Inspection on 24/10/07 for The Glen Nursing & Residential Home

This inspection was carried out on 24th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Glen Nursing & Residential... 21/10/08

The Glen Nursing & Residential... 20/09/06

The Glen Nursing & Residential... 01/02/06

The Glen Nursing & Residential... 14/09/05

The Glen Nursing & Residential... 02/02/05

The Glen Nursing & Residential... 13/07/04

The Glen Nursing & Residential... 22/01/04

The Glen Nursing & Residential... 09/10/02

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

CARE HOMES FOR OLDER PEOPLE The Glen Nursing & Residential Home Shapway Lane Evercreech Shepton Mallett Somerset BA4 6JS Lead Inspector Justine Button Unannounced Inspection 24th October 2007 09:30 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 Glen Nursing & Residential Home DS0000003298.V350921.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 Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Glen Nursing & Residential Home Address Shapway Lane Evercreech Shepton Mallett Somerset BA4 6JS 01749 830369 01749 831390 smithga@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd 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) Ms Gale Lesley Smith Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Number of persons for whom nursing care is provided shall not exceed 35. Up to 26 places for personal care, 23 of which must be sited within the original building. Up to three persons of either sex, in the age range 18-64, who require general nursing care. Maximum overall number 58. Date of last inspection 20th September 2006 Brief Description of the Service: The Glen is a service that supports up to 58 older people. The Glen is part of the BUPA Care Homes group. The service is situated in the village of Evercreech, which is a few miles from the town of Shepton Mallet. The home is situated within pleasant grounds in a country setting. The service is split into two wings with those service users who require nursing support in one and those who require personal care only in the other. There is a common kitchen and offices in the centre of the two wings. The bedrooms are distributed over three floors and there are two passenger lifts that allow easy access to all floors. Service users are able to visit all areas of the service even if their bedroom is on the opposite wing. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to assess relevant key standards under the Commission for Social Care Inspection ‘Inspecting for better lives 2 framework’. This focuses on outcomes for residents and measures the quality of the service under four general headings, excellent, good, adequate and poor. These judgement descriptors are given for the seven outcome groups in the report. The home completed an Annual Quality Assurance Assessment prior to the inspection. Surveys were sent to some residents, relatives and other professionals who have contact with the home. Eighteen residents and relatives returned surveys and their comments are incorporated into this report. All the residents described their ethnicity as white and British. There were fifty-two people living in the home on the day of the inspection. The inspection was unannounced and took place over the course of one day in October 2007. One inspector undertook the inspection. In addition the CSCI pharmacy inspector visited the home to review medication procedures at the home. We undertook a tour of the home and looked at selected residents and staff files and other documentation including policies and procedures, the complaints log, statement of purpose and service user guide. We spoke to the manager, some staff, a visitor and to some of the people living in the home. The current fees are £441-£818 dependant on the assessed needs of the individual. The Registered Nursing Contribution is refunded to the individual. What the service does well: All prospective residents and their relatives/representatives are given written information about the home before they move and an individual reference copy if they decide to live at the home. They are encouraged to visit the home and their needs are fully assessed by a senior member of the nursing team before they move in to make sure the home can meet their needs. All residents are The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 6 given details of the terms and conditions of residency that is clearly written in plain English. Resident’s rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. All staff is formally supervised to make sure there practice is good and they receive structured support from the manager. The home was clean, tidy and free from unpleasant odours. Residents are able to bring in furniture and personal belongings to personalise their private room Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the management in relation to a planned major refurbishment programme which is due to commence in the near future. The majority of relatives surveyed said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff was observed to be courteous and appropriately friendly towards residents. One resident described staff as ‘supportive but not intrusive’. Residents are seen as individuals and the home tries hard to accommodate their individual needs and characters. One resident said that ‘nobody wants to be in a residential home but if you have to this is as good as it gets’. What has improved since the last inspection? The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 7 The service is due for a major refurbishment commencing in November 2007. This will include updating the decoration in all of the bedrooms and lounges. New carpets will be laid in all communal areas and new furniture purchased. The management have arranged a meeting with relatives and residents in order to discuss the works to be done. There are four colour schemes available for the bedrooms and people living at the home will be able to make a choice from these schemes. The kitchen and the laundry will not be subject to any refurbishment. Since the last inspection the format for the care plans has been updated. The care plans were in the process of being upgraded during the inspection. What they could do better: Brian Brown, Regional Lead Pharmacist, visited the home on the 18/10/2007. During this visit it was identified that the room temperature was 25C on 26 occasions during September. The fridge temperature was 2C on 19 occasions, also in the last 7 days it had been below 2C on 4 occasions. Poor temperature control of medicines storage areas may place people at risk of receiving an ineffective medicine. The home does not provide adjustable beds for all people with nursing needs. Six people do not have adjustable beds. Risk assessments are in place for people for whom this equipment is not provided. The majority of people without adjustable beds had been assessed as not requiring them. For one individual however the care plan stated that the individual required staff assistance at night. This person did not have an adjustable bed but a divan type, which is not on wheels. The bed was positioned against the wall. It is difficult to assess therefore how staff provided the support as detailed in the plan of care without placing themselves at risk from back injury. The management must review this as a matter of urgency. Feedback from the relatives seen during the inspection and via the feedback forms returned prior to the inspection identified some common themes of concern. A number of people feel that there are not adequate numbers of staff on duty at all times. The duty rota’s were copied and reviewed following the inspection these demonstrate that there are adequate numbers of staff on duty but we did not compare this to the dependency levels of people living at the home. In addition a number of people told us that communication with some of the staff was sometimes an issue. The manager stated that a number of staff are receiving English lessons and so hopes that this situation will improve in the near future. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 8 There are some staff vacancies currently but the homes own staff and a small amount of staff from local agencies are covering these. Due to this a number of the staff particularly the registered nurses are working on average over fifty hours per week. The management need to keep this under review to ensure that this does not adversely affect the standard of care and support delivered to people living at the home. We examined the staff-training matrix following the inspection. This demonstrated that not all staff has received all necessary mandatory training. As previously stated the format for the care plans has been recently updated. The plans viewed contained all necessary assessments and associated plans of care. The plans of care however need to be more specific in some areas to ensure that they give clear guidance to the staff. The registered nurses need to ensure that all assessments are accurately completed. The sluice in one area of the home was broken on the day of the inspection. The sluices are not part of the planned refurbishment so the management need to ensure that they remain in working order and in good condition. The manager currently reviews and audits all accidents. It is advised that the time on the incident forms part of the audit procedure in order that any patterns of incidents can be identified and any necessary remedial action but in place. 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 Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed has a statement of purpose and service user guide, which sets out the aims and objectives of the home and includes basic information. Admissions to the home are not made until a full needs assessment has been undertaken by a member of the senior management team. The prospective residents and their families are fully involved in the assessment and are encouraged to visit the home before making a decision on residency. All residents are provided with a statement of terms and conditions of residency/contract that sets out in plain English what is included in the fee, the role and responsibility of the provider, and rights and obligations of the individual. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home produces a statement of purpose and service user guide that is readily available to prospective residents, their families and funding authorities. This is clearly written in plain English and a copy is available to all residents when they move into the home. All the relatives surveyed said that they had received enough information about the home. Some residents spoken to said that they had looked around the home before they moved in but others had been unable to visit and their family had chosen the home. The home produces a terms and conditions of residency that includes details of the room to be occupied and what is included in the fee but should make clear who is responsible for paying the fees, i.e. the resident or a funding authority. The home has an equal opportunity policy relevant to people living there which acknowledges peoples rights to be seen as individuals and makes clear that the home will make all efforts to meet individuals needs and aspirations. The homes pre admission assessment covers all the topics recommended in the national minimum standards. The inspector looked at the personal files of two residents who had moved into the home since the last inspection. Both files clearly showed that the homes manager, Ms Richardson, had undertaken a pre admission assessment, these are carried out at the prospective residents home, hospital or wherever they are staying. This gives the manager and prospective resident the opportunity to meet and make sure that the home can meet their assessed needs before they move. A copy of the funding authorities assessment had been obtained and kept with the care plan. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care planning practice was good however some areas in regard to assessments of health care needs were not accurately recorded. Accurate assessments are required to ensure that staff deliver appropriate care and support. Evidence was seen of input from the resident and/or their representative. Residents are able to have privacy in their own rooms. Personal support was offered in a way to promote the privacy and dignity of residents. Service users were treated with respect and looked well cared for. Poor temperature control of medicines storage areas may place people at risk of receiving an ineffective medicine. EVIDENCE: The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 13 Four people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. As stated at the beginning of the report the home is currently implementing new care planning documentation. The new care planning system takes into account the legislation with regard to “Mental Capacity”. The majority of the plans had been completed with the individual and/or their representative. All contained a range of appropriate assessments and associated care plans. The majority of the care plans were clear and detailed. Although the staff are working hard to implement the new care planning system two, out of those viewed, and did not give clear guidance to the care staff on the needs of the individual. For one individual, who had pressure ulcers, a Waterlow assessment (used to assess the risk of pressure damage) had been completed. The final score had been completed and concluded that the individual was at “high risk”. The scores however had been added incorrectly and should of concluded that the individual was at “very high risk”. This incorrect score may influence the level of care and support provided or the equipment, such as pressure reliving mattress or cushions that are used. The care plan stated that staff should support the individual to mobilise four hourly however the rest of the plan stated that the individual was immobile. One part of the plan stated the hoist to be used to aid moving and handling and yet in another part of the care plan it stated that the individual was able to transfer from bed to chair or wheelchair with no use of equipment. These statements give an inconsistent approach to the individuals care and staff would not be clear on the appropriate care and support required. The care plan contained ambiguous statements such as “provide nutritional supplements if required” and “offer a well balanced diet and fluids”. People who have or are at risk of pressure damage may require increased protein in the diet to aid healing. The plan therefore needs to detail the individual’s dietary requirements and the amount of fluids required on a daily basis. The care plan for the treatment of the pressure ulcer was relatively clear with tools such as photographs and sizes being used by staff. These tools enable staff to assess the progress of the wound and ensure the appropriate dressings/ treatment is being used. The frequency that the dressing was to be changed was not made clear on the care plan however. For a second individual who had a low body weight the waterlow score had been completed. The individual had been assessed as a “high risk” however given the low BMI (body mass index) this score should have been assessed as “very high risk”. Again this may influence the care and support provided by staff or the equipment used. The care plan for this individual stated that the individual required staff support to change position, essential in the prevention of pressure damage. On viewing the bedroom the individual had been provided with a non-specialist The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 14 divan type bed, which had been placed against the wall. It is difficult to assess therefore how staff provided the support as detailed in the plan of care without placing themselves at risk from back injury. The management must review this as a matter of urgency. The individual had been assessed as being at high risk of falling. Staff had provided the appropriate equipment in this area. An additional person had been assessed by staff as “very high risk” of developing pressure sores. According to BUPA guidelines anybody assessed as being very high risk should be provided with a specialist “airflow” mattress. However the care plan stated that a “spenco” type mattress had been provided. The “spenco” type mattress was confirmed to be in use when visiting the bedroom. This mattress is used for people with a lower risk score. Staff need to ensure that people living at the home are provided with equipment according to their assessed need. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. There was a good range of pressure reliving equipment, hoists and pressure mats available. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Health and social care professionals, through surveys received, and confirmed that they see their residents in private. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. Residents spoken to confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. Feedback received from residents indicated that the majority felt that they always got the care and support they needed. Comments included “this is a wonderful home” Three people on the surveys returned stated however that they sometimes felt that the attention to detail was sometimes lacking including support from staff to maintain clean finger nails, dentures and spectacles. Brian Brown, Regional Lead Pharmacist, visited the home on the 18/10/2007. Mr Brown reviewed the medication on both the nursing and personal care sides of the home Nursing side. The temperatures of the drug room are recorded by staff on a daily basis the temperatures of the room for the month of September 2007 were viewed. These demonstrated that the Room temperature was 25C on 26 occasions The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 15 Fridge Temperature 2C on 19 occasions, also in the last 7 days it has been below 2C on 4 occasions. Some inappropriate medicines were stored in the fridge. The management need to ensure that medication is stored at the correct temperature as detailed in the manufactures instructions. Medication stored at the incorrect temperature may affect the way in which they work. Controlled Drugs cupboard although compliant with safe custody regulations was not affixed to the wall in accordance with the regulations. Also some inappropriate medicines stored in the Controlled Drugs cupboard. Controlled drugs stock balances were checked and found to be correct. Calogen for one individual had been opened and was being stored in the trolley, not in accordance with the manufacturers instructions, and on speaking to members of staff they were storing it like this for up to 28 days when the manufacturer recommends storage in the fridge after opening and to discard after 14 days. One individual was prescribed a variable dose of medication but it was not possible to determine the actual dose given from the records made. Good practice seen in the recording of the BM levels and the dose of insulin administered for one individual. Date of opening was seen to be recorded on all opened eye drops. All sterile equipment was found to be in date, and all waste medication for return and destruction was recorded for individual people. Personal care drug room. The room temperature on the day of the inspection was at 27C and recorded as above 25C regularly. This is not in line with good practise and may influence the effectiveness of medication. The fridge temperature recording appeared satisfactory and was within normal limits. Controlled drugs were stored appropriately. Stock balances found to be satisfactory. Calogen when opened was found to be stored in the medicine trolley as above on the nursing wing. One individual was self-medicating some eye drops. A risk assessment was in place in the care plan and bottle dated when supplied. This is used as the means for monitoring the use of this medicine. Feedback was given to the manager at the end of Mr Browns visit. Mr Brown expressed concerns over the temperature control especially of the medicines fridge on the Nursing wing. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 16 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are well advertised. There is a range of social events and for the less able there are opportunities for one to one social contact. Comment cards indicated that not all people found the availability of activities adequate Families were seen to be welcomed and to be part of the home life. The menu is varied. The food on the day of the inspection was of a good standard. EVIDENCE: Feedback forms from people living at the home asked “Are there activities arranged by the home that you can take part in?” three people stated that there were always activities for them to undertake if they wished. Two people The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 17 stated that there were usually activities for people to do. Four of the forms from relatives and carers stated that they felt that there were not enough things to do at the home. This area was discussed with the manager on the day of the inspection. The manager stated that the home did not currently have an activities organiser due to sickness and that this may have effected the provision of activities. The home however had some staff members who were completing activities, providing a minimum of 18.5 hours of activity time. In addition the art group was also continuing twice a week. The weekly events programme was seen for week commencing 22nd October 2007. This confirmed that activities were available on a daily basis and included bingo, art, bridge and memory lane. The October newsletter also detailed events including an outside entertainer, a trip out, Holy Communion and harvest festival. The Christmas party has also been arranged for the 15th December 2007. The Glen hosts the community stroke club to enable service users to access the club and participate if they wish. Given the feedback from some parties it is recommended that the provision of activities be kept under to review to ensure that there are sufficient opportunities available for all people at the home. Visitors at the home are always made welcome and several were seen on the day of the inspection. When asked via the feedback forms “Do you like the meals at the home?” all but one of the comments was positive. One person stated that they had visual problems and staff did not always explain to them what the meal was. The individual stated that the food was not always presented in a way in which they could manage. The management may like to consider this as a training issue for staff. The main meal at lunchtime was observed. A choice was available of turkey in lemon and tarragon sauce or ham and broccoli quiche. Chipped potatoes and vegetables were served. In other BUPA care homes staff serve the vegetables in dishes to the table in order that people can choose what and how much they would like. This was not the case on the day of this inspection at the Glen. Staff plated the meals from the hot trolley. Consideration should be given to introducing the service to the table. A choice of puddings were available these included a fruit crumble, mousse and or ice cream. In addition one person was seen to request banana and ice cream and staff willingly obliged. The dining areas are well presented with napkins and condiments available. Those requiring assistance were aided thoughtfully and with respect. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 18 The morning coffee trolley and afternoon tea trolley were observed during the inspection. These biscuits only in the morning. There was no alternative, on the trolley, for those on specialist diets who may not be able to eat these items. Following the inspection the management confirmed that these are collected separately form the kitchen to ensure that temperature control is not compromised. Yoghurts and bananas were available in the afternoon. The management at the home stated that alternatives are available for those on specialist diet or for those people who do not want cake or biscuits. The management team need to ensure that staff actively offers an alternative. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the homes policies and procedures. Not all staff has received recent training in the prevention and recognition of abuse. EVIDENCE: The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 20 Feedback forms to people living at the home asked do you know who to speak to if you are not happy? All people, with the exception of one stated that they would speak to a staff member or the manager if they had any concerns. One person stated that they would not be happy to raise concerns and stated that they would “be nervous of complaining in case of unpopularity” Comments from relatives included “A wonderful home no complaints”. The Home has a complaints procedure that is clearly written and contains the contact details for CSCI. The home has received 5 complaints/concerns in August 2007, 3 in September 2007 and one in October 2007. The complaints file was viewed during the inspection. All the complaints had been dealt with in line with the homes policy and procedure. A range complimentary letters were also held on the file. One concern was raised on the day prior to the inspection to the home manager. This was discussed on the day of the inspection and referred to the local Social Services via the vulnerable adults policy. The management at the home took all appropriate action. The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. Abuse training is included in the new staff induction programme, however the training matrix was viewed as part of the inspection process and this showed that 37 staff had not recived abuse training. The management need to consider implememting a training to ensure that staff receive regualr updating in this area. Staff recruitment files were veiwed during the inspection. These contained all necessary checks. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is due for a major refurbishment of all communal areas and bedrooms in the very near future The home provides physical environment that is appropriate to the needs of people who live there. People are encouraged to personalise their rooms. The home is well lit, clean and smells fresh. The shared areas provide a choice of communal space with opportunities to relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of people who live there. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 22 EVIDENCE: The service is split into two wings with those service users who require nursing support in one and those with personal care needs in the other. The bedrooms are distributed over three floors and there are two passenger lifts that allow easy access to all floors. Service users are able to visit all communal areas of the home, even if their bedroom is on the opposite wing. The home is due for a major refurbishment, which is due to commence on November 2007. People living at the home and families have been invited to attend a meeting to discuss the impact this will have on the home over the next few months. In addition there are four colour schemes available for the bedrooms for people to choose from. The refurbishment will include all the bedrooms and communal areas. It will not include the kitchen, laundry or sluice areas. Due to the planned changes to the home the décor and furnishings were not viewed in detail at this inspection, apart from those rooms viewed as part of the care tracking process. The home was, however clean, tidy and odour free on the day of the inspection. There are gardens, which are accessible by wheelchair and provide pleasant places to sit or walk, in warmer weather. The Glen has in place a range of equipment and adaptations. A nurse call bell is available in all areas. Various hoists and moving and handling equipment are provided to meet the needs of service users (see comments in health and personal care). There are grab rails and specialist bathing hoists. The sluice rooms are small, some contain disinfection cycle machines and others do not. In addition one of the sluicing machines was not in working order on the day of the inspection. Consideration should be given to updating the rooms without a disinfection cycle as part of the refurbishment programme The purchasing of adjustable beds for all people receiving nursing care is on going. Several have been purchased since the last inspection. Risk assessments are in place for people who have not got these beds. It was noted however that one person who required staff support when in bed did not have an appropriate bed. It is the inspector view that the lack of an adjustable bed for this individual would pose a high risk for such things as back injuries to staff. The management need to ensure that the risk assessments are reflected in the equipment provided. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 23 . The Glen Nursing & Residential Home DS0000003298.V350921.R01.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): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to the numbers of current service users. These have not been compared to dependency levels. The perception of people living at the home and family/ friends is that some staff do not have the skills to meet the needs of the people living at the home. The staff working at the home have not completed all mandatory training. The home follows appropriate staff recruitment procedures. EVIDENCE: Comments from people living at the home, friends and family both in the feedback forms received and during the inspection with regard to staffing was very mixed. Comments included “staffing at the weekend is not adequate” “some staff have better skills than others” “skills of the staff differ greatly The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 25 some are excellent others are very poor” “changeover of staff is high this does not aid continuity” “staff always appear very busy” “staff are excellent”. There appeared to be concerns with regard to communication within the home and particularly between the staff and people living at the home. These related to the communication skills of staff whose first language is not English. This was discussed with the manager at the inspection who stated that a number of staff were currently undertaking English language courses so hoped that this situation would improve in the future. There are some staff vacancies currently but the homes own staff and a small amount of staff from local agencies are covering these. Staff recruitment is currently on going. Due to this a number of the staff particularly the registered nurses are working on average over fifty hours per week. The management need to keep this under review to ensure that this does not adversely affect the standard of care and support delivered to people living at the home. The staff duty rota’s were copied and reviewed following the inspection. These showed that there are adequate numbers of people on duty. Some shortfalls were seen if staff had become sick at short notice. The staffing numbers was not compared, by the inspector, to the dependency levels of people living at the home during the inspection. Nine staff are available in the mornings, 8 in the evenings and five staff on nights We were given a copy of the staff training matrix which was viewed following the inspection. This demonstrated that all staff have not received all necessary mandatory training. 13 staff have not received annual moving and handling training, 13 staff have not received 6 monthly fire awareness training. 33 staff have not received infection control training. The training matrix does not contain the date staff commenced employment at the home so some of these staff may have covered this training in induction however this would not cover all the shortfalls identified. Feedback forms obtained from staff prior to the inspection stated that staff felt supported at the home and felt that adequate training was provided in order for them to fulfil their role. This was confirmed with discussion with staff during the inspection. Three staff recruitment files were examined. These contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were also in place. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37, 38. The quality in this outcome group is Adequate . The home is well managed in an open management style. The home is run with the service users best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard. A system of staff supervision is in place. Health and safety is well managed in all but one area. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 27 EVIDENCE: The home Manager is supported by an experienced Deputy Manager and an administrator. The management style of the home is appreciated by staff and service users. The company, BUPA Care Homes (CFC Homes) Limited undertake quality assurance assessment of the home, surveys have been made to assess service user satisfaction. All records seen were stored appropriately and safely. Accident forms are completed and these are audited on a monthly basis. It is advised that the time on the incident forms part of the audit procedure in order that any patterns of incidents can be identified and any necessary remedial action but in place. Staff supervision is ongoing and all staff receive regular supervision on a rolling programme. Annual appraisals are conducted for all staff. Servicing and maintenance records were sampled these were found to be in good order. COSHH (Control of Substances Hazardous to Health) advisory sheets are held at the home. As previously stated during the inspection it was observed that at least one person who would require staff support to change position when in bed was seen to have divan type beds. In addition this bed was placed against the wall. The beds did not have wheels. Staff confirmed during the inspection that they pulled the bed away from the wall at night when care was required. When the care had been delivered the bed was pushed back towards the wall. This is a moving and handling issue and may compromise staff safety. In addition not all staff have received mandatory training in moving and handling which may increase the risk to staff. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 1 The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) Requirement The assessment and the associated care plans must be completed consistently and ensure that clear guidance is give to the staff on the care and support needs of individuals living at the home. It is required that medication is stored at a temperature in line with the manufactures guidelines. The Registered Person must review the risk assessment for the provision of adjustable beds and ensure that beds are provided in line with the completed risk assessments. It is required that specialist equipment is provided to individuals according to their assessed needs. This includes pressure mattresses. It is required that all staff complete all mandatory training including moving and handling and fire awareness. It is required that the health and safety of staff is not DS0000003298.V350921.R01.S.doc Timescale for action 20/12/07 2. OP9 13 (2) 15/12/07 3. OP24 16 (2)(c) 15/12/07 4 OP24 12 (1) (a) 20/12/07 5 OP30 18 (1) © (1) 13 (5) 30/01/08 6 OP38 15/12/07 The Glen Nursing & Residential Home Version 5.2 Page 30 compromised by the position of inappropriate equipment. This relates to the lack of inappropriate beds placed along bedroom walls. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4. 5 Refer to Standard OP9 OP22 OP12 OP26 OP27 Good Practice Recommendations It is recommended that the controlled drugs cupboard is fixed to the wall in line with safe custody regulations It is recommended that the risk assessments reflect the equipment provided for service users. It is recommended that the provision of social and recreational opportunities be kept under review in the absence of the activities coordinator. It is recommended that some of the sluices are upgraded to include mechanical washers. It is recommended that the management ensure that staff have competent communication skills and opportunity to meet the needs of people living at the home. The Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Glen Nursing & Residential Home DS0000003298.V350921.R01.S.doc Version 5.2 Page 32 - 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!