the care, there was insufficient time to spend with residents or do activities. They said that the high resident dependency was also a factor in this. The staffing rota showed that there are 4 care assistants and two registered nurses in the mornings and three care staff and one registered nurse afternoon and evenings. Two care assistants and one registered nurse are on duty overnight. No agency staff are used by the home at present. Staff concerns were discussed with the manager. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 23 The majority of newly employed carers undertake an induction course over a period of two weeks, the owner and manager are considering changing this to a course which will provide a first unit for National Vocational Qualification level 2 in care. One member of staff stated that she had not undertaken the induction training yet, this was verified in the records, there was some evidence that other staff have not had a written induction including registered nurse and ancillary staff. Newly employed registered nurses work three shifts alongside established staff, whilst ancillary staff receive verbal, local induction regarding fire exits and some policies. Some recently employed staff working at all levels have not received any mandatory training including fire training in their induction. Although few members of the care staff have attained their National Vocational Qualification level 2 in care, the provider is in the process of accessing courses for them to commence training for this qualification. Registered nurses have received updates in supra-pubic catheter care, wound care and other training relevant to the care of the older person. In house training is given to both care assistants and registered nurses by the nursing home support team, although both carers and registered nurses also attend external training courses. Care assistants stated they had no formal training in infection control and one member of kitchen staff requires food hygiene or handlers training. Six personnel files were examined and these were found to contain most information required by the regulations. Three members of staff have commenced duties with a Protection of Vulnerable Adults first check in place, and are working under supervision. However one member of staff in charge of a night shift only has a ‘Protection of Vulnerable Adults First check’, with the Criminal Records Bureau check being awaited, as they are in charge of a shift no supervision is in place. There has been no local fire training for this member of staff. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 24 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): 31,32,33,34,35,36,37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Aspects of management issues, including staff supervision and evidence of monitoring of the home by the provider were not in place, and this could have a detrimental effect on the wellbeing of residents. Lack of a fire risk assessment can put residents and staff safety at risk. EVIDENCE: The manager, Mrs K Heard, is a registered nurse (level 1) with several years experience in the management of this nursing home and the nursing care of the older person. She does not intend to undertake any management courses but is registered with the CSCI. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 25 The ethos in the home is adequate, residents comments included statements ‘the staff are alright’, ‘most staff are very helpful’, ‘the staff sometimes get annoyed with me’, ‘Staff not too good at times’, ‘There has been a lot of change and I am too old for change’, ‘staff do not come in and talk to much’, ‘The staff are very good and everything is alright’, ‘I like the home and enjoy living here’, ‘It’s not like living at home’ and ‘It’s okay, not too bad’. Staff spoken with stated that they thought that there were some improvements in the home, and that they thought that the atmosphere within the home was ‘fairly good’, and that they try to respect residents choices and make visitors welcome. They said that few agency staff are now employed. Two visitors were in the home on the day of the inspection and said that from their perspective the ethos within the home was ‘pretty good, considering’. No quality monitoring programme has yet commenced although the provider states that he has recently set up a quality monitoring process and has sent out questionnaires to staff, health care professionals, visitor, residents, other professional visitors. He has stated that he intends to collate the results from his and will use them to inform practice. No staff meetings have been held since the first two after he took over the home, but another staff meeting is being arranged to take place before Christmas. An action plan was sent following the last inspection report but no improvement plan received. The provider stated that he would supply this to the CSCI. The Statement of Purpose and Service user Guide now include information of how to access the inspection report from the home manager. The policies and procedures require reviewing including the medication policy which needs to reflect the current method of disposal of medication or the procedure to be followed if a resident wishes or is able to self medicate. The public liability insurance was seen and is current and displayed in the hallway, financial records for the home were not looked at; this was addressed at registration of the home. Records relating to residents personal finances were seen, these were accurate and itemised apart from one resident which required the individual items of expenditure to be accounted for separately. The provider is appointee for three residents, and now asks that residents have alternative arrangements for this. Discussions were held relating to the setting up of bank accounts in which to keep the money, which has been accumulated by residents and is held at the home. The provider has agreed to make enquiries regarding this. The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 26 Regulation 26 reports have not been undertaken and discussions relating to these were held with the provider, he had been asked and agreed to send these to CSCI but has only sent in one since the last inspection. He has agreed to recommence these. The majority of staff spoken with said that they had received formal supervision in the past three months. Personnel files examined identified that no registered nurses had received supervision, but care staff are receiving it regularly. Records are kept in a secure environment, both in the nurses’ office and in the provider’s office. All certificates relating to utilities and equipment were in place and in date, however there is no fire risk assessment completed and some staff have not received the mandatory training, which includes fire and moving and handling training. The fire risk assessment should be drawn up following consultation with the local fire authority and the CSCI informed when this is in place. The lift had broken down on the day prior to the visit to the home; this was repaired during this visit. The IEE certificate as requested at the last inspection is now in place. The Adelaide Nursing Home DS0000065729.V316968.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 2 1 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 1 2 1 3 3 2 3 2 STAFFING Standard No Score 27 2 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 3 2 3 2 The Adelaide Nursing Home DS0000065729.V316968.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. 2 3 Standard OP1 OP2 OP3 Regulation Reg 4 & 5 Requirement Timescale for action 10/12/06 16/12/06 16/12/06 4 OP7 5 OP7 6 OP12 7 8 OP19 OP26 OP27 That the Statement of Purpose and Service User Guide reflect current practice within the home. Reg 5(1) That all service users receive a copy of the current terms and conditions. Reg That the service user receives 14(1)(b) written confirmation that the home is suitable for meeting the assessed service user’s needs. Reg That evidence be provided of 15(2)(c) service users/representatives consultation in the formation and reviewing of care plans. (Previous requirement August 2006 not met) Reg 13(7) That consent forms and risk Reg 13(8) assessments are implemented for those service users requiring bed rails. (Previous requirement of August 2006 not met) Reg That service users are provided 16(2)(m & with suitable and fulfilling n) activities. (Previous requirement August 2006 not met) Reg That all parts of the home are 23(2)(d) kept clean and reasonably decorated. Reg That the dependency level of DS0000065729.V316968.R01.S.doc 10/12/06 10/12/06 10/12/06 10/12/06 10/12/06 Page 29 The Adelaide Nursing Home Version 5.2 18(1)(a) Reg 21 9 10 OP28 OP30 OP29 Reg 18(c)(i) Reg 19 Schedule 2 11 OP33 Reg 24 12. OP36 Reg18(2) Reg26 13. OP38 Reg 23(4)(d) service users be regularly reviewed and that staff are employed in sufficient numbers to meet the assessed needs of the residents. (This was a previous requirement of August 2006 not met) Ensure that all staff receive training to the work they are to perform. That all relevant checks are undertaken prior to a prospective employee commencing work. (This was a previous requirement July 2006, not met). Staff must not work unsupervised until their Criminal Records Bureau check is in place. That the home implements a robust quality assurance and quality monitoring process, as identified in the Statement of Purpose. (This was a previous requirement of August 2006, not met). That supervision of all staff is commenced. (Previous requirement 31.08.06 not met) That regulation 26 visits are undertaken and recorded by the provider and copies sent to the CSCI. That all staff receive training in the prevention of fire and following consultation with the relevant authority draw up a fire risk assessment. (This was a previous requirement 31.07.06 not met) 30/12/06 30/11/06 20/12/06 30/11/06 30/11/06 The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP2 OP9 OP15 OP16 OP18 OP16 OP37 OP24 OP28 Good Practice Recommendations That the current length of a trial period offered to residents admitted to the home is included in the statement of terms and conditions. That handwritten prescriptions on MAR charts be checked and double signed by two registered nurses. That there is evidence that fresh fruit is available for service users in line with the nutritional policy currently in place at the home. That a confidential central file be kept of all complaints and documentation relating to them. That policies relating to complaints and protection of the vulnerable adult are updated to reflect current practice That all policies and procedures are reviewed and amended to reflect current practice. That records and risk assessments are kept of those service users who have keys to their lockable drawers or doors. That a programme of training for National Vocational Qualification level 2 in care is introduced to facilitate meeting the requirements of National Minimum Standard 28 6 7 The Adelaide Nursing Home DS0000065729.V316968.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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