Inspection on 29/06/07 for The Crown Nursing Home

This inspection was carried out on 29th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Crown Nursing Home 03/02/09

The Crown Nursing Home 21/05/08

The Crown Nursing Home 26/11/07

The Crown Nursing Home 27/04/06

The Crown Nursing Home 08/12/05

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 Crown Nursing Home High Street Harwell Didcot Oxfordshire OX11 0EX Lead Inspector Marie Carvell Unannounced Inspection 29th June 2007 10:15 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 Crown Nursing Home DS0000065924.V338648.R02.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 Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Crown Nursing Home Address High Street Harwell Didcot Oxfordshire OX11 0EX 01235 820010 01235 834050 thecrown@schealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trinity Care (Crown) Limited Mrs May Sancio Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (0) of places The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 16. Date of last inspection 27th April 2006 Brief Description of the Service: The Crown Nursing Home is a purpose built home located in the village of Harwell, Oxfordshire, close to local shops and amenities. The home is part of the Southern Cross group of homes. The Crown is home to 16 older people who require nursing care. The accommodation is on two floors and all the rooms have en-suite facilities, but only three have a bath. There is a lift to provide access to the first floor. Twelve of the rooms overlook the garden and some have a small balcony. The garden, which is largely paved, was designed to be easily accessible for wheelchair users. The current scales of charges as at June 2007 are between £580.00 and £778.00 per week. Service users pay for hairdressing, chiropody (none diabetic service users), newspapers, toiletries and taxi fares. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘key Inspection’. The inspector arrived at the service at 10.15am and was in the service until 5.15pm. It was a thorough look at how well the service was doing, and took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. Two service users, relatives of three service users and one General Practitioner responded to surveys that the Commission had sent out. In addition two relatives contacted the inspector by telephone. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. Time was spent with many of the service users, four visitors and staff on duty, a tour of the premises was carried out and a sample of records required to be kept in the home were examined, including the case tracking of three service user’s files. The registered manager is currently on maternity leave and arrangements had been made for the manager of another home to attend at the time of the inspector to give access to personnel files. Although the manager attended and access was given to the inspector to personnel records, the manager was not familiar with the home or the whereabouts of some of the home’s records. The information received prior to the inspection Annual Quality Assurance Assessment (AQAA) completed by the manager before the start of her maternity leave, did not reflect the inspectors findings during this inspection. At the last inspection undertaken two requirements and two good practice recommendations were made, these are referred to in the body of the report. Brief feedback was given to the nurse on duty at the end of the visit inspection. What the service does well: The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 6 From discussion with service users, staff on duty and relatives, most felt that the physical care needs of the service users were being met. The medical needs of service users are met by several GP practices. One survey completed by a GP stated that he/she felt that the individual health care needs of service users are met. Staff on duty were observed to interact with service users in a respectful and appropriate manner. Some service users said that although staff were always very busy, most staff were kind and helpful. Several service users have friends and relatives who are able to visit on a regular basis. Relatives spoken to confirmed that they are always made welcome by the staff on duty. The cook always bakes a cake to celebrate birthdays and on the day of inspection, one service user was celebrating her birthday. Birthday cake was served with afternoon tea, with staff and visitors to the home singing happy birthday. What has improved since the last inspection? What they could do better: Records of three service users were case tracked. There was little evidence that the service user/advocate is involved in the care planning process. Not all care plans were signed and dated. Care plans were not in sufficient detail to ensure that all staff are familiar with the care needs of each service user, when care is to be provided or how. Care plans made no reference to cross gender care preferences, psychological health, nutritional screening or end of life care. Entries made in daily contact sheets did not consistently validate information recorded in care plans. The inspector was advised that several female service users were frequently distressed as male staff provided their personal care. At the last inspection a good practice recommendation was made that the manager should contact the supplying pharmacist to discuss how best to manage the medication administration system used in the home. The nurse on duty was unaware of this recommendation and whether any action had been taken. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 7 Information about hobbies and interests are not recorded in service user records, the home does not employ an activity organiser. Comments made by service users and relatives verbally and recorded on surveys included: ‘ Even during the warmer weather service users are not able to sit in the enclosed, paved garden. The reasons given are always because of insufficient staff on duty’; ‘ I just sit here everyday, there is no one to talk to, the television is always on but not all of us are able to see it’; ‘ There are never any activities arranged by the home that I can take part in’; ‘There are no activities as far as I can tell. They just sit and watch television all day. Sometimes one or two people come in from the church and talk to them’; ‘ There is absolutely nothing to stimulate the residents. I watch some of them becoming utterly bored’; ‘The staff don’t have the time, they are understaffed’; ‘ I feel that there is a lack of understanding of how a person with Dementia mind works, they (the staff team) do not seem to grasp that there will be repetitive questions all day long. I also feel that they do not fully appreciate that because a resident may be in their 80’s or 90’s they do not want to have to sit on a chair all day’; ‘ At one time residents would be taken for a walk to the shop for a newspaper and residents were offered hand massage, but not any more’. Several relatives said that they had spoken to the manager and senior managers about the lack of activities and stimulation in the home and although it is always agreed that this needs to be addressed, nothing happens. Several service users and relatives commented on the lack of control over their daily lives and examples given included: ‘ I get anxious at shift change over in the evening because I can’t see anyone sometimes to take me to bed’ ‘ I am concerned about the evening shift change over, there is no carer around sometimes and X gets very agitated. The carers seem to be doing other jobs and don’t have time to tend to the needs of the residents and staff seem to be tired at the end of the shift’. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 8 Relatives and service users expressed concerns that the routine in the home is task lead and at times, especially in the evenings there is no staff member present, as the lounge does not have a call alarm system service users have to shout for help. Relatives have on occasions had to intervene or go upstairs to the office to ask the nurse to assist. One service user said that he/she has to wait so long to be taken to the toilet, that by the time staff are available it is too late. Some service users would benefit from being provided with aids, such as plate guards to assist with eating in a more dignified manner. The two care assistants were trying very hard to assist eight service users with their meals. Consideration should be given to introducing “protected mealtimes” in the home, which means that the nurse is able to be present in the dining room observing meals being served and ensuring that all service users are assisted as necessary, rather than carrying out other tasks such as medication administration. Not all service users ate their meal and the inspector asked the nurse to assist one service user. It was not evidenced how the food intake of service users is monitored as no records are maintained. This was discussed with the nurse on duty, who agreed that this needs to be addressed as service users could be missing meals and could go hungry. During the afternoon, one service user asked the inspector for something to eat, as he/she was hungry. Staff on duty were unaware whether the service user had eaten breakfast or lunch. The inspector had been advised that all staff have received training in protecting vulnerable adults from abuse and the homes whistle blowing policy. During the inspection information was received by the inspector, about a possible safeguarding adults issue, which needed to be referred to Social Services under Safeguarding Adult procedures. The nurse on duty was unfamiliar with the process as was the manager of another home, who had assisted earlier on in the inspection. The inspector explained the process of the referral and action to be considered. This is being addressed outside this inspection report. Adaptations and equipment are provided. However it was noted that the lounge/dining area does not have call alarm system installed and as already mentioned in the report puts the safety of service users at risk when there is no staff presence. Some areas of the home would benefit from a deep clean, some carpets and armchairs were badly stained, one bathroom smelled unpleasantly of dampness, caused by a leak from the bath seal and several bedrooms smelled of stale urine, some tables used by service users were sticky. It was not evident when the housekeeper undertakes cleaning in the home as this was not evidenced or recorded. From discussion with staff on duty, examination of the duty rosters and observation of the home’s routine and care practices, staffing levels and deployment are stretched to meet the physical, social and emotional needs of The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 9 the service users. At the time of this inspection the home was caring for thirteen service users. No members of staff have been provided with health and safety training, not all staff have received basis food hygiene training although involved with food preparation, bank care assistants have not received training in POVA, none of the staff team have received training in Infection control and one part time member of staff, has not received any training. At the last inspection a requirement was made that all new members of staff must receive training appropriate to the work that they perform. This requirement has not been complied with. An induction programme in line with Skills for Care is being developed. Communication systems in the home are poor, it is not clear that staff handovers take place with care staff at the beginning of each shift. Staff meetings take place infrequency and minutes of a staff meeting held in May 2007 was seen. The inspector gained the impression that staff morale was generally poor in the home. Satisfactory management arrangements have not been put into place, during the manager’s absence. The inspector was informed that the operations manager visited on a Monday and Friday. At the time of this inspection, the operations manager was on leave. The nursing staff had been told to contact the manager of one of the Oxford homes, if an inspection took place, unfortunately this information had not been share with the manager of the particular home. The nurse on duty tried very hard to be as helpful as possible, but he was unaware of some of the home’s policies and procedures and the homes out of hours management arrangements. Staff do not receive formal supervision at least six times per year. A file containing supervision records is kept in the office, and can be viewed by anyone. Only supervision records of four staff were available, and showed that one member of staff had received supervision in November 2006 and the others not since September 2006, this was confirmed by staff on duty. Reports on the conduct of the home written by a provider representative, following an unannounced visit to the home each month are not carried out. Since October 2006 only two reports were available, the last report dated February 2007. The home’s policies and procedures are in place, although are of little use if the staff do not have a working knowledge of their contents. Not all records relating to fire, health and safety were available, the inspector was advised that these may have been with the maintenance person who does not visit the home daily as he/she works within a group of homes. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 10 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 Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 11 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 Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 12 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): Standards 1 and 3. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is adequate. The home’ s Statement of Purpose needs updating. Pre-admission assessments are adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home’s Statement of Purpose has been amended to refer to Southern Cross as the owners of the home and is displayed in the home’s entrance. The information is inaccurate as it refers to the home’s previous manager and states incorrectly, that the employs an activity organiser. The inspector examined the pre- admission assessment documentation for three service users. One service user recently admitted, had been assessed by a manager of another home, who advised the inspector that she had never The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 13 been to The Crown and was unaware of the facilities and staffing levels. It is unclear how the service user was assured following the assessment that his/her needs could be met. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 14 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): Standards 7,8,9 and 10. Standard 8 was subject to a requirement at the last inspection and standards 8 and 9 were subject to good practice recommendations. Quality in this outcome area is poor. Care plans need to contain sufficient information to demonstrate that the needs of the service users are being met. Medication storage, administration and recording were maintained to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records of three service users were case tracked. There was little evidence that the service user/advocate is involved in the care planning process. Not all care plans were signed and dated. Care plans were not in sufficient detail to ensure that all staff are familiar with the care needs of each service user, when care is to be provided or how. Care plans made no reference to cross gender care preferences, psychological health, nutritional screening or end of life care. Entries made in daily contact sheets did not consistently validate information The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 15 recorded in care plans. It was noted that the pre-admission assessment of one service user recently admitted stated that the service user was able to walk with a Zimmer frame and assistance from two carers. The service user was observed to be transported by wheelchair only. At the last inspection, a requirement was made that a record of a nutritional assessment including recorded weight must be kept for all service users. These are in place but the records have not been maintained. The inspector was advised that no service user currently have pressure sores. From discussion with service users, staff on duty and relatives, most felt that the physical care needs of the service users were being met but not emotional or social care needs. Comments made on service user surveys included: ‘I always receive the care and support that I need’; and ‘They wash and dress me, give me my meals, take me to the toilet and give me my pills. That’s about it’. The inspector was advised that several female service users were frequently distressed as male staff provided their personal care. The medical needs of service users are met by several GP practices. One survey completed by a GP stated that he/she felt that the individual health care needs of service users are met. At the last inspection a good practice recommendation was made that the manager should contact the supplying pharmacist to discuss how best to manage the medication administration system used in the home. The nurse on duty was unaware of this recommendation and whether any action had been taken. Medication storage, administration and recording appeared to be satisfactory. The manager was carrying monthly medication audits; these have not been undertaken for several months. Staff on duty were observed to interact with service users in a respectful and appropriate manner. Some service users said that although staff were always very busy, most staff were kind and helpful. Comments received from relatives included service users being ignored when requesting assistant to the toilet, an example was given when a service user was told loudly in the lounge area ‘ I can’t take you to the toilet, eat your tea’, ‘ another service user had been told to ‘be quiet’. Concern was expressed by one relative ‘ I am a bit concerned about one of the nurses because he/she sometimes shouts across the room to tell someone to be careful and he/she tends to stand over service users to talk to them instead of getting down to their level, as they are usually sitting in a chair’. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 16 From discussion with service users and relatives and comments made on service user and relative surveys service users are not always treated with respect. Comments received from service users included: ‘I don’t always understand what they are saying to me’; ‘ There isn’t much to do during the day only the occasional activity and the church give us a visit a couple of times per week’; ‘I have difficulty in expressing myself, because I get my words confused and I don’t always understand what they say and it depends on who is on duty’; ‘Because most of the staff are foreign they don’t say much and I sometimes feel lonely and I don’t always understand what the other residents are saying’. As in many other care homes, there is a wider range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with the nurse on duty, the inspector considers that the home would be able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, there are indications that service users sometimes find that some staff cannot communicate satisfactorily because English is not their first language. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 17 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): Standards 12,13,14 and 15. Quality in this outcome area is poor. Very little evidence is available that the home provides suitable social or recreational opportunities for service users. Service users enjoy the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evidenced during the inspection and confirmed in surveys and discussions with service users, relatives and staff on duty that few activities are provided for service users. The organisation’s brochures states that “Activities are a key part of daily life at Southern Cross Care Centres and assists us in delivering the holistic care that helps service users feel at home”. Information refers to specialist activity organisers in each home, matching hobbies and interests of the service user. Information about hobbies and interests are not recorded in service user records, the home does not employ an activity organiser. Comments made by service users and relatives verbally and recorded on surveys included: The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 18 ‘Even during the warmer weather service users are not able to sit in the enclosed, paved garden. The reasons given are always because of insufficient staff on duty’; ‘ I just sit here everyday, there is no one to talk to, the television is always on but not all of us are able to see it’; ‘ There are never any activities arranged by the home that I can take part in’; ‘There are no activities as far as I can tell. They just sit and watch television all day. Sometimes one or two people come in from the church and talk to them’; ‘ There is absolutely nothing to stimulate the residents. I watch some of them becoming utterly bored’, ‘ The staff don’t have the time, they are understaffed’; ‘ I feel that there is a lack of understanding of how a person with Dementia mind works, they (the staff team) do not seem to grasp that there will be repetitive questions all day long. I also feel that they do not fully appreciate that because a resident may be in their 80’s or 90’s they do not want to have to sit on a chair all day’; ‘ At one time residents would be taken for a walk to the shop for a newspaper and residents were offered hand massage, but not any more’. Several relatives said that they had spoken to the manager and senior managers about the lack of activities and stimulation in the home and although it is always agreed that this needs to be addressed, nothing happens. Service user meetings do not take place and there was no evidence that their views are sought. Information was received from the manager that bi-monthly relative meetings are held. This was not evidenced. Several service users have friends and relatives who are able to visit on a regular basis. Relatives spoken to confirmed that they are always made welcome by the staff on duty. Several service users and relatives commented on the lack of control over their daily lives and examples given included: ‘ I get anxious at shift change over in the evening because I can’t see anyone sometimes to take me to bed’; ‘ I am concerned about the evening shift change over, there is no carer around sometimes and X gets very agitated. The carers seem to be doing The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 19 other jobs and don’t have time to tend to the needs of the residents and staff seem to be tired at the end of the shift’. Relatives and service users expressed concerns that the routine in the home is task lead and at times, especially in the evenings there is no staff present, as the lounge does not have a call alarm system service users have to shout for help. Relatives have on occasions had to intervene or go upstairs to the office to ask the nurse to assist. One service user said that he/she has to wait so long to be taken to the toilet, that by the time staff are available it is too late. Time was spent with the cook on duty and the inspector joined service users for the midday meal. There was a choice of meal and a menu plan for the week was seen, although breakfast and the evening meal was not included, service users confirmed that they always had a choice of lunch, although some service users said that they could never remember what they had ordered and the menu was not displayed in the home. The cook on duty only works until 1.45 pm and prepares as much of the evening meal as possible. If the meal is a cooked meal then one of the two care staff on duty cook the meal. The meal of fish and chips was hot and nicely presented. Some service users would benefit from being provided with aids, such as plate guards to assist with eating in a more dignified manner. The two care assistants were trying very hard to assist eight service users with their meals. Consideration should be given to introducing “protected mealtimes” in the home, which means that the nurse is able to be present in the dining room observing meals being served and ensuring that all service users are assisted as necessary, rather than carrying out other tasks such as medication administration. Not all service users ate their meal and the inspector asked the nurse to assist one service user. It was not evidenced how the food intake of service users is monitored as no records are maintained. This was discussed with the nurse on duty, who agreed that this needs to be addressed as service users could be missing meals and could go hungry. During the afternoon, one service user asked the inspector for something to eat, as he/she was hungry. Staff on duty were unaware whether the service user had eaten breakfast or lunch. The cook always bakes a cake to celebrate birthdays and on the day of inspection, one service user was celebrating her birthday. Birthday cake was served with afternoon tea with staff and visitors to the home singing happy birthday. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 20 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): Standards 16 and 18. Quality in this outcome area is poor. Service users and relatives are not confident that their complaints are listened to. Staff are not familiar with the home’s policies and procedures to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is displayed in the entrance hall. Information received from the home prior to the inspection stated that two complaints had been received by the home in the last twelve months. Information about one complaint was recorded and available for examination by the inspector. Comments made by service users when asked whether they were aware of how to make a complaint included: ‘ I would speak to the carers’; ‘ I don’t know who to talk to because they are mostly foreign and don’t know what I am saying’; and ‘ Usually’. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 21 Comments made by relatives included ‘ I have already complained fairly strongly about the lack of activities to the manager, who has agreed that something needs to be done. Although enthusiastic words. It is action that residents want to see’; ‘ I sent an e-mail to head office, because I am not sure who to talk to at the home. I got a letter within a few days saying that the matter is being looked into, but sometimes I feel that I am being fobbed off’. One relative stated that he/she knew how to make a complaint and complaints were always responded to appropriately. No information has been received by the Commission concerning complaints about the home. The inspector had been advised that all staff have received training in protecting vulnerable adults from abuse and the homes whistle blowing policy. During the inspection information was received by the inspector, about a possible safeguarding adults issue, which needed to be referred to Social Services under Safeguarding Adult procedures. The nurse on duty was unfamiliar with the process as was the manager of another home, who had assisted earlier on in the inspection. The inspector explained the process of the referral and action to be considered. This is being addressed outside this inspection report. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 22 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): Standards 19,20, 21,22,24,25 and 26. Quality in this outcome area is adequate. The accommodation appears to be adequate to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector toured the premises with the manager of another home. The one communal area is used as a lounge/dining room although compact is comfortable and homely. Some areas of the home are shabby and the inspector was advised that some new furniture had been ordered and some areas of the home were to be redecorated, no evidence was available of timescales. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 23 All bedrooms have en-suite toilet and wash hand basin. There are accessible toilets situated off the lounge and near the entrance hall. Adaptations and equipment are provided. However it was noted that the lounge/dining area does not have call alarm system installed and as already mentioned in the report puts the safety of service users at risk when there is no staff presence. Service users are encouraged to personalise their bedrooms and those bedrooms that are shared, have screening to ensure privacy. It is not clear if when a bed in a shared room becomes vacant, whether the remaining service user has the opportunity to choose not to share, by moving into a different room if necessary. The communal lounge area was very warm during this inspection, with very little evidence of adequate ventilation. Visitors commented that rarely are the doors leading into the enclosed garden opened. The laundry is sited in the basement of the home, the laundry assistant advised the inspector that all soiled laundry is taken to the laundry via the outside of the home, so not to intrude on service users in the lounge. Records of hot water checks were not available for examination by the inspector. Some areas of the home would benefit from a deep clean, some carpets and armchairs were badly stained, one bathroom smelled unpleasantly of dampness, caused by a leak from the bath seal and several bedrooms smelled of stale urine, so tables used by service users were sticky. It was not evident when the housekeeper undertakes cleaning in the home as this was not evidenced or recorded. The housekeeper was busy with the laundry and said that in addition to washing the personal clothing of the service users washed all the bed linen and towels. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 24 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): Standards 27,28,29 and 30. Standard 30 was subject to requirement at the last inspection. Quality in this outcome area is adequate. Staffing levels are stretched to meet the needs of the service users. Staff training, supervision and communication systems in the home are poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with staff on duty, examination of the duty rosters and observation of the home’s routine and care practices, staffing levels and deployment are stretched to meet the physical, social and emotional needs of the service users. At the time of this inspection the home was caring for thirteen service users. The inspector requested at the inspection, copies of duty rosters, these were not provided. Because this is a care home providing nursing care, a registered nurse must be on duty at all times. The home currently employs three full time registered nurses for a total of 120 hours per week. One nurse only works day duties and the remaining two cover day and night duty, therefore the three nurses are covering 14 shifts of 12 hours per week. One of the nurses is to commence maternity leave in August. The Commission does not prescribe staffing levels The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 25 in care homes, the responsibility for providing sufficient staff to meet the needs of the service users, is with the provider. One senior care assistant and six care assistants are in post for a total of 239 hours per week, this includes a full time care assistant currently on maternity leave. Three bank care assistants are employed. In addition a cook and assistant cook are in post for 64 hours per week, a housekeeper/laundry assistant and a part time assistant domestic who works alternate weekends. The home does not have dedicated administrative support. The nurse on duty was unaware of whether there is any staff vacancies. At the time of the inspection, the duty roster demonstrated that the night nurse had worked until 7am that morning, the nurse on duty had come on duty at 7am and was working until 7pm, the senior care assistant was working 7am until 1pm and a care assistant was working from 7am until 7pm. At 1pm a second care assistant came on duty until 7pm. One nurse and a care assistant were rostered to work 7pm until 7am the following morning. The cook was working from 7am until 1.45 pm and the housekeeper/laundry assistant from 7am until 1.45pm. The duty rosters do not evidence that a handover between staff at the start of a shift takes place; the inspector was advised that this depended on the good will of staff coming on duty early. As already stated in this report, staff are required to carry out other tasks, some food preparation and cooking the tea time meal, on alternate weekends there is no housekeeper or laundry assistant and therefore the two care assistants on duty undertaken these task in addition to caring for the service users. A sample of staff personnel files were examined, other than one file, which did not evidence a copy of the nurses Statement of Entry to the Nursing and Midwifery Council, were seen to be satisfactory. All files contained an application form, which contained a full employment history, references, evidence of police checks and a formal interview. It was not clear whether the home has a training and staff development plan in place. From information provided prior to the inspection and some training records seen not all staff have received mandatory training. No members of staff have been provided with health and safety training, not all staff have received basis food hygiene training although involved with food preparation, bank care assistants have not received training in POVA, none of the staff team have received training in Infection control and one part time member of staff, has not received any training. At the last inspection a requirement was made that all new members of staff must receive training appropriate to the work that they perform. This requirement has not been complied with. An induction programme in line with Skills for Care is being developed. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 26 The inspector was advised that one member of staff was training to become a NVQ assessor, two members of staff have completed NVQ level II and two members of staff are currently undertaking NVQ training. Communication systems in the home are poor, it is not clear that staff handovers take place with care staff at the beginning of each shift. Staff meetings take place infrequency and minutes of a staff meeting held in May 2007 were seen. The inspector gained the impression that staff morale was generally poor in the home. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 27 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): Standards 31,33,35,36 and 38. Quality in this outcome area is poor. It is not evidenced that the home is effectively managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: She is currently on maternity leave. The home does not have a deputy manager in post or administrative support on site. Satisfactory management arrangements have not been put into place, during the manager’s absence. The inspector was informed that the operations manager visited on a Monday and Friday. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 28 At the time of this inspection, the operations manager was on leave. The nursing staff had been told to contact one of the Oxford homes, if an inspection took place, unfortunately this information had not been share with the manager of the particular home. The nurse on duty tried very hard to be as helpful as possible, but he was unaware of some of the home’s policies and procedures and the homes out of hours management arrangements. Comments made by relatives about the management of the home included: ‘The home has gone down hill over the last few months’; ‘The agency has a lot to answer for as far as the Crown is concerned. I have learned that the larger homes owned by Southern Cross have many activities and outings, whereas, the Crown has been left to become a backwater. This to my mind is applying double standards to their care homes’. The home’s annual development plan was unavailable. Records of service users’ monies held in safekeeping were examined and do not always comply with the home’s policy on handling service users monies. Staff do not receive formal supervision at least six times per year. A file containing supervision records is kept in the office, and can be viewed by anyone. Supervision records of four staff, showed that one member of staff had received supervision in November 2006 and the others not since September 2006, this was confirmed by staff on duty. Reports on the conduct of the home written by a provider representative, following an unannounced visit to the home each month are not carried out. Since October 2006 only two reports were available, the last report dated February 2007. The home’s policies and procedures are in place, although are of little use if the staff do not have a working knowledge of their contents. Records relating to fridge, freezer and food temperatures were seen to be up to date and well maintained. Not all records relating to fire, health and safety were available, the inspector was advised that these may have been with the maintenance person who does not visit the home daily as he/she works within a group of homes. The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 29 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 x 2 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 2 2 2 2 x 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 x 2 1 x 1 The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be in sufficient detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided and how. Information recorded must include cross gender care preferences, how psychological health care needs are to be met and end of life care. Timescale for action 06/08/07 2. OP8 17(4) A record of a nutritional assessment, including the recorded weight must be kept for all service users. This is a repeat requirement from the inspection carried out in June 2006 and has not been complied with. 06/08/07 3 OP16 22 That a record of all complaints whether in writing or verbally received by the home is maintained. This must include action taken and outcome. 06/08/07 The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 31 4 OP18 13(6) All staff must be provided with training in the protection of vulnerable adults from abuse. Nursing and senior staff must be provided with training in Oxfordshire Safeguarding Adult Procedures including procedures for notifying allegations of abuse. An appropriate call system is installed in the lounge/dining room. That all areas of the home are kept clean, pleasant and hygienic. 06/08/07 5 OP22 23 29/09/07 6 OP26 23 06/08/07 7 OP27 18 An urgent review of staffing 29/08/07 levels must be undertaken to ensure that sufficient staff are on duty at all times to meet the physical, emotional and social care needs of all service users. In addition catering, cleaning and laundry staff must be employed in sufficient numbers. All new staff must receive training appropriate to the work that they perform. This is a repeat requirement from the inspection carried out in June 2006 and has not been complied with. That a staff training and development programme is put in place. Including an induction programme in line with Skills for Care. 29/08/07 8 OP30 18 9 OP31 8 Satisfactory management arrangements must be put into place during the manager’s absence. 06/08/07 The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 32 10 OP32 26 Reports written following the unannounced visit to the home by a provider representative, each month are available in the home for examination. Quality assurance processes must be developed to evidence that the home is run in the best interests of the service user. Including the home’s annual development plan. All records required under this regulation must be maintained, up to date and accurate. All records relating to safe working practices to ensure that service users and staff are protected, are available at all times in the home. 06/08/07 11 OP33 24 06/09/07 12 OP37 17 06/08/07 13 OP38 17 06/08/07 The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 33 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 Refer to Standard OP1 OP12 OP14 OP15 Good Practice Recommendations Information in the Statement of Purpose needs updating and contain accurate information about the home. The social and emotional care needs are addressed and form part of the service user’s care plan. Service users are enabled to exercise choice and control over their lives. Consideration should be given to introducing protected mealtimes in the home. That records are maintained of all meals taken by service users on a daily basis, to evidence that service users are being provided with a balanced, nutritious diet. Documentary evidence is available in file of nurses Statement of Entry to the nurse’s register. Records of monies held in safekeeping on behalf of service users are maintained in accordance with home’s policy. All nursing and care staff receive formal supervision at least six times per year. All staff are familiar with the contents of all policies and procedures relevant to the role they undertake in the home. 5 6 7 8 OP29 OP35 OP36 OP37 The Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 34 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 Crown Nursing Home DS0000065924.V338648.R02.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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