CARE HOMES FOR OLDER PEOPLE
The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET Lead Inspector
Ms Jenny Hughes Unannounced Inspection 10:00 5 October 2007
th 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 Village Nursing Home DS0000025583.V345594.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 Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Village Nursing Home Address 41 Church Road Banks Southport Lancashire PR9 8ET 01704 220061 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) www.craegmoor.co.uk Parkcare Homes Ltd Mrs Doreen Whitlow Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (4) of places The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Up to 38 service users in the category OP (Old Age) who need nursing care. Up to 20 service users in the category OP (Old Age) who need personal care only. Up to 2 service users in the category of PD (Physical Disability). 2 named service users in the category of PD (physical disability) Date of last inspection 16th February 2007 Brief Description of the Service: The Village is a forty-bedded, purpose built, care home, set in its own wellmaintained 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 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 with greenhouse 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 User’s Guide. A small brochure is also given out to anyone making enquiries. As at 5th October 2007 the fees charged ranged from £319-50 per week, to £550-00 per week, depending on the level of care needed. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of this home included a site visit, which was carried out over two days. The site visit was part of the key inspection of the agency. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. During the visit we spent time speaking to residents, staff and the deputy manager. The registered manager had recently resigned her post so was not present. We also spoke to some visitors. Every year the registered persons are asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of their service. It also asks about the manager’s own ideas for improving the service provided. We use this information, in part, to focus our assessment activity. Surveys were sent and received from residents and their relatives, and staff from the home. During the site visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. We also carried out a tour of the home, looking at both private and communal areas. Everyone was friendly and cooperative during the visit. What the service does well:
Visitors are made welcome when they call, which may be at any time. The home is clean and tidy, and presently has an ongoing process of decoration, with new carpets in some areas, new chairs, and curtains due to arrive. The maintenance person said that he notes areas that need refreshing, and tries to deal with them as soon as possible. He said he also responds to staff reports of maintenance tasks to carry out. The management carry out clear pre-admission assessments to make sure the home can meet the needs of the person before they say it is the right place for them. These are done by a visit to where the person is living, to discuss their needs with them and their family. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 6 A new care planning system has been introduced by the organisation, and it is very person centred, recording what residents say is important to them, such as “being given time to express myself” or “chatting’” or “animals”. Likes and dislikes of residents are noted so that staff can clearly see them. Most residents said they chose when to get up or go to bed. “I wake up at 6am, and I can have a cup of tea if I want, before breakfast”, said a resident. Visitors spoken to told us that staff always kept them informed of their relatives’ condition. “As soon as they see you they come over and let you know how they’ve been doing. They’ll give you a ring as well if they need to.” said a relative. We spoke to staff, and they knew what care each person needed. Meals are varied, using fresh produce, and all but one resident said that they enjoyed them. We saw all of the residents eating their lunches, either in the dining room, where a few were helped by staff or visiting relatives if they needed, or in their own rooms. The cook said that an alternative would be offered if a resident did not want what was on the menu. “You do get a choice you know”, confirmed a resident. There is a clear complaints procedure in place, and any concerns or complaints are investigated thoroughly by the organisation. The new area manager in post confirmed that she encourages people to raise any concerns they may have, so that the home can have the opportunity to change and develop positively. Some residents told us that “I’d tell one of the staff”, if they were not happy about something, and others said that they would tell their family who would “sort it out”. Staff are recruited following a strict procedure, making sure all checks are carried out before they start work. This ensures they are suitable to work with vulnerable adults. The running of the home is monitored by the organisation through monthly overview audits. These are done on specific areas, such as, numbers of accidents, medication, finances, and infection control, and provides prompts for management in where there may be problem areas. What has improved since the last inspection?
All new admissions now receive a letter confirming the home can meet their needs. We saw that risk assessments were more detailed to inform staff what to be aware of, and there was a risk assessment in place to use for any resident who wished to self medicate, making sure they were competent to do this. Staff numbers have improved due to a recruitment drive, and they now need to be monitored and supervised to create a good working team.
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 7 Medication procedures have been amended in response to the last report, and we saw evidence that the home’s policies and procedures are followed. What they could do better:
The home needs to have a qualified experienced manager in post, who is registered with the Commission for Social Care Inspection. Those left in charge of the home at deputy level should be knowledgeable on the Organisation’s and the home’s procedures and record keeping systems. We saw that due to the introduction of the new care planning system, and so the transfer of information onto it, records were not being kept up to date. Records of reviews of care were sometimes months behind. These reviews should reflect changing needs, and the progress towards meeting those needs. Some reviews reported a constant “no change” over several years, giving staff no indication of any progress or change at all. We noted one resident out of reach of their call bell and who needed assistance. The staff informed us that the resident had just moved rooms, and a longer cord was needed on the bell to reach where the resident liked to sit. Residents should not be placed in rooms unless the facilities are already in place. Some televisions in bedrooms have poor, or no reception. The home says it offers this facility and so it should be provided. Now recruitment has taken place, and there are appropriate numbers of staff on duty, they need to be regularly supervised, monitored and managed to form a committed working team. They should be encouraged to use their initiative and skills to improve the quality of life of the residents. For example, staff should take the time to deal with simple daily living issues of the residents, such as one resident who wanted her plants watering, one had mouldy fruit in a fruit bowl, and one was anxious about something she needed staff to look for. A survey stated that, prior to the new recruitment, staff always seemed rushed, which caused them to speak sharply to residents sometimes. One comment was “staff are often too busy to attend to individual needs such as closing the window, or fetching items from a cupboard”. Staff now need to be looking at carrying out such tasks, and to always consider respect of the residents. The numbers of care staff who have achieved an NVQ qualification needs to increase. Presently 20 of care staff hold the award. There should be 50 qualified to achieve the standard. Activities need to be more regular and specific for people. Individual information is recorded on likes and dislikes, hobbies, and past history, and
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 8 this information should be used to help stimulate each individual, as well as providing group activities or entertainers. We spoke to one resident who said that they missed conversation, another resident liked plants and needed help to look after them. These are individual needs, which could be met with staff initiative. The home needs to hold a record of any complaints or concerns about the home. This gives the manager an overview and can show any patterns which may identify a particular problem which needs addressing. The results of any resident and relative surveys should be available to the staff at the home. This is because they need to know what areas they are performing well in and which need to be improved. 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 Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 9 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 Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 10 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): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear assessment procedure, which is carried out for all people who live there. This means that the service provided is tailored to an individuals needs and preferences. EVIDENCE: Residents able to respond when spoken to said that they knew about the home before they moved in, and it was their relatives who had made the decision that they would be looked after there in the right way. A Statement of Purpose and Service User Guide for the home, plus a brochure with pictures, were available in the hallway for all to see. The management said they provide the brochure information initially, and people are able to visit to view the home at anytime.
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 11 Resident files were randomly selected, and we saw evidence of pre-admission assessments on them, enabling management of the home to identify whether the home would be able to care for them or not. The home have adopted new care planning and assessment documents, and the new assessment includes all aspects of physical, social and psychological care, identifying strengths and needs of the individuals, and showed that the home was able to provide the care that was needed. All people are assessed as an individual, using the same assessment tool, showing equality of care. The manager or senior nursing staff carried out these assessments, usually visiting the individuals in their homes. All of the assessments had been agreed with the person or their family, with a signature to show this. Prior to admission, each person is firstly sent a letter confirming that, following the assessment, the home is able to care for them. A formal contract is drawn up which explains the services provided, and what the fees are. Intermediate care is not provided at The Village Nursing Home. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9, and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about individual’s care is not fully complete and up to date, meaning their needs, both physical and social, may not be met. Residents’ individual choices and needs are not always treated with respect. Medication practices safeguard residents’ health and welfare. EVIDENCE: A new care planning system has recently been introduced to the home by the organisation, and staff are in the process of transferring information onto this so all files are standardised. The care plan holds clear information about individual needs, and is very person centred. The deputy manager confirmed that the records allow staff to continue to show clinical involvement by nurses, but this is the resident’s home, and the new records also help to remind staff that the social and daily living issues are just as important.
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 13 Records of monthly reviews of the care plans were not up to date, as staff were taking time to transfer information onto the new records. Records of any changes through reviews must be kept up to date so that detailed information is there for staff to refer to and care appropriately. Some records which clearly stated monthly updates were to be done, were several months behind. Also when reviews are carried out, they must clearly address the needs of the resident at that time, and identify any progress made towards meeting those needs. Some reviews have continued for several years with a constant record of ‘no change’ being noted. Healthcare opportunities were offered equally to all individuals, and records of visits from healthcare professionals such as GP’s, chiropodists and physiotherapists clearly note the reason for the visit We noted one resident out of reach of their call bell and needed assistance. The staff informed us that the resident had just moved rooms, and a longer cord was needed on the bell to reach where the resident liked to sit. Residents should not be placed in rooms unless the facilities are already in place. Some residents we spoke to said that staff seemed to be rushed, and they felt they had no time for the little things which were important to them. “It’s trivia to them, but important to me. I just want them to look for a magazine I’ve lost”, said one resident, who then asked us to water her plants, which were looking very dry. A piece of over-ripened, mouldy fruit was in a fruit bowl, which we brought to her attention. These are the things which mean a lot to residents, and staff, particularly key workers, should be attending to them. Some residents said that they went to bed at about 4pm, and were served their tea in bed. Those able to respond said that they wanted to go to bed then, as that’s where they were most comfortable, rather than their chair. Care plans did not detail this, and should include all information for each individual’s daily care, giving reason for these actions. One resident said that they did not always want to go to bed then, and would rather do something like have a game of dominoes. Individual choice should be taken into consideration. Other residents said they went to bed and got up when they wished. Most of the people at the home were unable to say that they knew about their care plans, although one said “They have something written about us so they know what to do”. Resident surveys stated that the staff gave the care and support needed. Relatives spoken to said they were kept informed of their relative’s condition. Discussion with, and observation of, staff, confirmed that they were aware of the individual needs, and specialist needs, of the people living at the home. Staff were seen chatting with residents as they helped one of them mobilise.
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 14 We saw call bells being answered by staff fairly promptly, although some residents said that they sometimes had to wait quite a while for staff to respond, and surveys commented that they felt that sometimes staff spoke sharply to residents, showing lack of respect. The area manager confirmed that she had recently recognised the lack of appropriate staff numbers, and had taken immediate action. On this day the rota showed there was appropriate numbers of staff on duty, and we saw them around the home. Privacy and dignity are addressed during induction training, and we saw staff knocking on doors before entering, and closing bedroom doors before carrying out personal care tasks. The deputy manager confirmed that the medication practices had been amended in response to the last report, and the qualified staff who administered medication followed the home’s policy and procedures. We saw a staff member administering the medication over the lunch time period, from the locked medication cabinet, and individually recording each person’s medication. We viewed some records, which were correct and up to date. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals were nutritious, and mealtimes relaxed, which encourages residents to enjoy food and mealtimes. There are limited social activities, meaning that people are not being provided with stimulation, and not being given the opportunities to live lives that are as fulfilled as possible. EVIDENCE: Some activities are provided four times a week, by a designated activities coordinator. The activities list we saw on the noticeboard included arts and crafts, gentle exercises, skittles/bowls, bingo, crosswords and outings in the minibus. Activities are usually provided for one hour at a time, often in a morning. Visitors spoken to commented that there often seemed to be much inactivity for residents, particularly during the afternoon period, although they also stated that they were aware of the difficulties of motivating people. One visitor felt that more could be done socially for the diverse needs of each individual.
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 16 We spoke to one resident who said that they missed conversation, another resident liked plants and needed help to look after them. These are individual needs, which could be met with staff initiative. Some residents had a problem with their televisions, which they enjoyed watching, due to a poor signal. This issue needs to be dealt with, as it is a facility the home say they can provide, and provides some of the much needed stimulation for people. The care plans for each person identifies likes and dislikes, and a outlines a life history, and this information should be used to provide group or individual activity and stimulation which is relevant to each person, with the aim to improve the quality of life for each individual. The management need to develop this area. We saw a visiting policy in the Service User’s Guide. This confirmed that residents could see visitors in private if they wished. Visitors spoken to said that they were made to feel welcome, and several visitors called through the day. The residents spoken to told us that they generally enjoyed the food, which was varied, and we saw that it is provided from a four week rota of menus. The cook has been at the home for several years, and said that he tries to supply different specific meals on request if he can, for example tripe. There was a good stock of fresh vegetables and fruit in the store. Today the meal was fish, chips and peas, which the residents all tucked into in the bright and airy dining room. Staff tactfully helped those who needed a little assistance. The day’s menu was clearly displayed in the dining room so people could see what their meals were to be. We saw staff asking people what they wanted for their tea and lunch the next day. Special diets are catered for. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are confident their concerns will be listened to and acted upon. Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a complaints procedure in place, which is on view in the hall, and provided to all residents with the information given about the home when they are admitted to the home. Three complaints have been received by the Commission about the home since the last visit; two were about the standard of care provided to individuals, and staff attitude and care practices, and one was regarding fire procedures. The area manager for the home investigated one of the complaints, and she found evidence to prove some of the issues raised were founded. She took immediate action to address them. The timescales for dealing with the complaint were kept. Some issues which arose from the other complaints were also dealt with straight away. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 18 There was no complaints record in place in the home, although the management said they had been forwarded to head office, and hence these records were on the electronic system. A complete record of any complaints should be in a place, recording the investigation, and the outcomes, and giving an overview which may detail a pattern and a source of the complaints, which could be addressed. There should also be some record of any minor dissatisfaction, which can be dealt with before they become major complaints. The area manager confirmed that there should be a record of complaints within the home, and one would be set up without delay. There were policies and procedures for Safeguarding Adults, for which staff have attended training. There was also a whistle blowing procedure, and we spoke to staff who could tell us what they would do if they suspected some form of abuse. A coded lock on the front door of the home safeguards residents, as they are able to access outside the home, either alone or with staff or family assistance, but no-one is able to get into the home without first having contact with staff who answer the door. A strict recruitment procedure protects resident’s welfare. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a pleasant, safe and clean environment. EVIDENCE: The garden area at the back and around the front of the home is neat and tidy, and a seating area makes it a nice place to be in the warmer weather. All of the bedrooms are ensuite, and the two shared bedrooms have partition curtains for when residents want privacy. All mattresses are gradually being replaced with pressure relieving mattresses. All bedroom doors had locks and keys were issued to residents. We saw that the rooms we visited were full of personal possessions, from photographs, pictures and ornaments, to small pieces of furniture. “It makes it
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 20 look more like mine, doesn’t it”, commented a resident. One resident said that they chose the colour they wanted their room to be before they were admitted, and it was decorated as they wished. Some relatives had raised the issue of a lack of plug sockets in bedrooms, and the area manager said that she would follow the information up. We saw that the dining room, lounge and bathrooms were all clean and bedrooms were as clean and tidy as residents wished them to be. New lounge chairs, and gradual re-carpeting around the home, keeps it looking fresh, and the maintenance person discussed the regular repainting he carried out. The general redecoration is ongoing at present. We saw a record where daily issues are reported by staff, with the maintenance man dealing with them as soon as possible. “As soon as I see it I try to get on with dealing with it” he commented. He was very clear on his role, which also included checking equipment around the home, redecorating, gardening, and driving the mini bus, and kept good records of his work. All tests of lighting, fire alarms, nurse calls, and water temperatures are carried out very regularly, with clear records made. Grab rails, assisted baths, lifting and bathing hoists, and raised toilet seats all go towards helping the mobility of people around the home. There was a separate laundry room that was fully equipped. The washers had a sluice cycle so that fouled linen could be laundered. There were washable floor and walls, making the area easy to clean. There was a sink with hand wash, paper towels and gloves available so that good hygiene could be maintained by the staff in the laundry. The Village Nursing Home DS0000025583.V345594.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): Standards 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress has been made on addressing staff shortages, and the numbers of staff on duty now generally meet residents’ needs. Recruitment practices are thorough and safeguard residents. EVIDENCE: The home, through Craegmoor, is an equal opportunities employer, and show this with the recruitment of staff from different cultures and both male and female staff. They have a comprehensive recruitment procedure, which is followed by all of the establishments in the Craegmoor organisation. We looked at the recruitment of staff, and there was evidence that references were sent for and a POVA First and Criminal Records Bureau checks obtained before they started work. The management confirmed that for nursing staff professional qualifications are also checked. The staff group at the home are a mix of qualified nursing staff, and care staff, experienced or young and enthusiastic, both male and female. The workforce also includes some overseas staff. All new staff receive training at the start of employment so that they have the knowledge and skills to do their work. An induction pack is given to them and
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 22 completed over 12 weeks. At the end of this time the management confirm whether they are competent to do the tasks. A new staff member told us they were shadowing experienced staff, and felt well supported when carrying out tasks. We saw them asking advice and being guided in their day to day work. When asked about the how the content of the induction helped them, one survey responded with “Very well – I was shown everything I am doing now and having no problems.” Courses attended by staff include Moving and handling, health and safety, food hygiene, infection control, drug administration, and palliative care. NVQ awards have been attained by 20 of the care staff, (5 out of 25 staff), with only 4 (1) presently working towards it. This needs to be increased to at least 50 of qualified care staff to meet the standards required. Rotas were seen which showed an appropriate number of nursing and care staff on duty at all times. However this improvement is fairly recent, and the home have been trying to manage with less than adequate numbers of staff. This is evident in comments from residents who commented in surveys that “staff are often too busy to attend to individual needs such as closing the window, fetching items from a cupboard etc”, and also evident from discussion with them “They said theyd help me look for my dress, but no-one has been yet”. Comments made to us about staff being too busy and responding slowly to buzzers was not apparent, and they were seen to respond within a reasonable time to the nurse calls. The emergency alarm was responded to immediately. A staff survey also commented that staff felt over burdened, and staff said that they had often worked extra shifts to cover the rota. The management confirmed a recent overhall of the rota, and recruitment of staff, had taken place to ensure there were sufficient staff on duty. Staff confirmed “ it is better now. There are more staff to help out”. All staff now need to have ongoing training and regular monitoring and supervision by management, to enable the long term staff and new staff to develop into a working team with good practices, encouraged to use their initiative, and with a good knowledge of both the medical and social needs of the residents in their care. The Village Nursing Home DS0000025583.V345594.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): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The senior staff work to try and set examples and to protect the health and safety of residents, but there is no registered manager to lead, guide and support all of the staff as a role model, and to develop high quality services from a good working team. EVIDENCE: The registered manager has left the employ of the organisation, so at the visit there was no named manager in post. This post was being covered by the deputy manager, who is a qualified nurse, and has worked at the home for several years.
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 24 The deputy manager had difficulties locating some records, and being aware of the audit requirements of the organisation. Those left in charge of the home at deputy level should be trained so that they are knowledgeable on the home’s procedures and record keeping systems. The organisation demands regular overview audits are carried out by all of its establishments, and we viewed the last one for the home which was dated September 2007. The management said that residents are sent a questionnaire twice a year, and head office provides an analysis of the findings. The latest analysis available was from 2004. The outcomes from this feedback are very relevant in the development of the home, and all the management team should be aware of issues raised. The results should always be passed back to the home. Residents meetings are held, which the management said should ideally be every three months, and we saw they varied between two and five monthly. Minutes from the meetings discussed menus, outings, entertainers, and complaints. Staff meetings should be held every 3 months, but had not been held as they should, due to staff shortages. Relatives have meetings regularly, and the management tries to involve and inform people as much as possible. A visitor spoken to said they were very happy with how their relative was looked after, and felt the staff were very approachable. Another relative expressed concern over the absence of a manager to lead the staff. The area manager for the home said she was aware of the difficulties and plans to be very involved in encouraging the new staff team to be more proactive and creative in their roles, while recruiting a new manager. There is a policy and procedure for the management of residents money, valuables, and financial affairs, and a past incident involving a staff member, now terminated, has caused the organisation to carry out a thorough internal audit to identify any bad practices. The incident was handled professionally and efficiently once the area manager had been informed. Written and computerised records of any personal allowances received for residents were kept, which showed income, expenditure and any remaining balance. One to one supervision of staff has not been carried out regularly over the period of staff shortages. This is needed to monitor progress and identify training needs and concerns of staff. These need to be reinstated to develop the individual and the team. Regular servicing had taken place in relation to systems and equipment used by the home to make sure they were safe to use. Records viewed and
The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 25 discussion with staff indicated that they had received instruction in relation to safe working practices, such as moving and handling training and first aid training. This meant that they had been provided with the knowledge to make sure they were up to date with current good practice and able to carry out procedures safely. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The review of the plan of care must be carried out at least monthly, and the care plan revised as necessary. The review must note the progress made to meeting the resident’s need. Staff must treat residents with respect at all times, ensuring their dignity is upheld and choices and lifestyles are accepted and worked with. The activities programme must be developed to include more input for individuals, from the information gathered about them, which may stimulate people to join in, and improve their quality of life. There must be a record of all complaints made about the home, including the investigation and any action taken. These records must be kept in the home. The service must employ a suitably qualified and experienced manager who is registered with the CSCI
DS0000025583.V345594.R01.S.doc Timescale for action 31/10/07 2 OP10 12(4)(a) 31/10/07 3 OP12 16(2) 31/10/07 4 OP16 17(2) 31/10/07 5 OP31 9 31/12/07 The Village Nursing Home Version 5.2 Page 28 6 OP36 18(2) 7 OP38 12(1) Staff must be appropriately supervised, as part of the management process, on a continual basis, to help develop a good working team. The registered person must ensure that the person in charge of the day to day running of the home is trained and knowledgeable in the procedures and practices of the organisation. 31/10/07 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP30 OP33 Good Practice Recommendations NVQ in care should be obtained by 50 of the care staff. The home should receive information on the results of the residents/relatives surveys so that they are aware of what areas they do well and need to improve in. The Village Nursing Home DS0000025583.V345594.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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