Inspection on 31/01/06 for The Old Parsonage

This inspection was carried out on 31st January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Old Parsonage 28/01/09

The Old Parsonage 13/02/08

The Old Parsonage 20/02/07

The Old Parsonage 22/05/06

The Old Parsonage 15/07/05

The Old Parsonage 27/01/05

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Old Parsonage (The) The Street Broughton Gifford Melksham Wiltshire SN12 8PR Lead Inspector Susie Stratton Unannounced Inspection 31st January 2006 9:45 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 Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 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. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Old Parsonage (The) Address The Street Broughton Gifford Melksham Wiltshire SN12 8PR 01225 782167 01225 782167 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) Roseville Care Homes (Melksham) Limited Mrs Christine Ann Jones Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20) Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The staffing levels set out in the Notice of Decision dated 23 December 2004 must be met at all times 15th July 2005 Date of last inspection Brief Description of the Service: The Old Parsonage is a 19th century listed building that has been converted for use as a care home and is situated on the edge of Broughton Gifford village in the north west of the Wiltshire countryside. The home is registered to provide nursing and care for 20 people with dementia and/or mental disorder who are aged 65 or over. On the day of the inspection, there were 20 persons resident in the home. Accommodation is provided on 2 floors of the home and consists of 14 single rooms and 3 double rooms. There is an accessible paved courtyard area to the rear of the building. Parking space is available. The home was purchased by Roseville Care Homes Ltd on 24th December 2004. The responsible individual is Mrs Edith Parkin. The registered manager is Mrs Christine Jones, who is a registered mental health nurse; she leads a team of nursing, care and ancillary staff. Broughton Gifford is about 10 minutes away from Melksham to the north and Bradford on Avon to the south. Both towns have railway stations. The M4 is about 30 minutes drive away. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on Tuesday 31st 2006 between 10:45am and 5:00pm in the presence of Mrs Christine Jones, registered manager. Two inspectors were present throughout the inspection. During the inspection, the inspectors met with most residents. As many of the residents are unable to communicate, an emphasis was placed on observing care. Most of the residents were in the main sitting rooms throughout the inspection, although some preferred to walk about the ground floor. The inspectors also toured the home and met with one of the other registered nurses, some of the carers, two cleaners and the chef. During the inspection, among other documents, the inspectors reviewed the draft statement of purpose, complaints records, staff employment records, staff rosters, supervision records, accident records and maintenance records. What the service does well: What has improved since the last inspection? The home environment has been much improved since the previous inspection. All of the stonework on the outside of the building has been cleaned and external woodwork painted. All of the old unattractive linoleum has been removed and a light, wood-effect flooring put down. The home has been redecorated throughout in attractive colours. Curtains have been replaced. There is new bedroom furniture, which is in keeping with the rest of the atmosphere of the building. New chairs have been delivered. The appearance of the dining room is very much improved, this includes new chairs and dining tables. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 6 Two of the four requirements and six of the seven recommendations identified at the previous inspection had been addressed. One of the requirements had been addressed in part and the other showed some progress. All medicines are stored in metal cupoards or a trolley, which conform to guidelines. Residents with complex manual handling care needs have had their manual handling needs assessed. All commode buckets, bed rails, picture rails and wardrobes were clean and free of dust. A system for ensuring staff supervision had been commenced. More staff are now involved in drawing up and evaluating residents care plans. Risk assessments for falls include an assessment of the residents footwear. Records show that the medicines refrigerator is now at or below 6C. One residents care plan in relation to their individual medication has been reviewed. A copy of the most recent Health Protection Agency guidelines has been obtained. Systems have been put in place to effectively manage residents moneys. What they could do better: Fourteen requirements and twelve good practice guidelines were identified at this inspection. Currently there is only one assisted bathroom available in the home. The Commission must be informed in writing of when the bathroom on the ground floor is to be made available for residents. Appropriate equipment must be provided so that the second assisted bathroom on the first floor can be brought back into use. The one usable bath on the first floor must be fully cleaned and repaired or replaced. Toiletries belonging to residents should be labelled with their name and returned to their rooms. Any toiletries, which are used up or no longer needed, should be disposed of. Bathrooms and WCs should be easily identifiable by door labelling or other means. Residents’ room doors should have door knobs or push-plates. All medicines administration records must be fully completed at the time of administration, to provide evidence that medication has been given as prescribed to residents. Where medicines administration instructions need to be completed by hand, these should be signed and checked by a second person, who should also sign the document. All urinary catheterisations and complex wound dressings must be carried out under strict aseptic procedures, to prevent significant risk of cross-infection to residents. Health Protection Agency guidelines should be considered when purchasing new uniforms for staff. When new uniforms are provided, a policy and procedure to direct staff on safe infection control measures for uniforms is needed. One additional carer must be on duty during all the hours when residents are cared for in the lounge, to ensure that they are fully supervised at all times. The manager must not be performing administrative or managerial tasks when Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 7 she is the only registered nurse on duty. The manager must be able to verify that all applicants are suitable for their role where a reference is not written in English, this is a matter which has brought up previously. The Commission must always be informed in writing on each and every occasion of any event which may affect the well-being or safety of residents and actions taken. Care reviews must be arranged for all residents who have been assessed as having complex manual handling care needs, to ensure professional advice on their specific needs and relevant equipment is in place. A system for continuous supervision of staff must be put in place to ensure that all staff are supported in ensuring that correct and safe manual handling takes place when residents are being transferred or moved. A similar requirement was identified at the previous inspection. The manual handling coordinator for the home must be given opportunity to research other facilities which care for persons with complex manual handling care needs due to mental health needs, to ensure that staff in the home can meet the manual handling needs of their residents. The recently completed manual handling assessments should be reviewed, to assess if the home has enough hoists. More lifting slings should be provided to assist residents with manual handling needs, this matter was identified at the previous inspection. Hoists and weighing scales must be regularly serviced by an appropriate person. The wording of care plans should be precise, to clearly describe residents’ nursing and care needs and detail actions to be taken in measurable terms. Where residents are assessed as being at risk of pressure damage, a care plan should always be in place to direct staff on how risk is to be reduced. All frequent care charts should be fully completed at all times. More registered nurses should be trained in male urinary catheterisation. Residents with frail skin and those at high risk of pressure damage should be offered drinks which are high in vitamin C, such as orange juice. 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. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 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 Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 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 the following standard(s): 1 & 3. The home does not offer intermediate care, so 6 is N/A All residents have a full assessment of their nursing and care needs prior to or at admission. Prospective residents and their supporters are not given all the information that they need to make an informed choice about where to live by the home. EVIDENCE: The home’s statement of purpose is currently in a draft form. This draft statement of purpose presented a comprehensive document, which provided full information about the service and would make a useful basis for a service users’ guide. Until the home has a service users’ guide, prospective residents and their relatives are informed about the service by a brochure. This does not include all the areas detailed in standards or regulation, so residents and their supporters will not be fully informed about the service. Prospective residents have a full assessment of their nursing and care needs prior to and at admission by the registered manager, who is a registered mental health nurse. All aspects of their nursing and care needs are documented in detail. It was noted as good practice that where a resident was admitted to hospital for a period of time that the registered manager always re-assesses if the home can continue to meet their needs. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7, 8 & 9 All residents have assessments completed and care plans drawn up, to reflect their range of nursing and care needs. There are safe systems in place for the storage of drugs. Not all medicines administration records have been completed, so the home is not able to demonstrate that all residents have been administered their drugs as prescribed. EVIDENCE: Following assessment, all residents have care plans put in place, to direct staff on how to meet resident’s individual nursing and care needs. Care plans include all relevant areas, but some would be improved by being more specific and avoiding generalistic language. The registered manager is in the process of developing a key worker system, this will assist in improving clarity in the wording of care plans. Individualised environmental risk assessments are performed and where risk, such as a risk of falls is identified, a care plan is put in place to direct how risk is to be reduced. The home has completed revised manual handling assessments on all residents, using a traffic light method, to identify residents who have high, medium or low manual handling needs. Residents are assessed for risk of pressure damage, however re-assessments are not made Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 11 on a regular basis and while equipment is provided to prevent pressure damage and observed practice to prevent pressure damage reflects good practice guidelines, the home did not have individual care plans to direct staff on how to prevent pressure damage. There was evidence of regular consultations with external health care professionals such as residents’ GPs, the chiropodist and Tissue Viability Nurse. One resident’s records showed that they had become unwell. They showed that there was prompt referral by the home to this person’s GP, to ensure their symptoms were treated. Records relating to wound care are clear and show the wound’s response to treatment. It is much to the home’s credit that one resident who was admitted with complex pressure sores had been successfully treated and that the sores had healed while they have been in the home. The home maintains frequent care records for frail residents. Records of care provided and fluids given are fully completed during the day and for some, but not all, nights. Night staff need to all be advised that they must fully complete such records, to provide evidence that frail residents are receiving the care that they need. Where residents need urinary catheters, clear records are maintained. Only one registered nurse is trained in male catheterisation and as a resident could need their catheter changing when the only registered nurse trained to do this is on not on duty, more registered nurses should be trained in the procedure. Suitable storage facilities are provided for medicines. Records relating to controlled drugs are maintained in full. Limited life medicines have their expiry date noted. The home has full systems in place for disposal of drugs, which reflect recent legislative changes. Eight of the medicines records had not been completed and the records for one resident who no longer needed a regularly prescribed medication had not been completed at all times. All medicines records must be fully completed at the time of administration and if medicines have not been given, the reasons must be documented on every occasion to provide evidence that medicines have been administered as prescribed. Some medicines instructions had been completed by hand, when this is necessary, to ensure that the resident’s GP’s instructions are being followed, such records should be checked, signed/initialled and counter checked by a second person. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12, 13 & 15 The Old Parsonage has put a lot of work into developing activities and links with the local community. Due to the dependency of residents and the numbers of staff on duty, the activities programme is not always fulfilled. The home offers a supportive approach to providing meals to this very complex client group. EVIDENCE: The Old Parsonage now has an activities programme, which is displayed in the front entrance hall. All residents have full social care plans in place; these are individually drawn up and reflect important matters for each resident, such as when they would like to go to bed and how often they wanted to have their hair done. Records of larger group activities, such as music and movement are maintained. One of the sitting rooms showed a large collage which the residents had been supported in making. On the day of the inspection, the activities programme documented that one-to-one activities were planned for the morning. No such activities were observed taking place during the morning and, due to the care needs of the range of residents, most of the residents in the sitting room spent most of the morning with no activities and no direct supervision from staff (see Standard 27 below). The home have successfully developed improved links with the local community. Local religious groups come in to support residents. Staff take Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 13 residents out when they go on small messages, such as down to the shops or chemist. Relatives are encouraged and the manager reported that with the newer residents, many relatives visit regularly. Many of the residents are frail and need assistance to eat. On the day of the inspection ten residents needed to be fed their meals and others needed close supervision. Staff were observed to sit with residents when they fed them their meals. Due to the number of residents needing to be fed their meals, carers had to feed two residents their meals at the same time, this is not best practice. As well as feeding residents their meals, carers also had to observe other residents, reminding them to eat, when their attention wandered and encouraging them when they did feed themselves. One resident was observed to be eating their meals with a knife; this was because their cutlery had been placed on the tray the wrong way round. As so many residents need to be fed their meals, carers are not able to ensure that residents who can feed themselves and do not eat in the dining room can be adequately supported (see Standard 27 below). The chef showed a very detailed knowledge of the residents and what they liked to eat. This is a complex area, as most of the residents are not able to verbally express a preference. He reported that he watches meals which are returned and those which are eaten well by residents, to try and prepare meals that residents like. It was noted as good practice that several of the residents are able to have a cooked breakfast. The chef reported that he cooks all the meals from fresh ingredients and it was noted as good practice that he makes his own soups. Residents who need assistance with fluids have records to provide evidence of the amount of drinks they are taking. These records are completed in detail during the day. Residents at risk of urinary infections are given Cranberry juice. This is regarded as good practice. Current research indicates that residents with frail skin and those at risk of pressure damage should be offered drinks high in vitamin C, such as orange juice. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16 & 18 The Old Parsonage has a complaints procedure, which works in practice. The home works within local vulnerable adults procedures and regular training is provided for staff. EVIDENCE: The manager maintains a complaints register. It was noted as good practice that she documents all matters raised, including informal concerns, not just written complaints. The manager has experience of working within local vulnerable adults procedures and has shown that she takes relevant action where indicated. Where residents need equipment to ensure their safety, such as safety rails, this is documented and regularly reviewed. Staff have been trained in abuse awareness and the manager reported that she is planning to expand training further. The home’s whistle blowing procedures work in practice. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19, 20, 21, 22, 23, 24 & 26 The home’s environment has been much improved since the previous inspection. Most aids to support frail residents are provided. Residents’ well being will be affected as currently there is only one assisted bathroom. This one bath is not clean and the surface is rough. The home is clean throughout. Residents could be put at risk by the home not using aseptic procedure to perform complex nursing procedures. EVIDENCE: The home environment has been much improved since the previous inspection. All of the stonework on the outside of the building has been cleaned and external woodwork painted. This much improves the first impression of the building. All of the old unattractive linoleum has been removed and a light, wood-effect flooring put down. The home has been redecorated throughout in attractive colours. Curtains have been replaced. There is new bedroom furniture, which is in keeping with the rest of the atmosphere of the building. New chairs had just been delivered and were being placed around the home at the time of the inspection. The appearance of the dining room is very much improved and new chairs and dining tables. All these improvements greatly Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 16 improve the atmosphere of the Old Parsonage, making it look like a home. Residents’ room doors have not had handles or push-plates fitted and some doors already showed finger marks appearing. Only one assisted bathroom was available for use. This is because the assisted bathroom on the ground floor was being up-graded and one of the bathrooms on the first floor could not be used, as the home did not have a hoist which could be used with the bath. No workers were observed in the bathroom downstairs, which was not in a usable state. Staff said that the bathroom had been in this state for a period of time, and they did not have information on when the builders were to return. The home had not informed the Commission that they were no longer able to conform to Standard 21.4. They are reminded that the Commission must be informed of any matter which adversely affects the well being of service users and actions taken to address the matter. The one bath which could be used showed different coloured ingrained staining to its surface. Due to the risk of cross-infection to residents presented by unclean baths, all baths must be fully cleaned after each use. The surface of the bath was rough to touch and could have the potential to cause tissue damage to residents with frail skin. Pressure damage risk assessments showed that there were several residents with frail skin cared for in the home. The one bathroom which was in use, showed a range of toiletries left in the room, some of which had been fully used. All items no longer needed should be disposed of and residents own items should be labelled with their name and returned to their room. None of the bathrooms or WCs had indicator signs of their doors. In order to support the retention of continence for persons with dementia care needs, appropriate signage is needed on such doors. Grab rails have been provided as part of the up grading of the home. Frail residents were cared for in variable height beds. Electrically operated pressure relieving equipment was provided where indicated. The home only has one mobile hoist to assist residents with complex manual handling care needs. The recently completed manual handling risk assessments should be reviewed, to assess if one hoist is sufficient to meet the needs of the number of persons with complex manual handling care needs. At the previous inspection, the home were advised to provide more lifting slings; at present the home only has one such sling. More slings are still needed and should be provided in different sizes, to meet the varying needs of residents in the home. The home is clean throughout and the cleaners were observed to be very careful in performing their duties. The laundry was clean and well organised, with systems in place to ensure the separation of potentially infected laundry. The cleaners perform the laundry in the morning, with staff supporting them if items need to be laundered later on in the day. This was observed to take place during the afternoon by one of the carers, this is of concern as while the laundry clearly needed to be performed, at the same time residents who needed support were not being supervised in the sitting room (see Standard 27 below). Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 17 One of the members of staff on duty was not wearing a uniform and others were only wearing the tunic tops of uniforms. The manager reported that the owners were currently researching different types of uniform, so that all staff could present a smart appearance, to reflect the changes made to the home. As staff uniforms may be a factor in cross infection, the home should ensure that they consider Health Protection Agency guidelines on uniforms, when providing new uniforms. A policy should also be drawn up, to ensure that all staff are aware of their individual responsibilities for wearing a fresh uniform every day and safe practice when laundering uniforms. The home does not use aseptic procedure when performing urinary catheterisations or complex dressing procedures. This is contrary to Health Protection Agency guidelines and the home must ensure that all such procedures are carried out using strict aseptic procedure, including sterile gloves and a sterile field. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 While the home are meeting their Conditions of Registration in relation to minimum staffing levels, the dependency of residents has increased, which means that vulnerable residents with complex behaviours are not properly supervised. This means that the home cannot demonstrate that such residents are safe at all times. The manager is performing administrative duties, which affects her role when she is the only registered nurse on duty. Recruitment systems are largely in place, apart from one matter which was identified at a previous inspection and has not been addressed. EVIDENCE: The Old Parsonage is required to staff the home in accordance with a Condition of Registration set by the Commission. They were largely meeting the requirements of this Condition although a care assistant was observed to be performing a non-nursing duty during the afternoon of the inspection (see Standard 26 above). These staffing levels were agreed when the home cared for a proportion of persons who needed residential, not nursing care. All of the residents currently in the home are assessed as needing nursing care. The Condition of Registration specifies that the numbers stated are the minimum levels required to be on duty. On the day of the inspection, there were three residents who were frail and needed frequent attention, to ensure that their position was changed and that they were given sufficient fluids. The other residents who were in the sitting rooms needed support with a range of activities of daily living. One of the residents was documented to be at risk of falls and need close supervision to ensure their safety. Another resident needed encouraging to take regular fluids. Some service users had care plans Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 19 relating to complex behaviours and their need for observation. The registered manager reported that the dependency of residents had increased over time, some residents who had been in the home for a period of time were becoming frailer and residents who had been recently admitted all showed complex mental health needs. Both of the Inspectors considered that the dependency of residents had increased since the inspection of 27th January 2005. On the day of the inspection, both Inspectors observed that residents spent most of the time on their own, with no supervision, in one of the two sitting rooms. This was not because staff were avoiding providing care; this was because they were all providing care to residents who were not yet up and/or those who had complex needs. Additionally where residents needed two carers to bath them, this could take place in the upstairs bathroom only and left only one carer to manage the needs of the rest of the residents in the home. Where residents needed to have their position moved every two house, this needs two carers. During the afternoon, the number of carers reduce. On one occasion, the Inspector went to look for staff as residents in the sitting room clearly needed attention, but was not able to find any. This was because the registered nurse and carer were providing care to one resident with complex needs and the other carer was organising the full laundering of all bedding and clothing for this resident. During the inspection, the inspectors observed one service user who spent their time sitting on the floor and moving round on the sitting room floor, sometimes trying to get up. At various times this service user was seen pulling at the clothing of other residents. One resident was observed to aim a blow at another resident. One resident was observed to attempt to rise on several occasions and could have been at risk of falling. Some residents were seeking help and calling out. One resident needed support with clothing themselves again. Without full supervision all such residents are at risk and accident or injury residents is likely. Residents all appeared calmer and reassured when someone was sitting with them and showed fewer complex behaviours. As noted in Standard 12 above, the activities programme was not met during the morning. Additionally it was observed that residents were not given a morning drink until after 11:30am. All of this is of concern. The inspection indicated that staff were working very hard to meet resident’s needs but with the numbers on duty were not able to. One more member of staff is needed to be on duty from the time residents get up until the time they are in bed, to ensure that residents in the sitting rooms can be properly supervised and care needs of residents with complex nursing and care needs met. The Condition of Registration states that the manager must work ten hours in addition to the registered nurses on duty. This is so that she can perform the roles of staff supervision and audit that residents’ care needs are being met. Outside these hours, she is the only registered nurse on duty responsible for the nursing care needs of the residents. The home does not have any administrative support, so the manager performs this function within her role this includes, photocopying of information for newly employed staff, Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 20 performing all administrative functions relating to the recruitment of staff, managing residents’ pocket money accounts, answering the phone and some roles relating to co-ordinating improvements to the home. While the manager performs such roles, she is not available as the registered nurse on duty. This is contrary to the home’s Conditions of Registration. The files of four recently employed staff were reviewed. All files included proofs of identity, evidence of previous employment, health declarations and pova clearance. Interview assessment tools had been used to assess potential member of staffs’ suitability for the role. Three of the files showed two references, however one of the new employees showed two references in a language which was not English. As this person did not have previous caring experience, it was not possible to ascertain from the file if their referees had considered them to be suitable for their current role. This matter had been brought up with Roseville Care Homes in April 2005 and the owner advised that the registered manager needs to be made aware of the contents of any reference in a foreign language and a note made on the staff member’s file. It is of concern that this issue has been raised previously but that action has not been taken to address it. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 & 38 Residents are supported by an experienced manager who is also a registered nurse. Safe systems are in place for the management of residents’ money. Residents could be put as risk as not all staff have been adequately supervised. The home has systems in place to meet health and safety, although residents are likely to put at risk by poor manual handling practice and the need for regular servicing of certain equipment. EVIDENCE: The registered manager is an experienced manager and registered mental health nurse. She shows a detailed knowledge of the nursing and care needs of her residents and is particularly knowledgeable in complex mental health care needs, which may affect her residents. She presents an innovative and flexible approach to her role. It was noted for example, that she performs a regular review of all accidents to residents, to identify any trends. She is supportive to newly employed staff and assesses their skills and performance, to ensure that they are introduced gradually to their roles. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 22 A clear system has been put in place for the management of residents’ personal money. All residents have their own book, in which debits and credits are listed and receipts are maintained. These account books can only be accessed by one person and are audited regularly by a second person. The manager has commenced a system for supervision of staff as was required at the previous inspection. However a review of the file shows that not all supervisions have been completed for all staff, so the requirement has not been addressed in full. This matter needs further development. This may relate to other pressures on the manager’s time (see Standard 27 below). Inadequate time for supervision may be a factor in the poor manual handling practice observed (see below) A review of records shows that all staff have been regularly trained in matters relating to health and safety. There is only one mobile hoist in the home, and records indicate that it has not been serviced recently. Hoists need annual servicing to ensure that residents are not put at risk. The home’s scales also have not been regularly serviced. Changes in residents’ weights can be an indicator for a wide range of medical conditions; therefore records of residents’ weight must be accurate. As at the previous inspection, a range of practice relating to manual handling was observed. All residents’ manual handling needs have been assessed since the previous inspection, but not all have been assessed by a specialist professional. All staff have been trained in manual handling by a qualified trainer, however poor manual handling practice was observed throughout the inspection. The one lifting sling in the home was not observed to be used by any carers. Generally carers would move residents by pulling up them up under their arms; this is regarded as high risk practice for both staff and residents. Often staff would not advise the resident of what they were doing before moving them, as had been detailed in residents’ care plans. Where residents needed to be moved in wheelchairs, staff tilted the wheelchairs back and no foot-rests were observed to be used. One tall resident’s feet still were touching the floor when this was done. Moving a person in a standard wheelchair by tilting them back is unsafe to both the wheelchair user and staff, as wheelchairs are not designed to be used in this way. Concerns about manual handling practice were discussed in detail with the manager and registered nurse responsible for manual handling. The discussions indicated that this poor practice related to a range of areas. This includes some residents who did not have the correct equipment they needed. It was agreed that, using the manual handling assessments, such residents would be identified and case reviews organised with their funding authorities, to ensure that assessments by relevant professionals took place to receive direction on correct equipment to meet the individual resident’s needs. Some of the residents have complex, specific manual handing needs, which relate to Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 23 their mental health care needs. The registered nurse responsible for manual handling will research how other similar facilities manage the manual handling care needs persons who have dementia and put further training in place. Some of the reason why staff are performing unsafe practice may also relate to the pressure on staff to meet residents’ needs and that they may be performing unsafe manual handling practice as they regard this as quicker. This matter will need to be dealt with during supervision and will be assisted when there are more staff on duty. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 24 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 1 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 1 3 3 3 x 2 STAFFING Standard No Score 27 1 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 2 x 2 Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 25 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. 2. Standard OP9 OP21 Regulation 13(2) 23(2)(j) Requirement All medicines administration records must be fully completed at the time of administration. The Commission must be informed in writing of when the bathroom on the ground floor is to be completed and available for service user use. The Commission must always be informed in writing on each and every occasion of any event which may affect the well-being or safety of service users and action taken to support service users. The one usable bath on the first floor must be fully cleaned and repaired or replaced. Appropriate equipment must be provided so that the second assisted bathroom on the first floor can be brought back into use for service users. Service users with complex manual handling care needs, where staff need to use techiniques which may put the service user or staff member at risk, must be assessed by an DS0000061474.V275591.R01.S.doc Timescale for action 28/02/06 28/02/06 3. OP21 37(1)(e) 28/02/06 4. 5. OP21 OP21 12(1)(a) 13(3) 23(2)(j) (n) 10/03/06 31/03/06 6. OP22 13(5) 28/02/06 Old Parsonage (The) Version 5.1 Page 26 6. OP26 13(3) 7. OP27 18(1)(a) 8. OP27 18(1)a(3) ab 19(4)b i sce2(5) 9. OP29 10. OP36 18(2) 11. OP38 23(2)(c) 12. OP38 13(5) appropriate professional and their advice on manual handling complied with. (Addressed in part, assessments have taken place but more in-put from external professionals is needed. The advice on manual handling has not been complied with by staff.) All urinary catheterisations and complex wound dressings must be carried out under strict aseptic procedures, including sterile gloves and a sterile field. One additional carer must be on duty during all the hours when service users are cared for in the lounges, to ensure that they are fully supervised at all times. The manager must not be performing administrative or managerial tasks when she is the only registered nurse on duty. The manager must be able to verify that all applicants are suitable for their role where a reference is not written in English. (This is a matter which was brought up during an inspection on 12th April 2005.) The persons registered must ensure that a system for supervision has been put in place for all staff. (Work has commenced to address this requirement but it has not been addressed in full.) Hoists and weighing scales must be regularly serviced by an appropriately qualified person person. Care reviews must be arranged for all service users who have been assessed as having DS0000061474.V275591.R01.S.doc 28/02/06 10/03/06 31/03/06 28/02/05 30/04/06 31/03/06 30/04/06 Old Parsonage (The) Version 5.1 Page 27 13. OP38 13(5) 18(1)c i 14. OP38 13(4) 18(2) complex manual handling care needs, to ensure professional advice on their specific needs and relevant equipment is available. The manual handling coordinator 30/04/06 for the home must be given opportunity to research other facilities which care for persons with complex manual handling care needs due to mental health needs, to ensure that staff in the home can meet the manual handling needs of their service users. A system for continuous 28/02/06 supervision of staff must be put in place to ensure that all staff are supported in ensuring that correct and safe manual handling takes place when service users are being transferred or moved. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP8 Good Practice Recommendations The wording of care plans should be precise, to clearly describe service users’ nursing and care needs. They should detail actions to be taken in measurable terms. Where service users are assessed as being at risk of pressure damage, a care plan should always be in place to direct staff on how risk is to be reduced. All assessments should be regularly reviewed. All frequent care charts should be fully completed at all times. More registered nurses should be trained in male urinary catheterisation. Where medicines administration instructions need to be completed by hand, these should be signed and checked by a second person, who should also sign. DS0000061474.V275591.R01.S.doc Version 5.1 Page 28 3. 4. 5. OP8 OP8 OP9 Old Parsonage (The) 6. 7. OP15 OP21 8. 9. 10. OP21 OP22 OP22 11. 12. OP23 OP26 Service users with frail skin and those at high risk of pressure damage should be offered drinks which are high in vitamin C, such as orange juice. Toiletries belonging to service users should be labelled with their name and returned to their rooms. Any toiletries, which are used up or no longer needed, should be disposed of. Bathrooms and WCs should be easily identifiable by door labelling or other means. The recently completed manual handling assessments should be reviewed, to assess if the home has enough hoists. More lifting slings should be provided to assist residents with manual handling needs. (This is an un-met recommendation from the previous inspection.) Service users’ room doors should have door knobs or push-plates. Health Protection Agency guidelines should be considered when purchasing new uniforms for staff. When new uniforms are provided, a policy and procedure to direct staff on safe infection control measures in relation to uniforms should be put in place. Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Old Parsonage (The) DS0000061474.V275591.R01.S.doc Version 5.1 Page 30 - 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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