Inspection on 05/01/07 for The Close Nursing & Residential Home

This inspection was carried out on 5th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Close Nursing & Residential... 28/01/09

The Close Nursing & Residential... 28/01/08

The Close Nursing & Residential... 27/01/06

The Close Nursing & Residential... 08/09/05

The Close Nursing & Residential... 22/11/04

The Close Nursing & Residential... 29/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP Lead Inspector Delia Styles Unannounced Inspection 5th and 8th January 2007 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 Close Nursing & Residential Home DS0000027175.V322829.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 Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Close Nursing & Residential Home Address Burcot Abingdon Oxfordshire OX14 3DP 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) 01865 407343 01865 407734 closenhome@aol.com Cavendish Close Limited Mrs Nyembezi Sithole Care Home 97 Category(ies) of Old age, not falling within any other category registration, with number (97) of places The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The continuing use of beds for service users with nursing needs in the remaining original building (formerly St Michaels and St Paul’s wings) is subject to review in 12 months from the date of this registration. 01 August 2006. 27th January 2006 Date of last inspection Brief Description of the Service: The Close was originally a Tudor-style Victorian country house with two single storey wings, situated close to the market town of Abingdon and approximately 6 miles south of the city of Oxford. The home is set in 4 acres of grounds with access to the banks of the river Thames. An extensive new building project has replaced outdated and unsuitable facilities. The first phase of this project, Riverview, was completed in August 2005 and comprises a purpose-built two-storey building, with 20 en-suite bedrooms, offices, and new kitchen and laundry facilities serving the whole site. The second phase of building was completed in 2006, and involved the demolition of the original 2-storey house to create ‘The Willows’ unit, with 31 single en-suite rooms on two floors. The remaining older part of the home – renamed the ‘Waterside’ unit, has accommodation for a further 46 residents in single and shared rooms. The range of fees is from £409 to £850 per week. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’. A key inspection is one in which those National Minimum Care Standards (in this case, for older people) that the Commission considers to be the most important to residents’ well-being, are assessed. The inspector arrived at the service at 10 am on the first day, a Friday, and arranged with the manager, Ms Sithole, to return to complete the inspection and give feedback to her and the proprietor, Mr Halton, on the following Monday. The inspector spent a total of 8 hours in the home. The inspection was a thorough look at how well the service is doing. It took into account any information that CSCI has received about the service since the last inspection. The pre-inspection questionnaire (PIQ)sent to the home in early November had not been completed and returned to CSCI so it was not possible to send out questionnaires to health and social care professionals who regularly visit residents in the home to get their views about the home. During the inspection the inspector spoke to a number of residents, visitors and staff. A total of 10 completed residents’ questionnaires – ‘Have your say about The Close’ – were received before this visit. A tour of the home was undertaken and the inspector joined residents for lunch in Riverside unit. A sample of residents’ care plans and records, medication records and staff recruitment files was looked at. The inspector looked at how well the home was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector would like to thank all the residents, visitors and staff for their time and help during the inspection. What the service does well: The home is kept very clean and attractively decorated. Staff are welcoming and friendly. The grounds and gardens are well maintained and attractive. The new purpose-built parts of the home – Riverview and The Willows – provide spacious and well-equipped rooms and communal lounges and dining areas for residents. The home is well managed by the registered manager who communicates well with residents, visitors and staff. Although this is a large home, there is a sense of community and residents are treated with respect and as individuals by staff. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There has been a marked improvement in the standard of records of residents’ care, but more attention is needed to the way in which residents’ nutritional, psychological and social needs are recorded, and how well the home is doing in meeting these aspects of residents’ lives. The care plans should be drawn up with the resident and agreed and signed by them (if they are able) and/or their representative. This will help the staff to provide care that matches the residents’ assessed needs in ways that suit them, as far as possible. Generally, the records of resident’s medication were up to date and complete. But there were some Medicine Administration Record (MAR) charts that had handwritten alterations made by nurses, on the doctor’s instruction. If nurses take a verbal instruction from the doctor about changes he or she wants to be made in residents’ prescribed medicines and then the nurse handwrites the changes, it is best practice to have the doctor check and countersign the MAR charts as soon as possible, or to have a second nurse to check and countersign them. This reduces the risk of residents receiving the wrong dose or medicine. Unused or unwanted medicines must be safely disposed of by the home and should not return waste medication to the community pharmacy. In order to comply with legislation that came into force in April 2005, care homes with The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 7 nursing must make arrangements for waste medication to be collected and disposed of through a licensed waste disposal company and keep records of all transactions. Where residents are in shared rooms, the home should regularly check with residents and their families and representatives that this arrangement suits both residents and that when a shared place becomes vacant, the remaining resident is given the opportunity not to share by moving to a different room if necessary. The problems with privacy and space for residents in shared rooms and one lounge area in the older part of the home, ‘Waterside’, should be addressed: the proprietor should implement the changes that he has in mind to provide more spacious sitting and dining space for residents and reduce the occupancy of shared rooms if possible. This will better meet the needs of residents who are more dependent on staff help and who need to use wheelchairs and walking aids to get around in the home. Staffing numbers should be reviewed and increased to consistently meet the care needs of residents. The inspector observed an instance of poor staff practice as a resident was transferred from an armchair to a wheelchair. Staff should ensure that they use the correct moving and handling techniques and equipment when assisting residents, to reduce the risk of injury to residents and themselves. The correct moving and handling instructions for care staff to use should be included in each resident’s care plan (if they need staff assistance). On the first day of the inspection, a boiler had broken down, affecting the central heating and hot water system in the older part of the home and several rooms and the lounges had electric convector or oiled filled heaters to keep residents warm. Several of these were very hot to the touch and are a danger to residents if they touch or fall against them. If free-standing electric heaters need to be used in an emergency, these should be of a type that are stable and not likely to be knocked over, and have low surface temperatures, so that residents are not at risk of accidents or burns from contact with them. 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 Close Nursing & Residential Home DS0000027175.V322829.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 Close Nursing & Residential Home DS0000027175.V322829.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 & 3. Standard 6 is not applicable because the home does not provide intermediate care. Quality in this outcome area is adequate. People who come to live in this home have good information about the home in order to make an informed decision about whether the home is likely to meet their needs. The individual needs assessments need further development so that people’s diverse needs are identified and planned for before they move in to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a new colour brochure and updated the Statement of Purpose and Service Users Guide since the completion of the Riverside and Willows new buildings. The written information available for prospective residents and their families is sufficient for people to make an informed choice about the home. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 10 The majority of questionnaire respondents (CSCI) said that they had received a contract and had enough information about the home before deciding to live here. However, some residents’ comment cards indicated that in reality, their choice was driven by the fact that NHS facilities were pressing for their relative to be discharged:’ We did not have much time to look for a nursing home because X hospital wanted the bed. We did like the look of it, but on reflection you cannot really tell how good or bad a home is, until you have lived there’. Almost all of the residents’ questionnaires had been completed with the help of a relative. One person said ‘Tried it and decided to stay (only vacancy at the time)’. Another person’s choice had been made in anticipation of a relative coming to live at The Close. The home’s own quality questionnaire responses (October 2006), based on 52.8 completed of a total of 70 questionnaires, showed that 94 of people felt that they had sufficient information about the care facilities and the running of the home. All residents have a ‘trial’ four-week stay to see if the home meets their expectations. The home’s manager or her deputy assesses all prospective residents’ care needs. The inspector looked at a sample of 4 residents’ pre-admission assessments. There were omissions in the written assessments for 3 of the four sampled records: for example, there was no date or signature by the assessing nurse and/or their representative for someone admitted in November 2006; there was no moving and handling risk assessment or nutritional risk assessment and inadequate wound care assessment for a resident admitted in December 2006. The Close Nursing & Residential Home DS0000027175.V322829.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 adequate. The standard of records kept about residents’ care and treatment has improved since the last inspection though there is still a need to include more information about certain aspects of care and to provide written evaluation to show to what extent care has met the residents’ assessed needs. The health needs of residents are met and referrals are made for specialist medical and nursing assessment and treatment if necessary. The home must comply with current legislation that requires that any unwanted medicines are collected and disposed of through a licensed waste collection service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of 5 residents care plans was examined. The standard of record keeping has improved since the last inspection, with more evidence of regular review and updating of care plans. However, there were omissions or lack of clear instructions about how a specific aspect of care was to be carried out, and/or the effectiveness of the The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 12 interventions, in each of the plans looked at. For example, one resident had no moving and handling risk assessment or nutritional risk assessment; there was no date on the assessment of this person’s wound and the update of wound care was written in the daily record not continued on the wound assessment chart. This indicates that staff may not have accurate assessment information on which to base their evaluation of whether the person’s condition or care needs have improved since admission. Nutritional risk assessments are incomplete and there is insufficient written information for staff to follow about how to improve the nutrition for those assessed as ‘at risk’. A resident whose most recent nutritional assessment was done in July 2006 was considered to be at risk of losing weight. Their body mass index (BMI) had not been calculated and monthly weight records showed that they had lost more than 10 Kilograms in a 5-month period. The care plan indicated that they should have prescribed meal supplement drinks every day but the care records did not show whether this was the case. The senior nurse for the unit where the resident lives said that in fact s/he was now eating much better. The assessment for another resident who had been admitted 2 months prior to the inspection, had not been dated and signed by the nurse who had undertaken the assessment, or by their relative or representative (the resident has dementia and is unable to contribute information for their care plans). There is little information about residents’ social and psychological care needs in the care plans, or about how these will be met. These are important aspects of care, especially for those residents with short-term memory loss and confusion. Residents’ questionnaire responses about whether the home provides activities that they can join in showed that more than 50 ‘never’ or only ‘sometimes’ could do so, because they are ‘bedridden’. It is not clear how the social and recreational needs of the more physically or mentally impaired residents are addressed. As was the case at previous inspections, individual staff members when asked about residents’ needs and care were knowledgeable about them. The standard of written care records should match that of the practical care. It is important that residents’ care plans set out in detail the actions that care staff need to take to ensure that all aspects of the health, personal and social care of the resident are met. Plans should be drawn up with the involvement of the resident, written in a way that the resident can understand, and agreed and signed by resident (whenever capable) and/or their representative (if any). Some residents comment cards indicated occasional difficulty with getting concerns or queries acted on by staff; one complained that the staff did not ‘pick up on’ a resident’s illness quickly enough (someone who is prone to repeated minor infections); another felt that staff do listen to their concerns but that often they were not followed through but ‘its not always the staffs The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 13 fault. They are often short staffed with agency staff not knowing what’s going on’. A third person wrote that ‘staff do listen but the requests/agreements do not always get through to the rest of the staff’. A visiting health care professional told the inspector that they considered that the home provides good standard of care and there was a good team of nurses and care staff. There is evidence that specialist equipment needed by residents, for example pressure relieving mattresses and seat cushions, is available. Doctors from the local Berinsfield Medical Centre provide medical care for residents: a GP visits routinely twice a week and additional urgent calls are made to see residents if necessary. The home has computer broadband connection so that the visiting doctors are able to access and update residents’ medical records on-line and amend prescription orders with the pharmacist, so that residents’ current health status, and treatment can be more effectively assessed by the GPs. The inspector looked at the Medication Administration Record (MAR) charts for a random sample of residents in Willows and Waterside (St Michaels) wings. The home uses the ‘monitored dosage’ system of medication – residents’ tablets/capsules are put into individual cassettes with doses for each day for a week. These are dispensed from the local Berinsfield doctors’ surgery. The inspector learned that any unwanted or unused medicines are returned to the surgery. This practice contravenes legislation that requires that care homes providing nursing must have an appropriate waste transfer and disposal licence from the environment agency. The inspector made a requirement for the home to comply with current legislation for the safe disposal of medicines. The sample of MAR sheets seen by the inspector was up to date and correctly completed. Some did not have a photograph of the resident attached – a good practice recommendation to ensure that staff can identify the correct resident when giving out medicines – but staff explained that the photos have been taken and will be developed shortly. Several MAR sheets had hand-written additions where the doctor has asked the nurses to alter or add a new medication to the computer printed MAR sheet in advance of it being re-printed at the surgery. A number of the handwritten entries were not signed by the nurse writing the amendment and had not been countersigned by the doctor or a second nurse. The inspector recommends that staff follow best practice guidance for medication records: where a verbal instruction is given by a doctor to alter a prescribed medication, the nurse receiving the message should request that the prescribing doctor checks and countersigns the MAR chart in person as soon as possible. If not, a second nurse should check and countersign the first nurse’s handwritten amendments. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 14 This is an additional safeguard to reduce the risk of mistakes, and residents receiving the wrong dosage or medication. The new buildings provide spacious single rooms for residents, each with ensuite toilets and washbasins. The room sizes and the layout of the communal rooms in the older parts of the home (formerly St Michaels and St Paul’s wings – now ‘Waterside’) make it more difficult for staff to ensure that residents’ privacy and dignity are always protected. For example, one lounge area is a long narrow room and residents’ armchairs have to be arranged around the edge of the room, leaving little space between. Residents who need help at mealtimes and/or who have to be moved with the aid of a hoist, cannot be assisted by staff in a way that best protects their dignity in this confined space. A visitor requested that staff transfer her relative to a wheelchair so that they could go to the larger lounge and have a more private space for conversation (this happens each time she visits). The proprietor, Mr Halton, said he is planning to alter the use of the communal spaces in Waterside so that residents have a larger dining room and sitting areas that will give residents more personal ‘space’. There is much more cultural and racial diversity amongst the staff group compared with the residents - almost all residents are of white British racial and ethnic origin. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 15 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. There is a good range of activities within the home for more able residents, but the needs of those people who have significant physical and/or memory problems are not so well catered for so that not all residents have the opportunity to participate in stimulating and motivating activities. Meals and mealtimes are generally an enjoyable social occasion for residents. The manager and proprietor show a good understanding of areas of weakness and have used residents and their families’ feedback in plans to make improvements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a part-time activities organiser who works 30 hours a week, Monday to Friday from 11.00 am to 5 pm. The Statement of Purpose states that an additional activities co-ordinator will work from 2 pm to 5pm on weekdays, though this post appears to be vacant currently. The activities organiser was unwell on the first day of the inspection and several residents commented that they missed her and having the planned activity for that afternoon (a Christmas quiz). Residents’ questionnaire responses show that there is a mixed opinion about whether the home The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 16 provides activities that they can join in with: only 2 of the 10 respondents felt that there were always suitable activities for them; 5 responses indicated that those residents who were ‘bedridden’ could not join in the activities. One person wrote that they would like (their relative) to have more opportunity to go outside in the fresh air more often. The home’s own questionnaire analysis (October 2006) showed that from 37 responses, 22 felt that the lifestyle and activities in the home were ‘very good’; 27 rated them ‘good’ and 19 ‘OK’ (32 made no comment). The additional suggestions were that there should be more trips outside the home and more exercise for residents, for example a music and movement class. Planned activities and entertainments were well advertised in the reception area and on notice boards in each unit. Three volunteer workers come to the home regularly (weekly or fortnightly) to play board games with residents, entertain with guitar playing, and to lead a religious service (monthly). A Church of England minister attends the home every month and the Roman Catholic priest and representatives of other Christian denominations visit the home to lead regular services. Residents were mainly sitting watching TV, reading or sleeping after lunch. One told the inspector she would like more to do, as she had been used to a very active life. During the afternoon in Waterside a group of residents and their relatives gathered around the table for tea and a chat. In the inspector’s opinion, this large home, (which, when full has 97 residents accommodated in separate buildings) needs more staff dedicated to the social and recreational care needs of residents including evenings and weekends. The activities organiser achieves a commendable amount of work with residents, and care staff are involved if they have sufficient time. However, the social needs and abilities of residents with increased physical and memory problems need individual assessment and ‘ad hoc’ opportunities for meaningful and enjoyable pastimes. Visitors evidently feel ‘at home’ and were welcomed by staff. Both the CSCI comment cards and the home’s own questionnaire analysis confirmed that visitors always feel welcome – ‘staff are always smiling, welcoming and cheerful’. Residents’ spoken and written comments about the food and mealtimes in the home were generally very positive; 8 of the 10 comment cards said that residents ‘always’ or ‘usually’ liked the meals. One person said that sometimes meals were cold. The home’s own questionnaire analysis (October 2006) showed similar results, with more than 50 of the responses stating the food and menus were ‘very good’ or ‘good’; 30 felt they were ‘OK’ and 16 did not respond. Additional The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 17 comments were that more fresh food could be used – ‘vegetables, salad, fruit and soups’. The chef manager is meeting with residents again to discuss their likes and dislikes before preparing a new monthly menu cycle. The inspector joined residents for lunch in Riverside and coffee after lunch with residents in the Willows. Meals are freshly prepared in the new purpose-built kitchen in Riverside and transported in heated trolleys to each unit. Food was piping hot at the point of service. There was tomato soup and fresh bread rolls, followed by fish and chips and mushy peas, and rice pudding with jam for dessert. Food was nicely presented and staff were available to discreetly assist/help residents if needed. Residents confirmed that they could have an alternative if they did not like the listed menu choice. Everyone said they enjoyed their meal. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is adequate. The home has a satisfactory complaints system and there is evidence that generally residents and their visitors feel that their views are listened to and acted upon. However, the home’s formal processes need to be further developed so that its procedures are consistently applied. The home’s induction and training programme for staff about adult safeguarding issues help staff to identify and protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has updated its Statement of Purpose and Service User Guide since the last inspection and these include information about how to complain. Residents comment cards showed that residents and their families were confident about who to speak to if they had any concerns about their care, and how to make a formal complaint if necessary. The manager and other senior staff are readily available to residents and their visitors and both written and what residents told the inspector during the inspection confirmed this. Formal review meetings are held with care managers and social workers, residents and their representatives (for residents whose fees are paid in part by Social Services) to discuss the resident’s care and any concerns. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 19 Residents and relatives meetings are held in the home every 3 months that give further opportunities for people to raise any concerns or complaints. The Commission received information in November 2006 concerning one complaint made against the service since the last inspection. The complaint was referred to the provider to investigate. The manager described the circumstances that gave rise to the complaint, her investigation into staff actions at the time and the home’s amended procedures as a result, to the inspector at the time of the inspection. The home’s written response to the complainant was not made until early February 2007 which indicates to the inspector that the home’s response to the complainant did not meet the home’s own timescales for the investigation and correspondence about the outcome to complainants. All new staff have training about how to spot potential abuse of residents and all staff have mandatory updates in adult safeguarding matters. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 20 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, 23 and 26. Quality in this outcome area is good. The standard of cleanliness is excellent and the décor and furnishings, especially in the new buildings, provide residents with very comfortable and attractive accommodation. The programme of redecoration and refurbishment in the older part of the home has improved the environment for residents living here. The manager and proprietor have a good understanding of the shortfalls in standards because of the physical limitations of the older building and its layout and planned improvements should result in better outcomes for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new purpose built wings – Riverview and The Willows – completed in 2005 and 2006 respectively, provide a high standard of accommodation for residents in single en-suite rooms. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 21 A programme of refurbishment in the existing older part of the home – Waterside – has improved the appearance of communal rooms and corridors and residents’ own rooms considerably. New colour schemes, carpeting and soft furnishing, and replacement of old and worn-out furniture have created a fresh and lighter environment for residents. There are more plans to improve and re-equip the hairdressing area in Waterside. The home’s own quality questionnaire responses for October 2006 showed that relatives wanted improvements made to the paved, sloped areas outside Waterside because they are ‘uneven and dangerous when wet’ and the small patio areas outside some rooms ‘need more maintenance’. However, overall 67 felt that the environment was ‘very good’ or ‘good’ and 27 that it was ‘OK’. There are 15 single en-suite bedrooms in Waterside and 15 double rooms, one with an en-suite. Relatives spoke to the inspector about their concerns in relation to the shared room where the residents who share are ‘not getting on’ together and one person in particular is having disturbed nights. The manager has been asked about the possibility of moving one resident into a single room, but was told there is not currently a vacancy. When the inspector looked at the care records for the residents who are sharing, there was no reference to the changed situation or dissatisfaction of one of the two parties. The National Minimum Standards (NMS) for Care Homes for Older People state that ‘where rooms are shared, they are occupied by no more than two service users who have made a positive choice to share with each other. When a shared place becomes vacant, the remaining service user has the opportunity to choose not to share, by moving into a different room if necessary’. The inspector discussed the relatives’ concerns with the manager and proprietor who have agreed to review the accommodation arrangements for both residents. The inspector recommends that residents in shared rooms should be regularly reviewed in relation to their care needs and their opinion sought about their continued satisfaction or otherwise, with sharing accommodation: this should be documented and any requests for changes to residents’ living arrangements should be addressed as quickly as possible. The Close Nursing & Residential Home DS0000027175.V322829.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. The home is showing improvement and the management team has plans to improve staffing and training. This capacity to improve should ensure better outcomes for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s own assessment of residents’ needs and the calculations (based on national guidance) of staff hours needed to meet their needs, showed that there was a slight shortfall in the staff hours available. At the time of the inspection, the inspector checked the numbers of staff working in each unit, and this matched the minimum agreed levels set out in the home’s Statement of Purpose. Staffing numbers and skill mix appeared to meet the care needs of the residents at this time, and residents looked well cared for and comfortable. The manager confirmed that there has been a drop in staffing numbers partly due to staff turnover and sickness (20 staff have left in the past 12 months). The deputy manager was also on leave. Residents’ comment cards showed that staff shortages have a negative impact on residents’ care: 3 respondents felt that they ‘always’ had care and support from staff; 6 that this was ‘usually’ the case and 1 ‘sometimes’. There were The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 23 similar responses to questions about staff availability with additional comments such as ‘I usually go looking for someone if no one is around. But mostly if carers are not there, the nurse is’; ‘sometimes have to wait over 10 minutes when the bell is rung’; ‘depends on how busy they are. Overall they try hard’. One person’s additional comment was ‘very short of staff and this shows in the quality of the care that is given’. However, recruitment was ongoing through a recruitment agency and the manager was confident that the complement of staff would be increased. The home uses agency care staff to fill vacant shifts at the moment (40 shifts had included agency staff in the past 8 weeks). One agency supplies carers to the home, so that the agency staff get to know residents and work with the home’s own staff on a regular basis to minimise any disruption to residents’ usual care routines. The proprietor is committed to increasing kitchen and care staff numbers as the number of residents admitted to the new Willows unit increases. The number of care staff who have achieved National Vocational Qualification in Care at Level 2 or above has increased since the last inspection so that 62 of carers now have this qualification. This exceeds the target of 50 of trained staff set by the Commission. The home is part of a group owned by the proprietor and benefits from having a training consultant who organises in-house training for staff. The manager said that there had been some lapses in the staff training programme due to staff sickness. Staff mandatory training for example, health and safety, fire safety, adult safeguarding and moving and handling, are included in a matrix timetable, so that it is clear when each staff member has received training and requires annual update or refresher sessions. Future training sessions planned include end of life care, dementia awareness and First Aid. The inspector spoke to care staff who have recently started work in the home. They confirmed that they had had induction training covering all the required topics that enable them to care for residents safely. The inspector looked at a sample of three staff members’ recruitment and training files. The home has a satisfactory recruitment procedure that ensures that the appropriate checks and references are obtained so that people who are unsuitable to work with vulnerable older people are not employed. The Close Nursing & Residential Home DS0000027175.V322829.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, 33, 35 and 38. Quality in this outcome area is adequate. The management of this home provides a good standard of leadership. Residents and their families and representatives’ views are sought and taken account of, by the management team through the quality assurance systems in place. Further work should be undertaken to ensure that staff consistently follow health and safety guidance and practices to protect residents from accidents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ms Sithole has considerable experience of working in and managing care homes for older people. She has worked at The Close for four years and became the registered manager in 2004. She has academic qualifications in higher education (nursing) and a BA degree in Health Service Management. She is currently undertaking the Registered Manager’s Award and hopes to The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 25 complete the course this year to achieve this required qualification and meet the Commission’s standard for all registered managers. There are regular quarterly residents meetings and the proprietor sends out quality questionnaires to relatives every 6 months to get feedback from residents and their visitors about the services provided in the home. The proprietor has submitted a business and development plan for the home. The proprietor undertakes regular monthly ‘registered provider visits’ (required under Regulation 26 of the Care Standards Act and Regulations) to ‘spot check’ residents’ staff and visitors’ opinions of the home and facilities; the inspector saw the written reports of 3 such recent visits. The inspector looked at the arrangements in place for safekeeping residents’ personal finances and considered this to be well organised with a clear accounting system. The home’s administrator said that only one resident’s personal money is kept by the home, with a further 2 residents’ personal allowances managed through Social Services money management service. All the remaining current residents have relatives or representatives who deal with residents’ finances on their behalf. The inspector looked at a sample of accident records and fire safety log book and found these to be correctly completed, showing that routine safety checks (for the fire equipment and alarm systems) were up to date. The home’s policies and procedures are comprehensive and are reviewed at least annually. There are copies of these in each nurse’s station and the managers’ office. The inspector saw two staff members using an underarm lifting technique to transfer a resident from an armchair to a wheelchair. This is a ‘banned’ lifting technique because of the potential damage to the resident’s shoulders if they cannot support their own weight. When the inspector discussed with staff the way that they had carried out this manoeuvre, they said that the resident could usually stand and take her own weight. However, his/her visitor said that hospital staff had always used a ‘turntable’ (a device that goes under the resident’s feet before they stand and allows them to turn without taking steps) to assist her relative, but this method has not been continued since their admission to The Close. One resident’s comment card raised a concern about the use of hoists: ’I think carers could be a bit more careful with residents – knocking toes, legs etc’. The inspector considers that safe moving and handling training and practices for staff should be reviewed to make sure that all staff consistently use the recommended techniques and equipment that minimise the risk of injury to residents and themselves. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 26 On the day of the inspection, a boiler had broken down, affecting the central heating and hot water system in the older part of the home. (Though the boiler is newly installed, there have been several recent faults affecting the heating and hot water supply over the Christmas and New Year period, the inspector was informed). Staff had put electric convector or oiled filled heaters to keep residents warm in the two larger lounge rooms and some bedrooms. Several of these heaters were very hot to the touch (ranging from 60 - 100ºC on the inspector’s probe thermometer) and are a danger to residents if they touch or fall against them. If free-standing electric heaters need to be used in an emergency, these should be of a type that are stable and not likely to be knocked over, and have low surface temperatures, so that residents are not at risk of accidents or burns from contact with them. This recommendation was made at the last inspection, when additional heating was in use during building construction work. A specialist engineer had rectified the boiler problem by the time the inspector left the building. The maintenance man checked that room heaters were safely positioned and protected and/or turned off as soon as the central heating was working again. The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X 2 X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 16/03/07 The home must provide evidence that waste medication is Environment disposed of legally through a Agency licensed waste disposal agency. 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. Refer to Standard OP7 Good Practice Recommendations * Maintain and further improve the standard of record keeping in residents care plans with more detail about moving and handling, wound care, nutritional needs and evaluation of care. * Consider implementing the M.U.S.T or a similar evidence-based nutritional assessment tool. * Develop the assessment and care plans in relation to residents social and recreational needs. The above recommendations were also made at previous inspections. * Care plans should be drawn up with the involvement of the resident or their representative and agree and signed by the resident whenever capable and/or representative (if any). DS0000027175.V322829.R01.S.doc Version 5.2 Page 29 The Close Nursing & Residential Home 2. OP9 3. OP10 4. OP23 5. OP27 6. OP38 If nurses make hand-written amendments to residents’ Medicine Administration Records (MAR) on a doctor’s verbal instructions, these should be checked and countersigned by the doctor as soon as possible. If not, a second nurse should check and countersign the first nurse’s entry. Improve the layout of seating in the communal lounge areas allowing more space for residents receiving visitors, and carers assisting residents, to improve residents’ privacy and dignity in communal areas in the older part of the home. Where residents share a room, the home should review and document the individuals’ continued satisfaction with the arrangement. When a shared place becomes vacant, the remaining resident should be given the opportunity not to share, by moving to a different room if necessary. Review the staffing numbers and skill mix of staff employed by the home to ensure that there are always sufficient, appropriately skilled staff to meet residents care needs. Undertake a risk assessment for the any temporary use of free-standing room heaters and take action to protect residents and visitors from accidental burns from unguarded heater surfaces and trip hazards from trailing flexes. This recommendation was also made at the last inspection in January 2006 The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Close Nursing & Residential Home DS0000027175.V322829.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!