Random inspection report
Care homes for older people
Name: Address: The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET two star good service 09/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jennifer Hughes Date: 0 4 0 8 2 0 0 9 Information about the care home
Name of care home: Address: The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET 01704220061 Telephone number: Fax number: Email address: Provider web address: village.manager@craegmoor.co.uk www.craegmoor.co.uk Name of registered provider(s): Name of registered manager (if applicable) Parkcare Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 40. Date of last inspection Brief description of the care home The Village is a forty-bedded, purpose built, care home, set in its own well-maintained grounds. It is located in the village of Banks and there are sufficient amenities of shops, a Church and public house nearby. Transport links to nearby towns of Southport
Care Homes for Older People Page 2 of 9 2 1 0 5 2 0 0 9 Brief description of the care home and Liverpool can be accessed. There is ample car parking space alongside the home. The home provides personal and nursing care for older people, and is well equipped to suit the needs of its residents. All accommodation is at ground floor level, and there is easy access for wheelchair users and the less mobile. All rooms have an en-suite facility and there are two shared rooms. Communal space for service users comprises a lounge, dining area and two small seating areas along the corridors. The home has a patio area to the front and garden and patio to the rear. Qualified nursing staff and care staff are provided over 24 hours, every day of the year. Residents receive information about the home in the form of the Statement of Purpose and the Service Users Guide. A small brochure is also given out to anyone making enquiries. As at October 2008 the fees charged ranged from £366.00 per week, to £550.00 per week, depending on the level of care needed. Care Homes for Older People Page 3 of 9 What we found:
We carried out this visit to make sure action was being taken to address shortfalls in care planning and risk assessments, staff knowledge of the requirements of these, staffing levels and abilities, and the management of the home. The shortfalls had been recognised following two serious concerns raised regarding the care and safety of the residents, one made by the CHESS (Care Homes Effective Support Service) team, and one made by the home itself. The visit lasted approximately three hours. We casetracked a sample of residents records, viewed the staff rota and monitoring records, viewed medication audits, and spoke to the manager and the nursing staff on duty, and a visiting relative. We found that the manager was in the process of reviewing all of the care plans, and restructuring files, which made it easier to track care needs. Some files we viewed were not yet in the new format, but we found all of the information we viewed was up to date. The care plans we examined were extensive and informative. We advised that there should be some evidence that the resident or their next of kin has participated and agreed the plan of care, and the manager told us that she has recently met with relatives and asked that they read the care plans, and sign their agreement with them, or alternatively suggest amendments. We saw that plans contained specific guidance that ensured pressure areas were treated appropriately, and there was evidence of monitoring and review of the care plans.The progress of the treatment was documented and supported by photographs. We found that additional specialist help was accessed when required, for example from the District Nurse, Tissue Viability Nurse and Dietician, and information on the residents records showed that their instructions were being followed. We found that the complex care plans sometimes required the same information to be entered in up to three places, for example, on the daily record, the dressing change record, and the evaluation sheet. Also information from one chart, for example the Waterlow assessment, may be transferred to the evaluation sheet. In the records we viewed we found missing entries for two residents, although the relevant information was available elsewhere, and incorrect transfer of information for another. The manager was aware of the complexities of the care plans, and that staff should know the procedures used in the home and be competent in them. Other issues were linked to careless recording, which the manager is addressing with training and supervision of staff. We viewed assessments of mental capacity in the selected files, and found them to be very brief. The manager showed us a Best Interests Checklist provided by the organisation and which she plans to use. We advised that an overview summary of each residents care needs would be useful for staff, due to the complexity of the care plans. The manager was able to show us a format that was already available and ready to use. We found that there are communication systems in place to ensure that staff are aware of what nursing tasks need to be carried out. Care Homes for Older People Page 4 of 9 Nursing staff we spoke to were able to describe the care needs and care required of the selected residents. The permanent staff member was aware of the plans for visits from health specialists, while the agency nurse on duty was aware of the communication systems and where information could be obtained. Both were aware of recording procedures. We viewed the rota and found that the home was presently being staffed with two nurses during daytime shifts, with four or five carers, and one nurse overnight, with 3 carers. The manager had recognised some of the problems had occurred due to qualified nurses being overstretched with work, when inappropriately trained care staff had been delegated medication tasks to residents with no nursing needs. This left the one nurse then on duty little time to complete other clinical duties, as she also dealt with numerous queries and requests for assistance from care staff. The manager told us there are plans to ensure that care staff are appropriately trained in medication administration and care planning, some of which training has already taken place. The nursing staff we spoke to felt that the provision of two nursing staff on each shift was beneficial. The medication round could be completed without any interruption, and the nursing needs of people at the home could be fully met. The manager and staff told us that the manager is introducing a tabard to be worn whilst the medication round is being carried out, to act as a reminder that the nurse should not be interrupted. The manager confirmed that the staffing levels of nursing staff in the home will be revisited when the residents with no nursing needs can be fully supported by appropriately trained care staff. Residents with nursing needs will then be supported by numbers of nursing staff in line with their dependency needs. We found evidence that one to one supervision of staff is being carried out regularly, with under-performing staff more closely monitored. We also found up to date competency assessments had been carried out on nursing staff. We found evidence that daily medication audits were being carried out, with any errors noted and brought to the attention of staff. We also found that random fortnightly audits were carried out, with an action plan created to address any issues. The relative we spoke to was very satisfied with the actions being taken, and the communication with the relatives by the home regarding this. They told us that the home had a very active Relatives Group, which the new manager had met with, when she encouraged relatives to be fully involved in the care planning of their loved ones. They also said they felt that the organisation had already recognised the previous managers shortfalls and had been acting on this prior to the safeguarding referral being made. They commented that sometimes communication with overseas nurses was difficult, leaving relatives with a back-log of issues to address with the first nurse next on duty who they felt they could communicate with. The resident stated that there had been a noticeable improvement in the short time the new manager had been in post, and they found her very responsive to relatives requests. What the care home does well:
We found that the manager now in place at the home had a good understanding of the
Care Homes for Older People Page 5 of 9 areas in which the home needs to improve. Planning was in place and being actioned and it set out how this improvement was being resourced and managed. The care planning system provided staff with the information they needed to meet residents needs, and staff had a good understanding of those needs. The health needs of residents were being met with multi disciplinary working taking place as required. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 The home should evidence that the resident or their family has participated in the development of the care plan, with a signature of agreement. Recruited staff should be able to communicate with people at the home in order to be appropriate to meet the needs of the residents. The organisations record formats should be used where they would improve and enhance the information, such as the care plan overview, and the Best Interests Checklist. Records should be regularly audited to ensure staff follow recording procedures correctly 2 27 3 37 4 37 Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
