Inspection on 16/06/05 for The Green Nursing Home

This inspection was carried out on 16th June 2005.

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 Green Nursing Home 01/06/10

The Green Nursing Home 09/03/10

The Green Nursing Home 07/12/09

The Green Nursing Home 31/07/09

The Green Nursing Home 08/08/08

The Green Nursing Home 09/08/07

The Green Nursing Home 07/11/06

The Green Nursing Home 02/06/06

The Green Nursing Home 15/12/05

The Green Nursing Home 15/11/04

The Green Nursing Home 23/06/04

The Green Nursing Home 19/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Green Nursing Home, The Wharf Road Kings Norton Birmingham B30 3LN Lead Inspector Amanda Lyndon Announced 16 June 2005 th 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 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. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Nursing Home, The Address Wharf Road Kings Norton Birmingham B30 3LN 0121 451 3002 0121 486 3360 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Flintvale Ltd Care Home Category(ies) of Care Home registration, with number 58 of places Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered to accommodate 58 people over 65 years of age who are in need of nursing care for reasons of old age or dementia. Registration category 58 OP DE(E) TI(E). 2. Due to the layout of the building, in particular the distance from the main lounge to the rest of the home, a member of staff must be supervising the service users in the main lounge at all times. Date of last inspection 15 November 2004 Brief Description of the Service: The Green is a purpose built facility which offers nursing care to up to 58 older adults. The home has a mixture of shared and single bedrooms, some of which have en-suite facilities, spread over the ground and first floors of the building. There are communal bathing, shower and toilet facilities on both floors. The building has basic adaptations for service users with limited mobility, including two passenger lifts. Communal lounges are situated on the ground floor and the lounge doors open onto an enclosed garden with a water feature which is accessible to residents and visitors. Laundry and kitchen services are located on the ground floor, as is the dining room. The home has recently completed a new extension to the building, and an increase in occupancy. The home has off road parking to the front of the property and is situated close to bus links to the centre of Birmingham. There are a range of local shops and community facilities nearby. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was undertaken by four Inspectors, including the Pharmacist Inspector during a full day, and were assisted throughout by the Acting Manager. There were 46 residents living at the home on the day of the inspection. Information was gathered from speaking with the residents, visitors and staff, observing the care staff perform their duties and examining care and medication records. Prior to the inspection 14 comment cards were received by CSCI about the service provided at The Green Nursing Home, and the majority of these were positive in nature. A high number of statutory requirements made during the previous inspection had not been addressed, however, the Registered Providers and Acting Manager had made improvements in respect of a number of areas of the service provided by the home. The number of complaints received by CSCI in respect of The Green Nursing Home had reduced greatly over the past five months and some positive changes in practice and record management had been implemented as a result of these. What the service does well: Residents are generally well supported by the care staff to meet their health, welfare and personal care needs and are generally cared for in a respectful manner. One resident said “ If I need assistance, I use my buzzer and the staff come and help me”. Another resident said “The staff are very good to me and are very hardworking and they have time to talk to me”. One resident said “ I enjoy the company here, I played card bingo this morning and I enjoy the television and reading”. Another resident said “ I really love it here, I have made a great friend”. Residents are able to exercise choice over their daily lives and the activities that they choose to participate in which promotes their individuality and independence, bedrooms contain many personal items. One resident said “ You can choose what time you get up here, I have to wait sometimes but never too long”. The Green Nursing Home provides an attractive, homely and comfortable environment to live in and visitors are made to feel welcome. Residents are supported by an appropriate number of staff working at the home. One resident said Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home must continually monitor and evaluate whether they can continue to meet the care needs of residents living at the home and if a resident’s care needs are not able to be met by the home, reassessments must be undertaken in order to protect the resident and other residents living at the home. The care planning and personal risk assessment systems must be further developed and residents must be encouraged to be involved in the agreeing and reviewing of these in order to ensure that their personal preferences and routines are maintained. The Acting Manager must monitor the medicine management within the home to ensure that all medicines are administered as prescribed at all times. An activities programme must be developed at the home in order to provide residents with appropriate, stimulating and interesting activities to participate in. The menus must be reviewed in respect of both nutritional content and variety of food served to ensure that residents are receiving a well balanced diet. The complaints procedure must be accessible to residents should they need to refer to this. The home must introduce cleaning programmes for equipment used at the home and ensure that staff adhere to infection control guidelines to prevent the spread of infection. Two satisfactory references had not been obtained for all new members of staff prior to them starting work at the home and this lapse in procedures may fail to afford full protection to residents. A system for residents to be consulted about the service provided at The Green Nursing Home must be introduced in order for people living at the home to put forward their suggestions to improve the standard of service provided. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 7 The management team must take responsibility for developing and maintaining a safe system for the management of residents’ personal allowances in order to ensure that residents’ monies are held securely. A system for formal staff supervision and appraisal must be implemented to ensure that staff members are supported to work competently within their job roles. Remedial action on a number of health and safety issues in respect of equipment used, the premises and staff induction and training is required as this may pose a risk to residents’ safety. 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. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5 The admission and assessment processes and information available for prospective residents are generally comprehensive. The home were unable to fully meet the care needs of all of the residents living there and this will have a negative impact and possible risk to the safety of both the individual and other residents living at the home. EVIDENCE: The home had produced a statement of purpose and service user guide and these must be updated to include all current and relevant information as required by Regulations. Each resident is issued with a statement of terms and conditions of residency and this includes detail of the room number to be occupied, trial periods and fees payable. Pre admission assessments are undertaken for all prospective residents using a comprehensive document, however not all of these were completed in full. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 10 Prior to admission, individuals are invited to spend a day at the home in order to sample what life would be like to live there and residents come to live at the home on a 28 day trial period. The home were not meeting the care needs of a resident who was exhibiting physically aggressive behaviour towards both other residents living at and staff working at the home, this is wholly unacceptable and an urgent reassessment of this person’s care needs must be undertaken. A small number of staff had received training about caring for residents with dementia care needs. CSCI received a concern that residents’ hands and nails are not cleaned prior to mealtimes and whilst this was not evident on the day of the inspection, staff must ensure that they encourage residents to undertake this procedure in order to maintain their hygiene needs. The residents appeared to be generally well supported by the care staff to meet their personal care needs and were wearing clothing appropriate to the time of year. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Residents’ ongoing health and personal care needs were generally well met, however, changing or acute care needs were inadequately monitored and documented putting residents potentially at risk. Medicine management is unsafe and this may pose a risk to residents’ health, safety and welfare. Residents are supported in a respectful manner by the staff working at the home and this ensures that the residents’ dignity is maintained. EVIDENCE: Separate care plans for residents were not always written in respect of the individual care needs of residents and therefore, care plans were both confusing to read and did not describe the actual care to be given by the nursing and care staff in order to meet the person’s needs based on their preferences and wishes. Old Care plans for acute medical needs were re used in the event of a reoccurrence of the illness which is not considered to be good practice as the treatment of a condition may change on each occasion. Care plans were reviewed regularly, however the evaluations did not always reflect the information included in the daily reports and in addition, the nursing Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 12 staff had continued to evaluate care plans of resolved needs which is considered to be unnecessary. Residents and relatives met during the inspection were not familiar with the care planning system at the home and had not been involved in the agreeing and reviewing care plans. Personal risk assessments had been undertaken including nutrition, tissue viability and moving and handling, however these were not reviewed regularly and the moving and handling risk assessments did not always reflect the actual assistance that the resident required. The use of bed safety rail risk assessments were not always undertaken and consent in respect of the use of these was not always obtained. Although behaviour charts were in place as required, care plans of how to manage aggressive and uncooperative behaviour exhibited by residents were not always written. Continence assessments were not available for all residents that were using continence aids. Daily reports were found to be non descriptive, repetitive and did not include information about the activities that the residents had engaged in during that day, correction fluid must not be used on legal documents. All of the residents had the same General Practitioner who visits the home on a weekly basis as well as on request, however residents have the option of retaining their own GP on admission to The Green (If the GP is in agreement). Residents have access to Health and Social Care Professionals, including Social Workers, Psychiatrists, Chiropodists, Opticians, however a record of visits by these was not always available. Residents are weighed regularly but the frequency was not monthly which was inappropriate for some residents and appropriate pressure relieving equipment was available for residents’ use following assessment. One resident said “ If I need assistance, I use my call buzzer and the staff come and help me”. Another resident said “ I don’t think that having a shower once a week is enough”. It could not be demonstrated that all of the medicines had been administered as prescribed in all instances. Medicines dispensed in the Monitored Dosage System had been accurately administered and the Controlled Drug balances were accurate Medicines were unaccounted for, recorded as administered when they had not been and not all were recorded on the Medication Administration Record (MAR) charts despite being available for administration. The quantities of medicines received or balances carried over from previous MAR charts had not been Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 13 routinely recorded and some medicines had not been adequately checked in upon receipt for accuracy.. Medicines were found to be inappropriately stored in some instances. There were no written protocols available for the administration of occasional use medicines. No staff drug audits had been undertaken to confirm staff competence in medicine management. Prescription creams were dated on opening and discarded after 28 days with the exception of an unlabelled cream, which was located in a resident’s bedroom. Following the instructions of a Psychiatrist, the nursing staff had been covertly administering medication to a resident with dementia care needs and a Multi Disciplinary decision had not been made in respect of this. Despite appropriate protective aprons being available, a number of residents were wearing blue plastic aprons to protect their clothing during their meals and this does not promote their dignity. Information about residents’ personal and dietary needs was on display in a communal area the home and an alternative method of transmitting or storing this information must be sought to protect residents’ privacy and dignity. Residents have the option of using a pay phone or a private telephone line in their bedrooms. Privacy curtains were available in shared accommodation and staff were supervising residents in an appropriate and respectful manner and were addressing residents using their preferred names. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 There is limited opportunity for stimulation through leisure and recreational activities in the home. Residents are able to exercise some choice over their daily lives and the activities that they choose to participate in which promotes their independence and individuality. There is a limited variety of meals provided at the home and the nutritional value of a number of these are poor and may have a negative effect on residents’ health in the long term. EVIDENCE: There were limited activities on offer for residents living at the home to participate in including, progressive mobility to music and bingo, however, an activities coordinator had recently commenced employment at the home and plans were in place to improve both the choice of activities at the home and the evaluation of these. Residents had recently enjoyed a buffet tea to celebrate father’s day. Specific activities for people with dementia care needs were not available and none of the residents had an activity plan. A hairdresser visits weekly and Holy Communion is available at the home each month. One resident said “ I enjoy the company here, I played card bingo this morning and I enjoy the television and reading”. Another resident said “ I really love it here, I have made a great friend”. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 15 The home has an open visiting policy at all reasonable times and relatives can take residents for trips outside of the home whenever they choose. Residents’ bedrooms contained many personal items that reflected their individual tastes and this included satellite television and fridges for personal use. One resident said “ You can choose what time you get up here, I have to wait sometimes but never too long”. The main meal of the day was nutritious and an alternative was available, however, the menus identified a number of highly processed foods on offer and an alternative to the main meal of the day was not available. In addition, a daily record of food provided for each resident was not kept and there was no evidence that residents are consulted about the food that they are served both on a daily basis and in respect of new menu planning. One resident said “Before bed the staff offer me a sandwich, biscuit, chocolate and a hot drink”. Residents who were unable to sit at the dining table due to their frailty were assisted at mealtimes by the care staff in the smaller lounge in a dignified manner. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The complaints procedure is comprehensive, however is not accessible to the residents should they need to make a complaint. The existing procedures in place in respect of adult protection do not protect residents living at the home from abuse. EVIDENCE: The home had produced a comprehensive complaints procedure and this was accessible to visitors in the outer reception area of the home, however, this location did not make the information accessible to the residents living at the home. One resident said “ If anything was really bad here I would speak to the matron”. A record of the four complaints investigated by CSCI since the previous inspection were not available on the day of the inspection. These complaints included concerns about the home’s ability to meet residents’ health and personal care needs and the lack of communication between relatives and the home’s staff and all of these were found to be upheld. Whilst some improvements had been made in respect of practice and record management, it was apparent that improvements had not been made in all of the shortfalls identified. In addition a record of a recent verbal complaint received by the home made by a relative of a current resident regarding the care afforded to their relative, or the action taken by the home on the receipt of this complaint was not available, and as a consequence, the complainant was not satisfied with the outcome of this. The home had received a number of “thank you” letters and compliment cards. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 17 Despite a number of staff receiving adult protection and abuse training, the home had failed to follow adult protection procedures in respect of a resident who had exhibited physically aggressive behaviour towards other residents and unexplained bruising on another resident. The home had produced a whistle blowing policy, however, an adult protection procedure was not available. All staff working at the home had criminal records clearance and were deemed to work with vulnerable people. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25 & 26 The Green Nursing Home provides a homely and comfortable environment to live in where residents feel relaxed and secure. The home was generally clean. A number of staff perform poor practices that may pose a risk to both their own health and safety and that of residents living at the home. EVIDENCE: A number of areas in the home were well decorated, homely in style and floor coverings and furniture were of a good quality however this was not the case in other areas of the home and a number of window and door frames were in need of repair or replacement. There was a pond within the well maintained and attractive courtyard style garden and a risk assessment must be undertaken in respect of this. The large dining room doubles as a smoking facility for residents, out side of meal times and the chairs in the communal lounge areas had been arranged to promote social interactions between residents. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 19 There were adequate assisted bathing and showering facilities available at the home. Hand rails were available near all toilets however the toilet seat in one of the assisted bathrooms was broken. Storage space within the home was limited for wheelchairs and surplus commodes and there was a surplus supply of walking frames that should be returned to the appropriate supplier. Prior to the inspection, CSCI received a concern that a number of wheelchairs were dirty and foot rests did not operate safely. This was found to be the case and immediate requirements were made in respect of this. Appropriate privacy locks had been fitted to residents’ bedroom doors and these could be overridden in the event of an emergency. A number of residents had chosen to hold the key for their doors, however, the home must document the reasons why other residents do not do this. A lockable storage facility was available in the majority but not all of residents’ bedrooms. Bedrooms had been decorated in a homely style. A number of pillows were past their useful life and these must be replaced and a nurse call point was in each bedroom. The temperature within the home was comfortable, window restrictors had been fitted and radiators were a low surface type. A satisfactory Legionella water risk assessment had been undertaken. The home was clean and fresh with the exception of one bedroom and beneath one of the assisted bath chairs. Despite appropriate protective personal clothing being available, a staff member was performing domestic duties without using these and despite having a mechanical commode pot disinfector, staff continued to clean soiled commode pots manually prior to using the appropriate equipment provided and this is a risk to their health and safety. It is recommended that the clean incontinence pads available in the communal bathrooms are stored in a lidded receptacle for hygiene reasons. Personal toiletries located in shared accommodation did not identify which individual they belonged to and it was apparent that residents in shared accommodation were sharing a bar of soap which poses a risk in respect of infection control. An effective and hygienic procedure for the laundering of residents’ personal items of clothing and bed linen was in place and a contract was in place for the disposal of clinical waste and waste awaiting collection was stored securely. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Residents are supported by an appropriate number of staff during the day. During night time hours residents care needs may not be met due to the quality of care provided at this time. There is a generally robust system for staff recruitment in place, however two satisfactory references had not been obtained for all new members of staff prior to commencing employment at the home and this lapse in procedures may fail to afford full protection to residents. Staff undertake training to improve their knowledge of caring for older people. EVIDENCE: Kitchen, maintenance, cleaning and laundry staff provide ancillary support to the nursing and care staff on duty. There were vacancies for two care assistants, a kitchen assistant and a cook at the time of the inspection. One resident said “ The staff are very good to me and are very hardworking and they have time to talk to me”. The Inspectors were informed by the Acting Manager that the number of staff on duty did not fall below the approved levels, however, the staffing rotas were not an accurate reflection of the actual staff hours worked each week as agency staff were not recorded on the rotas. The Acting Manager provides on call support to the person in charge of the shift, however a system for the management of this should be devised to include other designated senior staff and the detail of this must be included on the staffing rota. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 21 The Green Nursing Home regularly use agency staff, however an induction for these people during their first shift worked at the home is not undertaken. Concerns were identified in respect of the quality of care provided at the home during the nighttime hours and an urgent review of this must be undertaken. Less than half of the care staff had achieved the NVQ Level 2 Award in care; however, a number of staff were currently working towards this. Three staff files were sampled and these contained the majority of information as required by Regulations. Prospective staff interview notes were not kept and interviewers did not seek further clarification in respect of information that prospective employees may have failed to provide on their applications forms. References were sought from referees using their home addresses and this did not provide evidence of the capacity in which they knew the prospective staff member and in addition, only one reference had been obtained prior to a new staff member commencing employment at the home recently. Pre employment health declarations were not always dated and signed. Induction programmes had been produced for staff undertaking different roles at the home and whilst the Inspectors were informed that all new staff undertake an induction, written evidence of this was not available. The care assistant induction programme was not in line with approved guidelines. In addition, a member of staff had not received instruction in fire safety and moving and handling since commencing employment at the home and was found to be working unsupervised. Individual staff training matrix records had not been undertaken for staff members and therefore it was difficult to determine the specific training needs of each staff member, however, a number of staff had received training specific to the role that they perform including bereavement care, risk assessing, managing challenging behaviour, infection control and dementia care. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 & 38 The home is in need of a permanent management team that can offer guidance and direction to the staff to ensure the health, safety and welfare of the residents. The systems for resident consultation in respect of the service provided at the home are poor and must be further developed. The system for the management of residents’ personal allowances is both inadequate and unsafe and poses a real risk of errors occurring in respect of this. Action is required of a number of health and safety issues at the home in order to provide a safe environment for the residents to live and staff had not received training in a number of health and safety issues and this may also pose a risk to residents’ safety. EVIDENCE: The home has a vacancy for a Registered Manager and the post was due to be advertised on the day of the inspection. The Acting Manager is a Registered Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 23 General Nurse and has had much experience of working both with older people and within a management role and the Inspectors received positive comments about the management style of this person from residents, visitors and staff. The Registered Providers visit the home regularly and undertake quality of service inspections as per Regulation 26 and a copy of the report of the findings of these visits must be sent to CSCI. A visitor met during the inspection described a lack of communication between relatives and the management and care staff teams at the home, however, the Acting Manager stated that she had recently tried to arrange a general meeting for relatives to attend and this had not been undertaken due to lack of interest. In addition, residents meetings were not arranged at the home. A trained staff meeting had been held recently and the minutes of this was available. A quality assurance system had not been implemented at the home, however the Acting Manager stated that plans were in place for resident service satisfaction questionnaires to be devised and distributed. The system for the management of residents’ personal allowances was both inadequate and unsafe. A number of account balances examined were found to be incorrect, money had been missing, which had been reimbursed back to the resident by the home, an appropriate fixed safe facility was not available, not all receipts were kept and initially the Inspectors were not able to access the money as the person holding the key was not on duty. The management team must take responsibility for developing and maintaining a safe system for the management of residents’ personal allowances. A system for formal staff supervision and appraisal had not been implemented at the home. There was a mixture of old and new policies and procedures available and these did not include issue or review dates and the missing persons policy did not include information about notifying CSCI should an incident occur. Risk assessments of COSHH products used at the home were available and these were due for review, fire risk assessments were up to date, however other risk assessments in respect of the premises and staff must be updated. Following the most recent Environmental Health inspection, the main kitchen had been decorated and effective food hygiene procedures were in place with the exception of fridge and freezer temperatures which were not available on the day of the inspection. It was noted that both the nursing and care staff were often in the kitchen without wearing appropriate protective clothing. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 24 A number of staff had received training in health and safety procedures including basic food hygiene, health and safety and moving and handling, however, evidence was not available to confirm the content and duration of this training as some staff members undertook two training sessions on the same day and not all staff had received moving and handling training provided by an appropriately approved trainer. In addition a number of staff were due to undertake first aid training in the near future. A fire drill had been undertaken recently, however the record of this did not identify the names of the staff members who had taken part and staff had not received formal fire safety training recently. A number of fire doors, including bedroom doors were open and this would pose a risk to residents’ safety in the event of a fire as magnetic door closures were not fitted to bedroom doors. In addition a number of residents had chosen to keep their bedroom doors open and risk assessments must be undertaken in respect of this. The Inspectors were informed that staff working at the home had inactivated the alarm linked to one of the fire doors in order to exit the building using this route and this is wholly unacceptable and poses a serious risk to residents’ safety. This was brought to the attention of the Registered Provider and remedial action was taken to address this at the time of the inspection. Accident reports are completed for the majority of accidents involving residents living at the home. CSCI were not always informed of all accidents or incidents that affect the health or welfare of residents as per Regulation 37 notifications. In addition, accident reports were not filed as per Data Protection guidelines, action taken following an accident or incident were not documented and audits were not undertaken in respect of these. Health and safety checks and servicing of equipment used at the home had been undertaken including the passenger lift, fire fighting equipment, gas appliances and electrical wiring, however servicing of assisted bathing and hoisting equipment and the nurse call system were due. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 25 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 2 2 x 2 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 Standard No 16 17 18 Score 2 x 2 2 2 1 x 1 1 2 1 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 26 yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4(1)(c )5(1) Schedule 1 Requirement The statement of purpose and service user guide must be further developed to include all information as required by Regulations and be available to any interested parties. (timescale of 15 April 2005 not met) Pre admission assessment documents must be completed in full. Urgent reassessments must be arranged in respect of any residents living at The Green whose care needs are not being met at the home. The Acting Manager received this in the form of an immediate requirement Staff must ensure that they encourage residents to wash their hands prior to mealtimes and provide the support required to do this. The care planning system must be further developed to include the following: Care plans must be agreed and Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 27 Timescale for action 16 October 2005 2. 3. OP3 OP4 14(1) 12(1)(a)( b) 14(2)(a)( b) 31 July 2005 30 June 2005 4. OP4 12(1)(a) (4)(a) 13(3) 12(2) 15(1)(2) 16 July 2005 5. OP7 31 August 2005 reviewed with the involvement of the resident and/or their representative. Care plans must be individualised to include the residents likes and dislikes. (timescale of 15 March 2005 not met) Care plans must detail the actual care to be afforded to the individual by the care and nursing staff and this includes the management of mental health care needs. Care plans must be written for all acute health care needs. The information within the care plan evaluations must reflect the residents current care needs. Bed safety rail risk assessments, consent and disclaimers must be undertaken for all residents that use this type of equipment. Personal risk assessments must be reviewed regularly. Moving and handling risk assessments must detail the actual assistance required from the care staff, type of equipment to be used and the action to be taken should a resident fall. Continence assessments must be undertaken and a record of this kept for all residents that use continence aids. Daily reports must be recorded in more detail and include information about the activities that the residents had engaged in during that day. Residents must be weighed at least monthly or more regularly if instructed to do so by a Health 6. OP7 13(4)(b) 31 July 2005 31 August 2005 31 July 2005 7. 8. OP7 OP7 13(4)(b) 13(5) 9. OP7 12(1) 31 August 2005 15 August 2005 10. OP7 12, 15 11. OP8 12(1)(a) 31 August 2005 Page 28 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Care Professional. 12. 13. OP7 OP8 12(1)(a) (b) 12(1)(2)( 3) A record of input from Health Care Professionals in respect of residents care must be kept. The Acting Manager must review the current system in respect of the frequency of residents receiving baths and showers at the home. All prescription creams must be labelled for individual use with the directions for use and stored securely at all times. The Acting Manager received this in the form of an immediate requirement Multi disciplinary guidance must be sought about the covert administration of medication. All staff must adhere to the policies and procedures for medicine management within the home. The quantities of all medicines received or balances carried over must be recorded on the MAR chart referred to prior to administration and signed directly after the transaction. All medicines must be stored in accordance with their product licences. All prescriptions must be seen and the system installed to check the dispensed medicines received into the home must be implemented at all times. Activities must be arranged for residents with dementia care needs Activity plans must be written for each resident and a record of all activities undertaken by residents living at the home must be kept. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 29 15 August 2005 15 August 2005 14. OP9 13(2) 17 June 2005 15. 16. OP9 OP9 13(2) 13(2) 31 July 2005 17 June 2005 16 June 2005 17. OP9 13(2) 18. 19. OP9 OP9 13(2) 13(2) 16 June 2005 16 June 2005 20. OP12 15 16(2)(m)( n) 15 September 2005 21. OP15 16(2)(i) Schedule 4 (13) A daily record of food provided for each resident must be kept. A review of the menus must be undertaken in respect of the nutritional content of the meals on offer and an alternative to the main meal option of the day must always be available. Residents must be consulted about the choice of meals on offer on a daily basis and in respect of future menu planning. An alternative location for the displaying of the complaints procedure must be sought in order to ensure that it is accessible to the residents. A comprehensive record of written and verbal complaints received about the service provided by the home must be available and this must include detail of remedial action taken by the home to address any issues of concern to the satisfaction of the complainant. An adult protection procedure must be written to include Birmingham Multi Agency guidelines and the contact details of all relevant people to be notified in the event of actual or alleged abuse and staff must ensure that they adhere to this procedure. The Acting Manager received this in the form of an immediate requirement A risk assessment must be taken about the pond in the garden. The Acting Manager received this in the form of an immediate requirement 31 July 2005 22. OP16 22(5) 31 July 2005 23. OP16 22(8) 31 July 2005 24. OP18 13(6) 16 June 2005 25. OP19 13(4) 23 June 2005 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 30 26. OP19 23(2)(b)( d) 27. 28. OP21 OP22 23(2)(c ) 23(2)(c ) All decoration, furniture and floor coverings in the home must be of a good standard and a number of window and door frames require replaining or replacing. All toilets must be safe for residents to use and any repairs must be undertaken. All wheelchairs must be thoroughly cleansed, serviced and in good working order. The Acting Manager received this in the form of an immediate requirement 31 October 2005 15 July 2005 23 June 2005 29. OP24 12(4)(a) 30. 31. OP24 OP24 23(2)(m) 16(2)( c) A written record of the reasons why individual resdidents are not able to hold the key for their bedroom doors must be available on file. A lockable storage facility must be available in each residents bedroom. All pillows must be in a good state of repair. (timescale of 15 February 2005 not met) The Acting Manager must ensure that procedures are in place to ensure that all areas of the home are clean and fresh smelling. Staff must wear appropriate personal protective clothing as provided whilst undertaking their duties at the home. The Acting Manager must implement plans to prevent care and ancillary staff from entering the kitchen frequently. (timescale of 18 November 2004 not met) Staff must not manually clean used commode pots and must 31 August 2005 30 September 2005 31 July 2005 32. OP26 33. OP26 13(3) 16(2)(j)(k ) 23(2)(d) 13(3) 31 July 2005 31 July 2005 31 July 2005 34. OP26 13(3) 16(2)(j) 35. OP26 13(3) 16(2)(j) 31 July 2005 Page 31 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 use the mechanical commode pot disinfectors provided at the home. The Acting Manager received this in the form of an immediate requirement The staffing rotas must identify the actual number of staff on duty and this must include agency staff. An urgent review of the quality of care provided at the home during night time hours must be undertaken. 36. OP27 17(2) Schedule 4 (7) 12(1)(a)( b) 18(1)(a)( 2) 01 August 2005 30 June 2005 37. OP27 38. OP29 The Acting Manager received this in the form of an immediate requirement 19)1)(b)(c Two satisfactory and authentic ) references must be obtained prior to new staff commencing employment at the home. (timescale of 15 December 2004 not met) The Acting Manager received this in the form of an immediate requirement Prospective staff interview notes must be kept and interviewers must seek further clarification in respect of information that prospective employees may have failed to provide on their applications forms. All new staff must receive a comprehensive induction and this must include instruction in fire safety and moving and handling and a written record of this must be available at the home. Staff must not undertake such care techniques prior to receiving the appropriate training. 16 June 2005 39. OP29 19(1) 31 July 2005 40. OP30 18(1)(c )(i) (2) 23 June 2005 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 32 41. OP30 18(1)(c )(i)(2) 18(1)(c )(i)(2) 42. OP30 The Acting Manager received this in the form of an immediate requirement. All agency staff must receive a basic health and safety induction prior to their first shift working at the home. The care assistant induction must be further developed to be in line with approved guidelines. (timescale of 15 April 2005 not met) The Registered providers must forward to CSCI the reports of their monthly visits to the home as per Regulation 26 requirements. Resident consultation meetings must be held at the home regularly. The Acting Manager must implement a quality assurance system which evidences full consultation with residents and/or their representatives about the service provided by the home. (timescale of 15 April 2005 not met) The Acting Manager must develop and implement a safe system for the management of residents personal allowances. The Acting Manager received this in the form of an immediate requirement A system for formal staff supervision and appraisal must be implemented at the home. (timescale of 22 November 2004 not met) Policies and procedures must include issue and review dates and the missing persons policy 31 July 2005 30 September 2005 43. OP32 26 31 August 2005 44. 45. OP32 OP33 12(2)(3) 24 24 31 August 2005 30 November 2005 46. OP35 16(2)(l) 23 June 2005 47. OP36 18(2) 31 August 2005 48. OP37 37 30 September 2005 Page 33 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 49. OP38 13(4) must include information about notifying CSCI should an incident occur. Risk assessments of the 31 August 2005 premises, food, staffing and COSHH items must be further developed to include details of hazards and safety measures specific to the home and must be reviewed. (timescale of 15 March 2005 not met) All records in respect of food safety must be available for inspection. (timescale of 22 February 2005 not met) Staff statutory training records must include detail of the content and duration of training sessions and moving and handling training must be provided by approved trainers. All staff must receive formal fire safety training and a record of staff members who take part in each fire drill must be kept. All existing staff must receive appropriate moving and handling training provided by an approved trainer. The Acting Manager received this in the form of an immediate requirement CSCI must be informed of all accidents and incidents affecting the health and welfare of residents living at the home as per Regulation 37. The Acting Manager received this in the form of an immediate requirement. Fire doors must be kept shut unless suitable magnetic 50. OP38 16(2)(j) 31 July 2005 51. OP38 18(1)(c )(i) 31 August 2005 52. OP38 23(4)(d)( e) 13(5) 18(1)(c )(i) 31 August 2005 31 July 2005 53. OP38 54. OP38 37 16 June 2005 55. OP38 23(4)(a) 16 June 2005 Page 34 Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 closures that are linked into the fire alarm system are installed. Risk assessments must be undertaken in the interim for all residents who choose to keep their bedroom doors open. The Acting Manager received this in the form of an immediate requirement. All fire exit door alarms must be activated at all times. 56. OP38 23(4) 13(4) 16 June 2005 57. OP38 17 13(4) The Acting Manager received this in the form of an immediate requirement Accident and incident reports 16 June 2005 must be completed in the event of all accidents and incidents involving residents living at the home, filed as per Data Protection guidelines and audits must be undertaken in respect of these. The Acting Manager received this in the form of an immediate requirement Assisted bathing and hoisting equipment must be serviced. The Acting Manager received this in the form of an immediate requirement The nurse call system must be serviced. 58. OP38 23(2)(c ) 30 JUne 2005 59. OP38 23(2)(c ) 16 August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that resolved care needs are filed separately from existing care plans. E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 35 Green Nursing Home, The 2. 3. OP7 OP9 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. OP9 OP10 OP10 OP22 OP22 OP24 OP26 OP26 OP27 OP27 14. 15. OP28 OP30 Correction fluid should not be used on legal documents. The Acting Manager should undertake regular staff drug audits before and after a drug round to confirm staff competence in medicine management and appropriate action must be undertaken when discrepancies are found. All medicines prescribed for occasional use must have a supporting written protocol. The appropriate alternative to blue aprons should be worn by residents at mealtimes to protect their clothing with their dignity in mind. An alternative method of storing or transmitting personal information about residents must be sought to protect residents privacy and dignity. The surplus supply of walking frames that do not belong to the home should be returned to the appropriate supplier. Communal bathrooms should be free from surplus commodes and wheelchairs and an alternative location for the storage of these should be sought. Where bedrooms do not contain all of the items of furniture listed in this standard, the residents agreement to this should be recorded. Staff should ensure that toiletries belonging to residents living in shared bedrooms are labelled for individual use. It is recommended that continence products are stored within their original packaging or in a lidded receptacle to prevent the risk of cross infection. An agency staff induction check list should be developed and implemented. A system for the management of on call support to the person in charge of the shift should be devised to include designated senior staff and the detail of this must be included on the staffing rota. All care staff should be working towards the NVQ level 2 qualification in care. An individual staff training matrix should be undertaken for each staff member. Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 36 Commission for Social Care Inspection Birmingham and Solihull Local Office 1st Floor, Ladywood House 45/46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Nursing Home, The E54_S24842_GreenNH_V224607_160605 - Stage 4.doc Version 1.30 Page 37 - 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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