Inspection on 04/07/07 for The Villa Nursing And Residential Home

This inspection was carried out on 4th July 2007.

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 Villa Nursing And... 15/08/06

The Villa Nursing And... 04/01/06

The Villa Nursing And... 15/06/05

The Villa Nursing And... 12/10/04

The Villa Nursing And... 06/05/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOMES FOR OLDER PEOPLE The Villa Nursing And Residential Home Park Avenue, Maddocks Madeley Telford Shropshire TF7 5AE Lead Inspector Janet Adams Key Unannounced Inspection 4th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Villa Nursing And Residential Home Address Park Avenue, Maddocks Madeley Telford Shropshire TF7 5AE 01952 581022 01952 582431 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) Mrs Susan Juru Mr Douglas Juru Care Home 33 Category(ies) of Dementia (26), Mental disorder, excluding registration, with number learning disability or dementia (7) of places The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of 33 service users. Within this 33, a) the maximum requiring nursing care shall not exceed 26 of whom 22 may be older people with dementia requiring nursing care. b) 7 may be younger adults with a mental disorder requiring nursing care. c) the remainder may be older people with dementia not requiring nursing care. Date of last Inspection: 11th January 2007 Brief Description of the Service: The Villa is a care home, which provides both personal and nursing care in single and double accommodation for older people as well as younger people with mental health needs. Owned and managed by Mr and Mrs Juru, The Villa is situated in Madeley, a long established Shropshire town, situated above Ironbridge Gorge, and now part of the Telford conurbation. Opportunities for shopping and recreational activities are to be found within walking distance and in Telford Town Centre, which is reached via a frequent bus service. The Villa is set in its own grounds and comprises of an original 19th century house, which has been added to by more recent extensions. It has several communal areas, including a large lounge/diner, a separate dining room, and two other lounge areas, one being located in the in the nursing wing. These are all on the ground floor. A ‘quiet’ sitting area is also available on the first floor. In addition to this, two outside patio areas with good access are furnished with quality garden furniture for residents to use if they choose to. The owners of The Villa make their services known to prospective service users in their statement of purpose, and its brochure/service user guide. The current fees charged vary between £349 and £520 per week depending on the care, support and accommodation required. The only additional charges to service users are for hairdressing, toiletries and newspapers. Consideration is also given to accommodate residents’ pets, and at the time of the inspection, five cats were seen to be living there. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the majority of this inspection visit to the home. She was assisted on day 2 by another inspector for a short period of time. The inspection lasted a total of 13 hours over a period of three separate visits. A few weeks before the inspection was carried out, CSCI (The Commission for Social Care Inspection.) wrote to the home manager to request some necessary information to assist with the inspection. This meant that although The Villa knew the inspection was imminent, they were not aware of any date or time. On the afternoon before the inspection, two hours were spent observing the care being given to a small group of people in the main communal lounge. The care of four people was looked at in depth when comparisons with the observations were made with the home’s records and the knowledge of the care staff. Other inspection information was also gathered in a variety of ways. It included observing activity within other parts of the home, inspecting the premises, an ‘in depth look’ at records for staff, observing, talking and listening to over half of the 31 people living there, and the staff on duty at the time of the inspection. Residents completed a total of 20 written comments on this occasion. Many others were happy to share valid comments when they were spoken to in private or together in groups in the lounges. Although no visitors were available to talk to on this occasion, two relatives sent back comment cards to CSCI. Both made positive comments about the home. One visiting professional also sent in a comment card about this home. These comments are included in the main body of the report. Everyone, including residents and staff were very welcoming and helpful throughout. A total of 27 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. What the service does well: Observations made at the inspection, as well as comments received from visiting professionals and relatives confirm that The Villa is committed to offering a home to people who have both complex mental and physical care and support needs. The home has a team of staff who try hard to meet the individual needs of people in their care. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: As a result of this inspection 2 additional statutory requirements were made, which were as a result of Immediate Requirement notices issued during the inspection, making a total of 13 that the home has to take action to meet. Although the home has a statement of purpose and service user guide they are not up to date with contact details for the Commission for Social Care Inspection or provide information about complaints, or funding/payment arrangements and fee rates. Prospective service users need full information before making a choice to live at a home. Care plans need to be expanded to ensure all necessary information is kept up to date to realistically reflect all of the health and personal the care the residents need and get, to keep them safe, taking into account good practice guidance such as that of the Nursing and Midwifery Council. Wound care, dementia management issues and end of life care are issues in need of priority, as well as any necessary risk assessments to keep people safe. Management need to demonstrate it provides meaningful activities and leisure time to promote the well being of all the people living at The Villa, especially with regard to the people with mobility and dementia related challenges. One person commented, ‘I cannot take part in activities because of my lack of mobility.’ Observations of people confirmed that eating and food in the home is not considered to be an enjoyable or dignified event. It is a concern that the cleanliness of the home was not as good as it was at the last inspection. As a result of this, unpleasant odours were detected in several areas of the home. This has been a concern of CSCI since June 2005 as reported at the last key inspection in August 2006, some of the communal The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 7 carpeting and armchairs are in need of attention as well as bedrooms, which have suffered extensive damage due to excessive rain. The home manager also needs to make sure an action plan devised in response to the infection control audit carried out by the Health protection agency in March 2006 year is carried out within a reasonable timescale, this will improve the environment considerably. Medication management at The Villa is an area of major concern especially with the administration, and safekeeping of medication in the home. A CSCI specialist pharmacy inspector has been involved in making sure the home takes appropriate steps for all medicines to be managed safely. Two immediate requirement notices were issued to the home during the inspection due to this matter. There is not quite enough staff with relevant care qualifications even when the two people currently undertaking NVQ training are included. This needs to be 50 minimum. Some of the practices observed during the inspection confirmed some staff have communication challenges, especially when people with dementia related conditions were being cared for. Staff recruitment, and supervision records need further details added. Staff Supervision sessions need to be carried out more frequently with more details recorded to show how staff are working to improve resident care. Accident recordkeeping needs more evidence to show the right action has been taken to reduce the chance of any accidents happening again. This will then make sure, that care staff are aware of, the needs of people who have been injured as a result of an accident. The home management team must ensure they prioritise remedial action for any incident, which results in the environment being at risk to residents and staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Villa Nursing And Residential Home DS0000022281.V340237.R01.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 The Villa Nursing And Residential Home DS0000022281.V340237.R01.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): Key Standard 3. (6 not applicable to this service). National Minimum Standard 1 and 2. Prospective residents and their representatives are provided with most of the information needed for them to choose a home that will meet their needs. Quality in this outcome area is adequate. Prospective residents and their representatives are provided with most of the information needed for them to choose a home, which will meet their needs. Omissions in the records for the admission of new people to the service do not demonstrate that the process is personalised or that consideration has been given to the social aspect of care. This judgement has been made using available evidence including a visit to this service. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 10 EVIDENCE: The homes statement of purpose and service user guide provides service users/ representatives with most of the details of the services the home provides, enabling an informed decision to be made regarding admission to the home. These documents require minor amendments as this information lacks some basic details which the manager acknowledged at the inspection visit of January 2007.Currently It also does not comply with the change in Regulations September 2006 with regard to the detail concerning fees and funding arrangements As confirmed at an inspection in January 2007, people who use the service are provided with a statement of terms and conditions on admission to the home. It gives information on what service users can expect to receive for the fee they pay and sets out terms and conditions of occupancy. Fees are reviewed annually and service users are notified in writing. Additional charges to service users are clearly laid out in the contract. For people who are paying for their own care, and without a care management assessment, the assessment is always undertaken by a skilled and experienced member of staff. Where the assessment has been undertaken through local authority care management arrangements the registered person usually obtains an up to date assessment. Evidence of assessments was seen in three out of four resident’s files looked at. The fourth person was admitted in fairly urgent circumstances in January 2007,and had an assessment had been provided by social services dated October 2006.There was no written assessment information about any change of need for that person between those dates. The record of this recent admission was not signed or dated by the admitting nurse. Nor had this staff member completed the manual handling assessment for the new resident. The Villa Nursing And Residential Home DS0000022281.V340237.R01.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 & 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all service users’ care needs and risk assessments are set out in their individual plans of care. This does not ensure that all care needs have been addressed and will be fully met. Current medication management systems do not ensure that service users health matters are always safely addressed. EVIDENCE: At the start of the inspection the inspector was shown round the home and introduced to residents by the registered manager so people were aware it was being carried out and to welcome them to share information about life at The Villa. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 12 Some people were seen to be so frail they were not able to communicate their opinions, therefore the time spent by two inspectors observing people in the communal lounge was helpful in confirming findings of the inspection process. A total of 5 different sets of care records were looked at in depth. The presentation and layout of the information written about the people living at the home has much improved, although inspection observations confirmed a lot more work is necessary to show they actually reflect the needs of the individual they are written for. They are not personalised with enough detailed information about the people or their medical conditions to fully describe how the people concerned need to be properly looked after. It is of note the home have started to involve people who live at the home and friends and family when appropriate, however this process is not fully up and running as yet. For example, it was confirmed by the home manager before the inspection that there was one person in the home with a pressure sore. On the tour of the home it was seen that a specialist mattress was in place on the person’s bed. The person’s records were looked at and it was established that the pressure sore required wound care management. Although the home has good forms to record this type of information, lack of details meant there was not a realistic ‘pen picture’ of how the pressure sore was being looked after. Lack of evaluation of the wound condition meant there was no recognition that the mattress in use on the person’s bed is not suited to the type of pressure sore the person had, and the size of the wound had not been measured or recorded for four months. In addition, there was no evidence of involvement of the person’s doctor about this matter since December 2006. It is positive the home use a form to identify triggers for positive and negative behaviours in order for staff to be aware how to promote well being of its residents - unfortunately this was seen to be blank in all care records seen. In all four sets of records for people requiring care due to their dementia related illness, behaviour assessment forms were seen to be blank. In the records for a person at the end of her life, recordkeeping did not account for the obvious spiritual needs of the individual. The person’s bedroom had a lot of religious statues and pictures confirming the importance of her faith. There was no written evidence to show when the person had received ‘last rites’ by her priest, and any necessary spiritual wishes and needs of the person at the actual time of her passing away had not been recorded. When the people who lived at the home completed CSCI comment cards were asked if they received the support and care they needed, 6 out of 14 agreed they did, other comments received stated comments like, The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 13 ‘The staff are very helpful and always listen to me,’ whereas others made comments such as, ‘I would like staff to talk to me but they always say they’re too busy.’ Care practices recorded in the next section of this report confirm that resident dignity is not promoted and respected at all times. When medication management at The Villa was explored, this was seen to be an area of major concern. The care records of all 5 people looked at identified that staff were crushing their medication and mixing it with a medicine for bowel management. Upon examination of the medication administration records and discussion with two qualified nurses, it was confirmed a total of ten people have their medicines given this way. This practice is unsafe, and had been identified at a pharmacy inspection visit by Telford and Wrekin Primary Care Trust in October 2006. It is a concern the home had not followed the advice in the report from this visit. As a result, an Immediate Requirement notice was issued to the home to take urgent action within 48 hours to ensure all residents received their prescribed medication safely. The manager was informed that specialist advice was to be sought from the CSCI Pharmacist inspector to offer support to the home for this matter. Following this advice, as part of the inspector’s return visit to the home on July 6th a further Immediate Requirement notice was issued to ensure that the home had, • Fully explored the ten individuals’ capacity to consent to this procedure, taking into account all current mental health legislation. • Carried out meetings with all professionals (including doctors, social workers, and pharmacists,) involved with the well being of the ten people involved in this matter, to make a decision about the most appropriate way these people should have their medicines administered. • Received written confirmation from its pharmacist for every person involved with details about each medication and how safe it is when crushed with other medication ingredients. The CSCI Pharmacist Inspector recommended this matter required priority to be resolved within 5 days. Other shortfalls such a poor audit trails of the receipt of medications were also observed during this inspection, showing there is no clear system for compliance with the administration, and safekeeping of medication in the home. The above issues confirm there is a lack of training and staff understanding of the safe handling of medication. There has been failure to respond to unsafe practice that places people who use services at risk. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is poor. Social, cultural and recreational activities are not provided to meet resident’s expectations although there has been some consultation and assessment. Not all residents are provided with social activity and can keep in contact with family and friends Residents receive a healthy diet according to their assessed requirements although it can lack the variety and choice they would like. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It is positive the younger individuals living at the home are encouraged and empowered as far as it is practical to maximise their independence. In the information the registered manager provided as part of the inspection preparation, she confirmed that the home has had increased input by the local community mental health ‘assertive outreach team’ to enable them integrate The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 15 into activities within the local community. However, discussions with residents and staff members confirmed not much in the way of activities is organised within the home. Although resident care plans now contain an activities and interest checklist, to determine what peoples interests are – there was no evidence that the information had been used to organise meaningful activities for the residents. Written comments received from all 14 residents were unanimous to confirm that there were not enough activities arranged for them to take part in. Several comments residents made were negative, such as ‘I get very bored’, ‘Nothing to do’ ‘I miss going out’ ‘I cant take part in activities because of the medication I’m on’ Being as some people who live at the home are not fully able to answer questions and write down their opinions about The Villa, due to their dementia related conditions, two inspectors spent time in the main communal lounge to observe of the behaviours of these individuals in response to the care and support they were given. They were observed for two hour periods on two different days. In the care records of one person observed, the ‘named nurse’ had written in a person’s activity plan ‘Due to memory deterioration unable to do anything’. Observation with the actual person confirmed this to be inaccurate. The individual was observed to be engaged in conversation with a carer who gave the person time and patience to express herself, and they were seen to be having a stimulating chat about the person’s preferences of different types of fruit and drinks. It was observed that staff spent very little time with the residents during these times, and some did not establish a sociable rapport with residents. Although one carer was seen to be very positive and caring for residents with respect, the way a trained nurse and another carer addressed individuals was not seen to be a positive experience for the residents involved. Meal times especially appeared rushed and undignified. Six residents were seen to be wearing waterproof ‘bib type’ protection over their clothing almost an hour before lunch was served. The way staff assist people to eat is another area of care practice requiring improvement. For example, a nurse was observed to be feeding residents in a hurried manner whilst standing up, and another carer was sat between two residents feeding them both at the same time. Ten residents commented they felt the food could improve in portion size, and variety. This confirms that although the home provides a balanced diet, eating and food in the home is not considered to be an enjoyable or dignified event. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. The service has a complaints procedure, which is accessible so that people who use the service have information of how to make complaints about the home. Although training is provided so that people living at the home are protected from abuse and have their legal rights protected, not all practices observed in the home safeguard them at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Villa has a complaints procedure that is up to date, clearly written, and is easy to understand. It is on display in the hallway. However these details are not reflected in the home’s current Statement of Purpose and Service User guide. Not all residents knew how to formally complain however, in most cases they knew who to speak to if they had a particular area of concern. CSCI has not received any complaints about the home since the last inspection. The complaint log was examined; there had been no complaints since the last inspection. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 17 The majority of policies and procedures for safeguarding people who use the service are in place and the paperwork to offer staff formal guidance about this matter is freely available for them to access in the downstairs office. As some of the residents living at the home were demonstrating behaviour challenging to other people during the inspection visits, the registered manager was asked for a copy of the home’s policy and procedures for managing aggression. It was seen that although the home has a lot of background information about this sensitive issue there currently is not a policy for staff to follow if they had to deal with such a situation. This report describes concerns about residents’ safety and well being, especially with regard to medication management. It has been deemed appropriate to make a referral to the local Safeguarding Adults team in order to fully investigate how the home management can be supported to improve the lifestyle of the people living at The Villa. The outcome of this matter will be contained in the next inspection report. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24, &26 Quality in this outcome area is poor. The deterioration in the condition of the physical design and layout of the home means not all residents to live in a safe, well-maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Access to the home is in the progress of being improved, and work was seen to be in progress to improve the home entrance and drive way. An external shelter has also been provided in preparation for internal parts of the home being a ‘smoke- free’ environment. Upon entering the home it was apparent that some of the procedures for cleanliness and maintenance of the home have not been adhered to. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 19 An unpleasant smell was evident upon each occasion of entering the home, and several other parts of the home equally had unwelcoming odours. Several carpets were badly stained, and the furniture in the communal areas was stained and had unpleasant odours. Armchairs seen in use were visibly soiled and also had an unpleasant odour, which worsened as you sat in them. Meals were seen served to service users on to visibly soiled tables. On the tour of the home similar findings were observed in the communal bathrooms and toilets. Flooring was badly stained and the accumulation of grime gave the impression that the home has not had a deep clean for some time. A bathroom which had been reported to have been upgraded had flooring of an unclean unsatisfactory standard. Toilets were seen to have dried on stains and urinals were heavily stained and discoloured. Upon the inspection of ten of the bedrooms of people who use the service, many were seen to be in a poor condition, in particular the two that had been damaged by excessive rain damage. This was a particular concern; it had resulted in extensive damage to ceilings. The wall of a room with an over bed light and the nurse call system installed was extremely damp to touch. Discussion about what remedial action had been taken to put the damage right confirmed that the manager had not had the electrical supply for the above equipment checked out by an appropriately qualified professional since this incident. There was no warning signage to alert staff or residents to any hazard. The room was still being occupied by a resident, and although it was a double room, there was no evidence to show any effort to move the persons bed and personal belongings out of the damp area, into another room or part of the room which was dry and unaffected by the damage. As a result of these findings an ‘Immediate Requirement’ notice was issued. It was assuring to see work in progress to improve this room, and that the electrical wiring to the damp wall had been carried by the time the inspector revisited the home two days later. It is a concern that cigarette burn damage to a carpet caused by a resident smoking in a bedroom did not trigger off the fire alarm system. A further Immediate Requirement notice was issued to make sure urgent remedial action was taken by the home management to ensure the fire detection system in the home is sensitive enough to detect the possibility of a person smoking in a bedroom. Remedial action for this matter was also seen in progress within two days. Since June 2005 CSCI have reported concerns about the cleanliness of the home, and as a result of an inspection in January 2006 the home was advised to request the support of the Health Protection Agency to conduct an audit of infection control measures in the home in order to improve standards. This was The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 20 carried out in March 2006, and although improvements were seen at the last inspection in August 2006, it appears standards have not been maintained. The home was seen to be lacking in appropriate hand washing facilities. High risk areas such as staff and communal toilets as well as bathrooms did not have adequate hand washing and drying equipment. Poor systems for residents sharing bedrooms meant toiletries were not kept separate. Creams were seen in use for people they were not prescribed for in several double rooms, which made it impossible to know who had been using the creams. The above issues show that the quality of life for people using the service is being made worse by the environment they are living in. The registered manager herself commented as part of the pre inspection preparation that one thing the home could do better was to ‘Maintain a clean, pleasant hygienic environment.’ It is obvious systems need to be implemented to make sure the home is kept clean and fresh in the long term at all times. It was therefore assuring to see the ‘Essentials of Safe Clean Care’ information in the office awaiting circulation to staff. This latest Department of Health guidance will assist the team in putting infection control standards right. The Villa Nursing And Residential Home DS0000022281.V340237.R01.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 adequate. The home employs supportive staff in sufficient numbers to meet the needs of residents, although some recruitment and training measures require improvement to fully offer protection to people living and working at The Villa. This judgement has been made using available evidence including a visit to this service. EVIDENCE: By looking at the staffing rotas on display in the downstairs office, it was noted that consistent staffing numbers and skill mix are employed to enable the home team to meet residents’ needs. It was reported the home had one carer vacancy and a person was being interviewed on the inspection day for the position. An in depth look at four sets of staff files including those of two new starters shows that recruitment systems continue to improve. All application forms were seen to have appropriate health declaration information, although both lacked details about previous employment history. From the records kept it could not be seen whether the gaps in employment had been explored further to confirm that the home has robust vetting procedures for new staff. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 22 Staff training records confirmed that regular mandatory training such as fire safety and manual handling continues to be carried out, which is necessary to ensure all new starters get the induction training they need to do their job properly. Staff files looked at confirmed that home has a structured induction training programme for its team. At present there is not quite enough staff with relevant care qualifications to meet the minimum 50 required, even when the two people currently undertaking NVQ training are included. 12 out of 14 residents who took part in the CSCI inspection survey stated that staff listened and acted upon what they said, although two did make comments that they could not understand what some of the carers were saying. Discussion with one staff member who was recruited from overseas confirmed that she had failed her English language examination twice and was not able to adapt to be a qualified nurse in this country. Some of the practices observed during the inspection confirmed some communication challenges, especially when people with dementia related conditions were being cared for. When the above issues were discussed during the inspection the manager was offered copies of CSCI guidance leaflets for checking the suitability of new staff safeguarding adults. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36, & 38 Quality in this outcome area is adequate. Experienced, suitably qualified individuals ensure management arrangements are meeting the majority of the needs of the service. Some systems for the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to meet people’s changing needs as well as necessary legislation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Juru continues to show her ongoing commitment to be a competent care provider. In January 2007 she attained her Registered Managers Award. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 24 Several improvements have been as a result of the management team acting in response to the suggestions made by residents at their monthly forum meetings. The gazebo provided in the garden, and comments to improve food provided are examples that demonstrate efforts to show effort the home is run for the benefit of the people living there. When staff records were looked at it appears formal supervision systems seen started at the inspection of August 2006 have not progressed, and on average one supervision session has been held for individual staff members since that time. These sessions need to be carried out more frequently with more details recorded to maximise the team performance. Robust systems to manage service users monies continue to be maintained although the system would benefit with recordkeeping to acknowledge the receipt of bank statements for the people who rely on the staff to keep these documents safe. The home has had two inspection visits from the fire and safety service since the inspection in August last year. After the last visit in March 2007, CSCI were informed that the fire safety officer was satisfied with the remedial action the home had taken to improve fire safety in the home. All necessary service and maintenance records requested were seen to be up to date and complied with necessary health and safety legislation, however failures in the management of emergency situations as described earlier when residents bedrooms were subject to flood damage give cause for concern. The fire safety officer was made aware of these findings. The current safe working systems in the home has resulted in good accident recordkeeping, although there is not enough detail to make sure the right action has been taken to reduce the chance of any accidents happening again. The care records of two people who had falls recorded in the accident book showed their falls risk assessment and management plan did not account for these recent events to show the issues had been fully looked at to reduce the chance of further falls. Management of chemicals in the home is not in line with necessary legislation. Chemicals seen decanted in unlabelled containers show that some practices need to be improved to keep people living and working at The Villa safe. The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 X X X 1 X 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 26 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 13(6) Requirement Timescale for action Care plans must contain risk assessments for all aspects of 16/10/07 resident care including those for moving & handling, smoking, and the potential effects of their medical conditions to make sure the health and personal care that people receive is based on their individual needs. (Previous timescales of 11/02/06 & 10/10/06 not met.) 2 OP7 15(1) Care plans must show ongoing evidence of resident /relative involvement to confirm people who use services are able to be involved make choices about their life style. (Previous timescales of 11/02/06 &10/10/06 not met.) 16/10/07 3 OP8 12(1)(b) 15(1) All care plans must include 16/10/07 details of all aspects of a persons care needs to make sure the health care that people receive is based on their individual needs, especially with regard to wound DS0000022281.V340237.R01.S.doc Version 5.2 Page 27 The Villa Nursing And Residential Home management. (Previous timescales of 11/02/06 &10/10/06 not met.) 4 OP9 13(2) Records must be show receipt and administration of all prescribed items received in the home to confirm people receive all the medicines they have been prescribed. (Previous timescale of 11/02/06 &10/10/06not met.) 16/10/07 5 OP9 13(2) 6 OP12 16(1)(2), (m, n) Medications must only be 20/07/07 administered in the form it is supplied in to make sure staff are trained to administer medicines the way they have been licensed by the manufacturers to be taken, to maximise the well being of the person it is prescribed for. Immediate Requirement issued 06/07/07 16/10/07 The home must have written evidence in residents’ records to show the flexible way individual’s routines of daily living and activities meet their preferences and capacities especially with regard for people who have dementia related illness. (Previous timescale of 10/10/06 not met.) All parts of the home including bathrooms, toilets, carpets, armchairs tables must be kept clean safe and in good repair at all times. (Previous timescales of 11/02/06 &10/10/06 not met.) 16/08/07 7 OP20 16(2) The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 28 8 OP24 13(4)(a) 9 OP26 13 (3) Bedrooms occupied by residents which have been subject to accidental damage must have remedial action and repairs carried out to make sure they are fit for use and are in a safe hygienic condition at all times especially with regard to electrical and fire safety installations. Immediate Requirement issued 06/07/07 The home must devise and carry out an action plan to meet the recommendations of the Infection control audit by the Health Protection agency in March 2006 to ensure people who use the service to live in a safe, well-maintained and comfortable environment. (Previous timescale of 10/10/06 not met.) 20/07/07 16/08/07 10 OP29 19(4, 5) The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home. Recruitment procedures must ensure all pre employment screening has been carried out. (Previous timescale of 10/10/06 not met.) Staff records must show they receive training appropriate to the work they are to perform including meeting the needs of people with dementia related conditions, in order for staff to communicate more effectively to promote service user well being. Care staff records must have details to demonstrate they get supervision at least 6 times a DS0000022281.V340237.R01.S.doc 16/08/07 11. OP30 18 (1) (c) (i) 16/10/07 12 OP36 18(2) 16/10/07 The Villa Nursing And Residential Home Version 5.2 Page 29 year, which must include signatures of the staff involved to make sure they can support the people who use the service and support the smooth running of the service effectively. (Previous timescale of 31/01/06 not met.) 13. OP38 13 (4) (c) Accident management systems in the home must show effective remedial actions are carried out and documented in care records to maximise resident safety and minimise the risk of accidents happening again. (Previous timescale of 10/10/06 not met.) 16/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Villa Nursing And Residential Home DS0000022281.V340237.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Villa Nursing And Residential Home DS0000022281.V340237.R01.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. 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