Inspection on 11/04/05 for The Quinta Nursing Home

This inspection was carried out on 11th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Quinta Nursing Home 30/05/08

The Quinta Nursing Home 17/05/07

The Quinta Nursing Home 30/05/06

The Quinta Nursing Home 16/08/05

The Quinta Nursing Home 03/11/04

The Quinta Nursing Home 29/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Quinta Nursing Home Bentley Nr Farnham Hampshire GU10 5LW Lead Inspector Anita Tengnah Unannounced 11.04.05 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Quinta Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service The Quinta Nursing Home Address Bentley, Nr Farnham, Hampshire, GU10 5LW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01420 23687 Dr Muhammad Ashraf Chohan Ms Parveen Abbas Alishah CRH 41 Category(ies) of OP, TI(E) registration, with number of places The Quinta Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3rd November 2004 Brief Description of the Service: The Quinta nursing Home is a registered to provide nursing and personal care to 41 service users in the older people category. The home is situated in the village of Bentley with some local amenities close by. Accommodation is provided on two floors with a passenger lift that allows access to both floors. All the bedrooms are single with en suite facilities. There is a variety of aids and 5 assisted baths to meet the needs of the residents. the service also benefits from gardens that are enclosed and accessible to service users. The Quinta Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection took place over one day on the 11th of April 2005. As part of the inspection process a tour of the building was undertaken. The inspection took place over 8 hours. The inspector spoke to 13 service users, 6 visitors including the GP and other healthcare professionals who were visiting the home, 5 staff and the Provider. The process included examining care records, staff records and discussions with service users, staff and visitors. The care plans of 4 service users were examined as part of the inspection. Care plans were formulated and included manual handling assessments. What the service does well: What has improved since the last inspection? What they could do better: The Quinta Nursing Home Version 1.10 Page 6 Care plans including wound assessments and care plans should be reviewed and updated to reflect the changing needs of service users. This would ensure that staff have the information required to deliver care effectively. A review of medication administration procedures is needed to ensure that prescribed medication is administered only to named service users. The manager must ensure that procedures regarding Adult Protection are followed and reported to the appropriate authorities for the protection of service users. The home should have a daily menu and service users facilitated in exercising choice and autonomy with regards to meals choices and service users made aware of the availability of cooked breakfast. A robust induction and recruitment policy and procedure must be followed thus ensuring that staff are fit and competent in delivering care. All checks must be undertaken prior to employment to safeguard the health and welfare of service users at all tomes. All accidents/ incidents must be recorded and reports of these submitted to the Commission. The responsible individual should undertake unannounced visits and reports of these forwarded to the Commission, in accordance with Regulation 26. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Quinta Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Quinta Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5,6 The admission procedure has improved thus ensuring that there is a proper assessment prior to people moving into the home. EVIDENCE: The home has recently reviewed the statement of purpose and the service users guide following the extension of the service. A copy was available in the entrance hall. A relative confirmed that the service users guide had been issued recently following review and information was relevant. The manager undertakes pre admission assessments for all service users. Record seen also included a care manager’s assessment for a service user that had been recently admitted in February. Prospective service users are offered the opportunity to visit the home. The manager reported that family visit as it was not always possible for service users to attend the home due to their frailty. Information as per the statement of purpose was available to prospective service users in order for them to make an informed choice at the point of enquiry. The home does not offer intermediate care. The Quinta Nursing Home Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 The system of care planning and review was poor and did not provide staff with the information they need to meet the needs of service users. Care plans with regards to wound/ pressure ulcers management were found to be inadequate, therefore needs are not fully met. The system of drug administration has the potential of placing service users at risk. EVIDENCE: Care plans were formulated on admission, however care plans seen had not been reviewed or updated to reflect the changing needs of service users. A service user reported that she had suffered scalding from a hot drink where the area she showed to the inspector appeared sore and red. Daily record seen on the day of the accident described cold compress was applied. There are no further entries of what care was given and whether the GP was informed or advice sought. No care plan was available pertaining to this. A member of staff told the inspector that cream was applied. Discussion with staff suggested that some care needs were met, however this was dependent on individual staff The Quinta Nursing Home Version 1.10 Page 10 skill rather than planned care. Fall risk assessment was not available for another service user whose record showed risk of falls. Service users reported that they liked living at the home and that staff were kind. Good interaction was observed between long standing staff and service users. The GP visits the home on a weekly basis and as requested. Records of the GP visits were recorded in the care records. The GP commented that this was good practice and was happy with the care that service users were receiving at the home. There is a medication policy in place and one senior staff has the responsibility of medication for the home. All medication was maintained securely, there was no one receiving controlled drug at the time of the inspection. Records of all drugs received and returned were available. There was a large amount of dressing and fortified drinks that was prescribed for service users and no longer in use. Staff reported that the drinks were being kept for other service users if required. Another service user was receiving oxygen therapy that was prescribed on her Medication Administration Record (MAR) sheet. Staff reported that she was receiving frequent oxygen and yet her MAR sheet did not contain any record of the frequency or amount of oxygen administered. The practice of using prescribed medication for other service users was noted at the inspection. This was discussed with senior member of staff and advised that this practice is illegal and must cease. All medication no longer required by service users that these are prescribed for must be returned to pharmacy and records of these maintained. A procedure for all medication received and returned must be developed and put in place to inform practice and maintain continuity in the absence of the one nominated staff responsible for medication. Staff were unsure about the type of dressing that were used on one service user who had pressure ulcers to heel, lower leg. It was reported that this service user also had a sore to his sacral area. Care records seen did not contain a care plan for the sacral sore. The incidence of pressure sores, their treatment and outcome were not recorded. The Quinta Nursing Home Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,15 The meals at the home are well balanced and nicely presented. However the lack of menu does not offer choice and autonomy for service users. The open visit policy does allow for service users to maintain contact with relatives and friends. EVIDENCE: A number of service users were spoken and they all commented that the meal at lunch time was good. Meals appeared well balanced and nourishing. Lunch was observed being served and was well presented. Staff were available to offer support with meals in a sensitive manner. One service user commented that he did not like “foreign food “. The chef dealt with this in a professional manner and an alternative was provided. Service users spoken to were not aware of the menu for the day. They reported that daily menus were not available for lunch, although they were consulted about teatime meal. Cooked breakfast was also not available and 5 of them said that this would be a welcomed change. One service user said that hot drinks and biscuits were available at bedtimes. Another service user reported that hot drinks were available previously but not regularly since the extension of the home. This would mean that following teatime meal at 18:00 hrs, the next meal would be breakfast at between 8-8.30am. The Quinta Nursing Home Version 1.10 Page 12 These were discussed with the Provider and assurance was given that daily menu, hot drinks/ snacks and also cooked breakfasts would be provided. The Provider reported that the manager must monitor this and ensure that service users are offered choices. The local vicar visits the home on a monthly basis and external entertainers attend the home monthly. Carers arrange activities on an ad hoc basis. There is no structured activity programme and none of the service users spoken to could say what type of activity is available. Six service users said that there was no activities, another said that she was very lonely as staff are very busy and do not have time to chat. She would like to go out but require assistance. The manager had discussed at two previous inspections the recruitment of an activity coordinator. This remains the plan and would be beneficial to service users. The Quinta Nursing Home Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The failure to follow set procedures in the prevention of abuse is detrimental to the welfare and well -being of service users. Complaint log did not reflect all complaints received by the home. EVIDENCE: The home has a complaint policy and procedure in place. The complaint procedure was also displayed in the service users rooms. Service users and relatives were aware of how to make a complaint. An Adult Protection procedure and the Hampshire abuse procedure were available. The complaint log was seen and one complaint was recorded. Staff spoken to report that recording of complaints did not always take place as the manager deals with them. The manager must ensure that an accurate log of all complaints is maintained to include action taken and outcome. The Commission has received one complaint since the last inspection that has been dealt with as per Adult Protection procedures. It showed that the manager failed to follow the guidance in reporting, recording allegation of abuse to the appropriate authority and undertook the investigation. There was also failure in following the recruitment procedure prior to employment of a casual worker. Such failures place service users at risk, as checks were not undertaken to ascertain fitness. The manager has a duty of care to assure that carers have the skills and are competent to deliver the care. The Quinta Nursing Home Version 1.10 Page 14 The Provider is aware of these issues and a training need to be put in place to ensure that all staff are competent in recognising situation of abuse and reporting. The Quinta Nursing Home Version 1.10 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 standard(s) 19,20,23,24,25 There has been considerable improvement and the décor; furnishing provided a warm, homely and comfortable surroundings for service users and bedrooms were personalised. There has been little improvement regarding fitting of locks to communal bathrooms and service users bedrooms. EVIDENCE: A tour of the premises was undertaken as part of the inspection. The home was clean and warm. A major refurbishment of the service was completed at the end of last year and the home was extended to 41beds. All service users rooms were personalised and call bells were available. Service users were complimentary regarding their rooms and the communal areas of the dining room and lounge. Furnishing was of good standard and appropriate for the needs of service users. The home has adequate washing and bathing facilities to meet the needs of service users. The home has gardens to the side and back of the building. Service users spoken to were keen to be able to make use to the larger garden to the side. The Quinta Nursing Home Version 1.10 Page 16 Some seating in the garden to the side would be beneficial and encourage service users to make use of it. Locks were available in all the new rooms. A programme to fit locks to the remaining bedrooms has not been completed. These remain outstanding from the last inspection. The home has a laundry and all service users personal laundry is undertaken internally. Beddings are contracted out. A designated -staff has been employed for the laundry. Staff reported that this arrangement works well. The laundry area was clean and flooring was impermeable, hand- washing facility was prominently sited. Particular areas need attention: Grab rail to the bathroom on the first floor as previous requirement. This remains outstanding from the last inspection. Both bathrooms on the first floor in the old part of the building need refurbishing as tiles are missing from the wall. Flooring in the sluice should be replaced as this was planned as part of the extension and remains outstanding. The two communal bathrooms identified at the time of inspection must be fitted with locks. The Quinta Nursing Home Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29. The major shortfall and failure to follow a robust recruitment procedure, does not protect service users and has the potential of putting them at risk. EVIDENCE: The home has a duty rota for carers and a separate rota for ancillary staff. There are a number of staff that have worked at the home for a long time and are committed in providing a high standard of care. Agency staff are used to cover any shortfall in staffing. Staff records examined as part of the inspection showed that the home was failing badly with its recruitment procedure. One casual carer was employed without any of the recruitment procedures being followed including no interviews, references or checks being undertaken. Another carer who started work in November did not have a current CRB check and POVA first check as required since the POVA first check was introduced in July 2004. The home has documentation for induction. The record of another carer employed with no previous experience in care was seen. There was no record available to demonstrate that he is undertaking an induction. Furthermore there was no record of a work permit or CRB and POVA first check. All these issues clearly shows that the recruitment policy has been ignored and does not take into account the safety and welfare of service users. The manager is failing in her duty of care in ensuring that people employed are fit and competent to deliver care. The Quinta Nursing Home Version 1.10 Page 18 The Quinta Nursing Home Version 1.10 Page 19 The Quinta Nursing Home Version 1.10 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,37. Poor record of accidents at the home and the failure to follow policies and procedures in recruitment does not safeguard the best interests of service users. The manager needs to demonstrate clear lines of accountability and ensure that training, induction and recruitment of staff remains her responsibility as the registered manager for the safety and welfare of service users. EVIDENCE: All records were maintained securely. The Commission has received some reports as per Regulation 37. However the record of a service user that suffered scalding showed that no accident form was completed and a report as per Regulation 37 was not recorded or submitted to the Commission. There is evidence that the safety, welfare and health of the service user was not promoted and protected. The Quinta Nursing Home Version 1.10 Page 21 The manager is a registered nurse and has been registered with the Commission. Following a report of an allegation of abuse, the manager failed to take action in reporting this matter to the appropriate authority or to the provider. In order to protect service users, training in Adult Protection should be put in place for all care staff. Staff reported that the provider visits the home regularly. As part of the auditing of care provided and ensuring that the home is meeting service users needs as per the statement of purpose; unannounced visits must be undertaken and reports of these submitted to the Commission as per Regulation 26. The Quinta Nursing Home Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 x 2 3 3 3 x STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x 2 x x x x 1 x The Quinta Nursing Home Version 1.10 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Care plans and risk assessments must be reviewed and updated on a monthly basis or sooner to reflect changing needs of service users. Wound assessment and care plans must contain information in order to inform practice. All incidences of pressure ulcers must be recorded. (Timescale of December 2004 not met) Prescribed medication must only be used for named service users. Medication no longer required. must be returned to Pharmacy as per the returned procedure. Service users must be provided with a daily menu and choices regarding meals including breakfast.(Timescale of December 2004 not met). Locks to the 2 communal bathrooms must be fitted as identified at the inspection Grab rails to the communal bathroom on the first floor must be fitted (Timescale of December 2004 not met). Version 1.10 Timescale for action 30/05/05 2. 9 13 30/05/05 3. 15 16,14 30/05/05 4. 5. 21 21 16 14 15/05/05 30/05/05 The Quinta Nursing Home Page 24 6. 24 12,13 7. 29 19 8. 30 12,18 9. 10. 31 26 12 11. 38 17(1) schedule 3 A programme to fit suitable locks to the remaining service users bedrooms must be in place and an action plan with timescale forwarded to the Commission.(Timescale of December 2004 not met). A robust recruitment policy and procedure must be adopted and staff records must be maintained as per schedule 2 for the protection of service users. All staff must undertake an induction programme for the welfare and safety of service users. The manger must ensure that clear lines of accountability is prevalent within the home. The Registered person is required to undertake visits to the care home as per Regulation 26 and submit reports of these to the Commission.(Timescale of December 2004 not met) All accidents/ injuries should be investigated and reported as per Regulation 37 notices to the Commission. 30/05/05. 30/05/05 30/05/05 30/05/05 30/05/05 30/05/05 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 Good Practice Recommendations The Quinta Nursing Home Version 1.10 Page 25 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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. 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