Inspection on 22/07/08 for The Meadows Nursing Home

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Poor service.

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 Meadows Nursing Home 29/06/07

The Meadows Nursing Home 23/05/06

The Meadows Nursing Home 21/11/05

The Meadows Nursing Home 06/07/05

The Meadows Nursing Home 12/12/04

The Meadows Nursing Home 10/07/04

The Meadows Nursing Home 08/03/04

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Meadows Nursing Home, The 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD Lead Inspector Sandra J Bromige Key Unannounced Inspection 22nd July 2008 08:05 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 DS0000004124.V368711.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000004124.V368711.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadows Nursing Home, The Address 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD 0121 453 5044 0121 453 0212 themeadows@asterhealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern CC Ltd Manager post vacant Care Home 36 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (36), of places Physical disability over 65 years of age (36), Terminally ill (4) DS0000004124.V368711.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home may also accommodate three persons under 65 years with a learning disability. The Home may also accommodate a maximum of three people aged between 55 - 64 years with a physical disability. The Home may also accommodate 1 person aged between 50 - 64 with a physical disability. 29th June 2007 Date of last inspection Brief Description of the Service: The Meadows Nursing home is one of two homes which are now owned by Southern CC Ltd. It is registered to accommodate a maximum of 36 residents. The home is divided into two units, Pine/Willows and Beeches. Pine and Willow units are on the ground floor and the Beeches unit is located on the first floor and caters for residents who have dementia related illness. A passenger lift provides access to first floor rooms. With the exception of one bedroom all rooms are single occupancy. The home is situated in a rural setting near to the Lickey Hills and is also only five minutes from the motorway. Up-to-date information relating to the fees charged for the service is available on request from the home. A copy of the inspection report is available on our website www.csci.org.uk. DS0000004124.V368711.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We, the commission undertook an unannounced inspection of this service over two days by one Inspector. This was a key inspection – this is an inspection where we look at a wide range of areas. Before the inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the service for completion. The AQAA is a self-assessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Some of the provider’s comments have been included within this inspection report. During the visit to the home care records, staff records and other records and documents were inspected. Surveys were sent out and received from residents (nil), staff (three) and healthcare professionals (six). There was a tour of parts of the accommodation and interviews with staff, including the manager designate. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents and their relatives. We have not received any complaints about this service since the last Key Inspection was completed in January 2008. What the service does well: A representative from the home visits prospective residents and carry out an assessment of their care needs to make sure they are able to provide the care needed. Staff address and care for residents’ in a sensitive manner, which ensures their privacy and dignity, is maintained. Residents receive a good quality varied diet and residents are consulted regarding food preferences and choice of menu. They have a good choice of a cooked breakfast, cereals, porridge, toast and bread and butter with fruit juice, tea and coffee to drink. Residents are able to eat in the dining room or in the privacy of their bedroom. The home has a complaints procedure, which is available at the entrance to the home. Records of complaints and their investigation and outcome are held in the home. A suggestions box is also available. DS0000004124.V368711.R02.S.doc Version 5.2 Page 6 The home is clean and tidy and the management of odours is generally good. Residents are able to bring some of their own personal possessions into the home. A good range of equipment is provided such as ceiling hoists, electrically operated height adjusted beds, manual handling aids and small equipment to help residents to eat their meals e.g. plate guards. More than 50 of the care staff have NVQ level two in care or above. We found a relaxed atmosphere in the home and all staff were pleasant and helpful throughout the inspection. What has improved since the last inspection? What they could do better: The service has failed to comply with three requirements issued at the last Key Inspection of the service. The requirements relate to the poor quality of the care records and the staff recruitment procedures. Due to the poor quality in these areas the home are placing residents at risk of harm and are in breach of regulation. Therefore, we have issued Statutory Requirement Notices relating to these areas. The home should make sure their statement of purpose and service user guide is available in other formats, which are suitable for the client group they care for taking into account their physical and mental health needs. DS0000004124.V368711.R02.S.doc Version 5.2 Page 7 The home’s medication policy should be available to staff so that residents health and welfare if safeguarded. A system should be introduced to ensure accurate medicine audits can be done so that staff can check medication is being administered to the directions of the general practitioner. The provision of social care in the home needs further development to ensure it is person centred and residents’ social and spiritual needs are met. The owner should provide a designated budget to support this provision of person centred social and spiritual care. The home need to review the current practice of cleaning and storing wash bowls to make sure residents are not at risk of cross infection. The home needs to make sure the nurses and care staff working in the home has the right skills and knowledge to meet the care needs of the residents particularly those who have dementia. The home needs to check the competency levels of all the nurses working in the home. Nurses should receive training in the management of syringe drivers to make sure staff have the right skills to use this equipment if required for the provision of pain management for end of life care. New staff need to receive induction training and training appropriate to their role to make sure residents and staff are not placed at risk of harm. The owner or a representative needs to carry out monthly unannounced visits to the home to monitor the quality of the service provided to the residents. 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. DS0000004124.V368711.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000004124.V368711.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3 - Standard 6 was not inspected, as intermediate care is not provided by this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that the care home can support them. This is because there is an accurate assessment of their needs that they have been involved in. This tells the home all about them and the support they need. Residents who stay in the home know about their rights and responsibilities because there is a contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. EVIDENCE: The improvement plan submitted by the service in March 2008 following the last Key Inspection stated they have reviewed the home’s statement of terms and conditions to include a breakdown of fees for each resident. A contract was seen for a recently admitted resident and this included information about the breakdown of the fees including the nursing care contribution. DS0000004124.V368711.R02.S.doc Version 5.2 Page 10 The Annual Quality Assurance Assessment completed by the deputy manager confirms ‘a pre-admission assessment is conducted for all new service users prior to acceptance into the home to ensure the home is able to meet individual care needs’. A pre-admission assessment for a recently admitted resident was seen. It was a thorough assessment, which considered all of the needs of the resident including social and religious care needs. The Annual Quality Assurance Assessment indicates the home could improve the information provided to prospective residents through making it available in other formats e.g. large print and audio. This needs to be actioned to ensure the information is suitable for all prospective residents. The ‘residents handbook’ seen in residents rooms needs to be updated as it make reference to the previous owners. DS0000004124.V368711.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident their health and personal care needs will be met. Care records are not person centred, they do not accurately reflect care needs. This has the potential to place residents at risk of harm. Improvement is needed in the management of medication so that residents who use the service are safeguarded from harm. Residents right to privacy is respected and the support they get from staff is offered in a away that maintains their dignity. EVIDENCE: A resident recently admitted had prior to admission been taking food supplements. There was no care plan in place for nutrition and no nutritional risk assessment for the resident. The resident has been prescribed food supplements to be given once a day. Records held showed the resident had not been weighed since admission. The resident told us they like to eat sandwiches as they ‘do not eat much’. DS0000004124.V368711.R02.S.doc Version 5.2 Page 12 A resident’s personal hygiene care plan states they ‘require one assistance to meet his hygienic needs’. The care plan is of a poor quality. It does not include whether the resident likes or needs a bath or shower, hair care, nail care, oral care. The assessment states ‘needs assistance with clean the dentures’. There was no evidence to indicate if this resident had been offered a bath or shower since admission 11 days ago. Records showed the resident had been seen by the general practitioner for a skin condition on the 14th July 2008, although there was no mention of this in the care plan. A carer told us that they do not help the resident with their personal hygiene. This is contrary to the information in the care plan. The resident appeared clean and tidy, although there was a strong smell of urine in the resident’s bedroom. We looked at the records of one resident with a diagnosis of diabetes, which is controlled by their diet. The assessment for this resident did not include they had diabetes. The care plan for diabetes stated ‘check blood sugar weekly’. The care plan had last been evaluated on the 5th July 2008 and stated ‘blood sugar remains stable’. The last recorded entry for the blood sugar levels was dated 6th November 2007. It was unclear how the staff could state that blood sugar levels remained stable, as there was no evidence to show they had been checked since November 2007. The care plan includes ‘give X diabetic diet’. It did not state what a diabetic diet is. Two care staff spoken with told us this resident was diabetic and this meant no sugar to be given. The trained nurse in charge on the dementia unit stated the resident was on a ‘normal diet’. The trained nurse was asked if any residents on the unit were diabetic. They told us of two residents who were diabetic this did not include the particular resident. We were told ‘no one else’ on the unit was diabetic. Another nurse spoken with also stated they were not aware this resident was diabetic. The nutrition care plan did not state the resident was diabetic. The action plan stated ‘weigh monthly’. The last recorded weight was 25th May 2008 on the nutritional risk assessment. The resident has been losing weight since January 2008. The action plan stated to re-weigh the resident in two weeks. There was no evidence in the care records to show this has been done. An entry in the nutritional care plan dated 30th May 2008 stated the resident has ‘Procal powder three times daily’. The medication administration record lists the Procal powder ‘take as directed’. We were unable to locate a tub of Procal for the resident. The manager designate was asked to establish if the Procal had been given on the day of the inspection as it had been signed for by the nurse on the medication administration record. The manager designate told us ‘it was given this morning but the carer did not tell the nurse that she had finished the container. Two other residents have had their Procal signed for this morning but none was given as the nurse just signed for it and did not check with the carers first.’ This is poor practice. The nurse on the dementia unit stated this resident was on a normal diet and did not have any food supplements. This nurse had signed for the Procal (food supplement) as being given that morning. She also told us the resident ‘does not need a food chart at present. Will closely monitor her weight and if losing weight put her on a DS0000004124.V368711.R02.S.doc Version 5.2 Page 13 chart & some special diet.’ The resident is on a food chart and the records show they had lost nine pounds in weight since January 2008. Written feedback from healthcare professionals who visit the home stated there is a ‘lack of clinical experience, no clinical leadership, staff need prompting on occasions to act on identified needs, rarely is there a trained nurses for the dementia unit and no Registered Mental Nurse on the staff.’ ‘Care can be very hit and miss depending on which nurse is looking after the patient’. ‘Staff need prompting to react to health needs on occasions’. We were not able to see a medication policy for the safe control and handling of medication for residents who live within the home. The manager designate did look for the policy and assured us that there was one available but stated that it must have been moved. This means that there was no written medication procedure available to ensure that the residents were safeguarded. The majority of medication seen was stored safely in a locked treatment room and also in a locked office upstairs. This means that residents’ medication was stored safely in order to protect residents from harm. We saw written records to ensure that medication was documented when it arrived into the home, however this was not always recorded every time. For example, we saw two boxes of medication for one resident that had not been recorded as received. This means that accurate counts and checks on medication could not always be undertaken to ensure that medication had been given as prescribed by a doctor. We saw some evidence of good practice to ensure medication could be checked. For example, the dates of opening of medication in boxed containers were recorded. It was therefore disappointing that balances of medication were not always recorded and carried forward onto a new medicine record chart. This would be seen as good practice, which would help in checking that medication had been given as prescribed by a medical practitioner. We saw a prescribed cream for the treatment of a skin disorder in the bedroom of one resident, however this had not been documented on the medication record chart and there was no evidence that it was being applied. The manager designate said that the family may have brought it in and not informed the staff. However, the cream had been in view of staff but nobody had taken responsibility to find out if it was required for treatment. This means that a prescribed treatment for a resident had not been checked with a doctor to see whether it was required and it had not been recorded or documented. The majority of the medicine records seen were well documented with staff signatures to record that medication had been administered to people living in the service or a code was recorded to explain why medication had not been administered. DS0000004124.V368711.R02.S.doc Version 5.2 Page 14 We saw accurate and up to date records for the disposal of medication. This helped to ensure that safe levels of medication were stored within the home. Some people were prescribed medication to be given when required. For example, we saw two care plans for residents’ who had been prescribed a medicine to calm and control their behaviour when required. The first care plan did contain written information to inform staff under what circumstances this medicine should be administered. The second care plan we saw did not contain up to date information about the resident’s behaviour. The most recent entry in the care plan for behaviour was dated 7th June 2008 stated ‘care continues as per plan’. The last entry that stated anything more detailed was on 10th May 2006 and stated, ‘continues with diazepam even though X can be aggressive at times’. The medicine records showed that staff had administered the medication on two dates 6th July 2008 and 15th July 2008. The daily notes seen for the resident did not reflect the reason why the medicine had been administered on those specific dates. For example, on 6th July 2008 there was no daily entry documented and on the 15th July 2008 the entry stated ‘X had a settled day’ with no reference to the fact that a calming medication had been administered. This means that staff are not following good practice to ensure that the health and welfare of people are safeguarded. Staff were seen to respect residents privacy and dignity. Male and female care staff are employed so residents are able to received personal care from someone of the same gender. Care staff told us they close curtains, tell residents what they are doing and keep them covered when giving personal care. A resident on the dementia unit was seen wearing slippers, which were badly stained with dried food. Staff need to be mindful of this to ensure this persons dignity is maintained at all times. A requirement made at the last Key Inspection has been removed as it no longer meets current CSCI guidance. DS0000004124.V368711.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of social and recreational activities for residents has improved, although they are not person centred. Residents are able to keep in touch with their family, friends and representatives. Residents have a choice of nutritious meals and snacks at a time and place to suit them. EVIDENCE: The home employs an activity co-ordinator for 30 hours a week. She told us she is now able to spend the time focusing on the provision of activities in the home. She is spending time with residents finding out what they would like to do. Workshops are in the process of being developed for example, gardening, woodworking, and painting on glass. On the day of the inspection there was musical entertainment in the afternoon and this was well attended by the residents. Equipment has been provided for the snoozelan on the dementia unit, although this facility needs further development for example, adding colour, textures, and sounds to the room. There is currently no budget for activities. A garden party has been planned for August to enable the home to start up a ‘residents comfort fund’. Social care plans were not in place for all residents’ case tracked. A social/spiritual care plan for a resident included in the action plan ‘identify X interests and skills and provide opportunities to DS0000004124.V368711.R02.S.doc Version 5.2 Page 16 utilise them’. There were no interests included in the action plan and did not show consideration of the residents spiritual needs. Records showed the resident’s activity plan had not been completed since 30th June 2008. Written comments from a visiting healthcare professional to the service included, there is ‘little stimulation for service users in the dementia unit. Activities co-ordinator has improved situation.’ The chef sees all of the residents each day after breakfast to enable them to choose their meals for the rest of the day. A good choice of meals is available including a cooked breakfast every day. Staff were observed assisting residents to eat in a discreet and sensitive manner. DS0000004124.V368711.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 17 & 19 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents who use the service are able to express their concerns and have access to the homes complaints procedure. Residents are not protected from abuse. EVIDENCE: The Annual Quality Assurance Assessment states, ‘the home ensures all the service users are informed of the complaint procedures. Copies of the complaints form are available at the entrance of the home and within the homes service users guide’. ‘All complaints are investigated and responded to within given time scales records kept of these’. The homes complaints procedure and records were seen. They have revised the complaints procedure since the last inspection to include the timescale for dealing with complaints. Records showed four complaints had been received since the last inspection relating to communication, staffing levels, activities, and quality issues. These had all been resolved to the satisfaction of the complainants. A concern was raised with us and the complainant took this up directly with the home. The Annual Quality Assurance Assessment states ‘the home ensures CRB and POVA checks are completed before a member of staff can work. Two DS0000004124.V368711.R02.S.doc Version 5.2 Page 18 satisfactory references are also required to commence work. All staff are trained’. This is not an accurate statement as a nurse and two care staff spoken with had not received any training about abuse or care of people with dementia. The staff records for a care assistant and the duty rota showed she was working in the home without a Povafirst or Criminal Records Bureau check being applied for. The home had not done a Nursing and Midwifery Council (NMC) Personal Identification Number (PIN) check to make sure she was still registered to practice until this information was requested on the day of the inspection. DS0000004124.V368711.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the décor of the home and further equipment has been purchased to provide a more homely and comfortable environment. Some further improvement is needed to ensure all areas of the home are safe, pleasant, homely and hygienic. EVIDENCE: The snoozelan on the dementia unit is now equipped with some sensory equipment, and furniture and is being used by the residents. The carpet in the lift has been replaced. The Annual Quality Assurance Assessment states they have purchased more furniture for the garden and conservatory area. It is evident from observation the back corridor downstairs needs redecorating. The rooms of residents’ case tracked were seen. One resident invited us into their room. They did not have a key to the room and upon entry there was a DS0000004124.V368711.R02.S.doc Version 5.2 Page 20 strong smell of urine. Another bedroom seen did not have a towel rail in the bathroom, lagging was missing off part of the pipe and the rest was not secure and could be pulled off. The pipe was warm to touch. The washbowl was wet and was labelled with the name of another resident. On the dementia unit there is no hand washbasin in the sluice and prior to breakfast there were dried food stains on the tables and pieces of biscuit and cake on the floor in the lounge. Written comments from a visiting healthcare professional said, ‘I have found the home dirty at times. After meals dining area not always cleaned. Sticky tables, chairs and floors’. The laundry had a pile of soiled linen on the floor. This is poor practice regarding the control of cross infection. The label on the fire extinguisher showed it had been serviced in January 2008. Discussion with staff confirmed there are no records for bedrail and window restrictor checks. They stated they do a visual check of these each month but they are not recorded. DS0000004124.V368711.R02.S.doc Version 5.2 Page 21 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. There are not enough competent staff on duty in the dementia unit to ensure residents receive the appropriate support needed which places them at risk of harm. Staff are not receiving induction training and specialised training to enable them to carry out their role effectively to meet residents needs and to protect them from harm. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. EVIDENCE: Staff spoken with told us they ‘have been short of staff – new staff starting now.’ ‘Getting better’. Written comments from staff told us ‘since takeover of the home with the new owner many staff left the home. Resigned and left the home with less staff, now the new deputy manager is recruiting new staff to fill those vacancies which were left by staff who left’. Staff told us after 5pm each day there is only two care staff on the dementia unit and one nurse for the entire home. This is not in line with the home’s published staffing levels in their statement of purpose. The statement of purpose states for Pine/Willow unit there are ‘from 8am until 9pm there are two registered nurses for the whole nursing home (36 beds). The statement of purpose for Beeches unit states ‘from 8am until 8pm there is a registered nurse specifically for the unit’. Staff rotas for the week of the inspection show on five days that week there is only one nurse on duty after 5pm. Comments in surveys received from visiting healthcare professionals to the home told us, ‘only one qualified DS0000004124.V368711.R02.S.doc Version 5.2 Page 22 member of staff on duty in the afternoons to cover both units.’ ‘Dementia unit is poorly staffed and no mental health nurse, rarely registered nurse upstairs.’ The manager designate told us the home does not currently employ any specialist mental health nurses, although information submitted to us by the owner following the inspection show they employ a nurse who is mental health trained and a nurse who has a post registration certificate in dementia care, level two. The off duty for the period of the inspection shows the mental health nurse works at the home as a bank nurse two days each week. Three staff spoken with which all work on the dementia unit told us they had not received any dementia care training. Comments in surveys received from visiting healthcare professionals to the home told us ‘staff lack understanding of dementia, lack of experience’. Comments in surveys received from staff told us ‘ it would be nice to have ongoing training to meet the need of disabilities of our individuals i.e. specialist training to assist those who have had CVAs, those with dementia, those who have Downs Syndrome to assist in managing challenging behaviours of some individuals’. ‘It would be nice to have continuous ongoing training to assess and update my knowledge.’ The home employs male and female staff from a multi-cultural background. One care assistant spoken with who was working on the dementia unit had a poor command of English and she told us ‘she was not good with English, she was just learning’. Comments in surveys received from visiting healthcare professionals to the home told us, ‘many staff all from overseas and English is not there first language. This makes communication poor and difficult to form relationships with people with dementia’. The Annual Quality Assurance Assessment stated, ‘all staff receive induction training’. This statement is incorrect as two care staff told us they had not had any induction training. There was no evidence of any induction training in their staff files. The manager designate told us no syringe driver training has taken place in the home since the last inspection. The Annual Quality Assurance Assessment states that more than 50 of the care staff have NVQ level two or above. The Annual Quality Assurance Assessment states ‘the home ensures CRB and POVA checks are completed before a member of staff can work. Two satisfactory references are also required to commence work. All staff are trained’. This is not an accurate statement as a nurse and two care staff spoken with had not received any training about care of people with dementia. The staff records for a care assistant and the duty rota showed she was working in the home without a Povafirst or Criminal Records Bureau check being applied for. The home had not done a Nursing and Midwifery Council (NMC) Personal Identification Number (PIN) check to make sure she was still registered to practice until this information was requested on the day of the inspection. DS0000004124.V368711.R02.S.doc Version 5.2 Page 23 DS0000004124.V368711.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed appropriately, which has the potential to place residents at risk of harm. EVIDENCE: The registered manager has resigned since the last Key Inspection was completed in January 2008. The manager designate told us she took up her position on the 15th July 2008. Comments in surveys from visiting healthcare professionals told us they were concerned about the ‘language barriers’, ‘no manager, no clinical lead, no RMN’. Staff told us since there has been a change of manager ‘a small nucleus of staff have bonded very well together in supporting the deputy manager and this has created a very happy atmosphere in which to work under difficult conditions’. We are ‘happier, like to come to work, less stressful’. DS0000004124.V368711.R02.S.doc Version 5.2 Page 25 It is evident from the minutes of the ‘Quality meeting’ with staff at the home which took place on the 17th April 2008 they discussed the need to carry internal audits to see if the service is meeting identified National Minimum Standards (NMS). A further meeting was set for May 2008. The manager designate told us this meeting did not take place. The minutes from a meeting on 2nd June 2008 showed the deputy manager had met with seven staff to discuss areas which needed improvement. We asked to see the monthly visits carried out by the provider. The manager designate told us she could not locate any only the blank format. The manager designate told us there had been a maintenance audit but she had not received the information from this audit an a medication audit had been carried out by an external pharmacist on the 8th July 2008. She told us following the recommendations made, no action plan had been put together as yet although some action has been taken. The Annual Quality Assurance Assessment submitted does not give a reliable picture of the service. We were not able to inspect the management of residents’ monies, as the manager designate was unable to locate the key to the safety deposit box where the money is held. Staff spoken with told us they had received moving and handling and fire training. There were no records held for bedrail and window restrictor checks. We were told these are done each month but are not recorded. DS0000004124.V368711.R02.S.doc Version 5.2 Page 26 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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 2 DS0000004124.V368711.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement Timescale for action 12/09/08 2. OP27 18(1) 3. OP29 19(1), schedule 2 Residents and/or their representative must be consulted about their care plan. The care plan must be kept under review and revised at any time when it is necessary to ensure that their care needs are identified and a clear action plan is put into place for staff to follow and prevent residents from harm. Timescale of 31/03/08 not met. A statutory requirement notice was issued. There must be suitably qualified 30/09/08 competent and experienced staff working at the home at all times to ensure the service can meet the care needs of residents who require specialised care such as dementia care. Two written references must be 03/09/08 obtained for all staff prior to commencing work at the home to ensure that residents are protected from harm. Timescale of 31/03/08 not met. A statutory requirement notice was issued. DS0000004124.V368711.R02.S.doc Version 5.2 Page 28 4. OP29 19(1), schedule 2 5. OP30 18(1) 6. OP30 18(1)(3) 7. OP33 26 Staff must not commence work at the home until a minimum of a POVAfirst check has been received to ensure that residents are protected from harm. Timescale of 31/03/08 not met. A statutory requirement notice was issued. New staff must receive induction training and training appropriate to their role upon employment and updates at regular intervals to ensure residents and staff working in the home are not placed at risk of harm. The competency of the staff must be reviewed to ensure they have the skills and knowledge to identify and meet the residents care needs. The provider must carry out monthly unannounced visits to the service in accordance with this Regulation to monitor the quality of the service being provided to the residents who live in the home. 03/09/08 31/08/08 30/09/08 31/08/08 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 OP1 Good Practice Recommendations The homes statement of purpose and service user guide should be available in other formats to meet the needs of the residents and should be given to all prospective residents and their representatives. The medicine policy should be easily available to staff in order to ensure that the health and welfare of residents taking medication are safeguarded. A system should be introduced to ensure that accurate medicine audits can be done and check that people who DS0000004124.V368711.R02.S.doc Version 5.2 Page 29 2. 3. OP9 OP9 4. OP12 5. 6. 7. 8. 9. OP19 OP26 OP26 OP30 OP38 use the service have been administered medication according to the directions of a General Practitioner. The provision of social care needs to be person centred to make sure residents recreational and spiritual needs are met. The owner to support this provision should provide a designated budget. The protection on the hot water pipes should be checked to ensure that it is secure to ensure residents are not at risk of harm. It is strongly recommended that hand washing facilities are provided in the identified sluice on the first floor to prevent cross infection. Infection control practice should be reviewed relating to how washbowls are cleaned and stored to prevent cross infection. All qualified staff should receive training on syringe driver management. Records of maintenance checks for bedrails and window restrictors should be maintained to demonstrate that these safety checks are being done. DS0000004124.V368711.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000004124.V368711.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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