CARE HOMES FOR OLDER PEOPLE
Three Corners Nursing Home 3 Greenway Road Churston Ferrers Brixham Devon TQ5 0LW Lead Inspector
Fiona Cartlidge Unannounced Inspection 26th October 2005 11:10 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 Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 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. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Three Corners Nursing Home Address 3 Greenway Road Churston Ferrers Brixham Devon TQ5 0LW 01803 842349 01803 846079 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.threecorners.co.uk Mrs Elizabeth Agnes Hunter Vacancy Care Home 40 Category(ies) of Dementia (7), Mental disorder, excluding registration, with number learning disability or dementia (7), Old age, not of places falling within any other category (7), Physical disability (40) Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. To undertake update/training in adult protection - recognising and reporting allegations of abuse, within 3 months of the registration being granted. Service Users aged 65 years and over PD Maximum registered 40 service users (both) OP Maximum registered 7 service users (both) DE Maximum registered 7 service users (both) MD Maximum registered 7 service users (both) Date of last inspection Brief Description of the Service: Three Corners is situated in a level position on the edge of the village of Galmpton, which lies between Brixham and Paignton, a car park is available in the front of the home. The access to the home is via a modern porch. The same family has owned the home for twenty years. The home is registered to provide care for up to forty older people of either gender who have personal care and general nursing care needs. The accommodation is provided in twenty-two single rooms and nine shared rooms. Each room has a nurse call system and is equipped with the furniture and adaptations required for individual Service Users. A variety of equipment and adaptations are provided to meet the needs of disabled Service Users. There is at least 1registered nurse on duty at all times supported by a team of Health Care Assistants. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 5hours and 50 minutes and was unannounced. A partial tour of the home took place when some bedrooms and the communal bathrooms and living rooms were viewed. Personal records of care of 3 residents and personnel records of 2 members of staff were inspected. The inspector spoke with 15 residents, 2 visitors, 4 staff members the Care manager, administration manager and registered provider. Feedback was received from 1 visitor/relative before and after the inspection. This was the homes second inspection of the year and readers should consider the contents of the last inspection report and this one to assess how the home has been measured against the National Minimum standards in inspection year April 2005-2006 What the service does well: What has improved since the last inspection?
Progress in redecoration and refurbishment is slow but there was evidence that some paint work has been refreshed. Feedback about the experience of living in the home from most residents was more positive during this inspection. Through the investigation of three recent complaints the registered provider and matron have a better understanding of how to deal with complaints as part
Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 6 of the homes plan for continual improvement, in a manner, which will positively impact on practise in the home. What they could do better: 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. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,6 The admission process is safe - it ensures that adequate information is obtained about prospective residents; this allows senior staff in the home to make a decision about if/how those peoples needs will be met. EVIDENCE: The inspector examined personal documentation held on behalf of 3 residents one of which had recently been admitted to the home; all included preadmission information supplied from care management or hospital settings. The inspector spoke to a number of residents about how they had made the decision to be admitted to the home, the inspector was told by one person that they had been admitted under urgent circumstances rather than going to hospital and for a short period only whilst awaiting multi – disciplinary assessment and possible discharge to a rehabilitative facility. Another resident said they and their relative had been given the opportunity to visit the home and assess its suitability before making a decision to stay. At the time of admission over a year ago, they told the inspector, that they had been assured a shower room was going to be provided, that assurance has yet to be met. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 9 Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The Care plans show some improvement but had not been reviewed regularly, this may pose a risk to residents, as staff may not be consistent in their approach to changes in a persons needs. Poor and inaccurate recording of medication administration has the potential to place residents at risk of either over medication or not receiving medication as it has been prescribed. EVIDENCE: The documented assessments seen, provided information about skin integrity, moving and handling, safety - including risk of falls, and social needs. The information generates the plans of care, which provide the basis for the care to be delivered. The inspector viewed 3 care plans; these had not been reviewed as recommended on a monthly basis the last recorded review dates were in August. There was some documentary evidence that residents and or their representatives had been involved in the planning process, one resident who’s care the inspector case tracked confirmed they had been involved in the plan to meet their needs.
Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 11 Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district and specialist nurses, chiropodists, physiotherapists and dentist’s visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Residents told the inspector that the staff respect their privacy and dignity, the inspector observed that when personal care was being provided this was done behind closed doors, the staff spoke to residents in a polite manner and were witnessed (with the exception of 1 occasion) to knock on the doors to private accommodation before entering. Feedback was received by the commission before the inspection from 1 relative/visitor indicating that they are usually satisfied with the overall care provided. The inspector examined the system of medication management, one administration record lacked signatories where medication should have been administered as prescribed, another medication was written as 1 or 2 tablets to be given, there was no indication of how many had actually been administered. Another medication prescribed one at night had signatories to indicate that it had been administered both in the morning and at night for a number of weeks. Medication no longer in use had been placed in the correct bin for disposal by a licensed waste contractor; however this bin was being stored in a cupboard, which could be accessed by non-nursing staff. There was only one signatory beside records made at the time of the medication being placed in the bin - best practise indicates a registered nurse and witness should record the actual date the medicine was added for disposal, with the name and strength of the medication, quantity, name of resident for whom the medication was prescribed, signature of the member of staff and witness and on removal by the contractor, date and signature of consignment of the waste to the contractor. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Social activities meet the needs of some residents. Meals are nutritious and well presented and appreciated by the residents. The arrangements for visiting are good. EVIDENCE: A number of people living in the home were spoken to and everyone who commented on the food said how much they liked it. The home lacks a separate dining room/area people either eat in the conservatory sat in arm chairs at single tables or in their own accommodation. Comments included the food is better than it was’, ‘I’m quite satisfied’, ‘I never go hungry’, ‘the food’s fantastic’. An activities programme is in place, which includes simply having music on or watching television/videos together in the lounge. One resident said ‘nothing ever happens, I sleep mostly’, another told the inspector ‘I sometimes enjoy music events, but don’t usually go to the lounge because everybody goes to sleep’. Some residents told the inspector they didn’t like mixing; those spending time in their own accommodation said they liked reading, watching television, knitting, bird watching and one said the nurses pop in and out and I like speaking to them.
Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 13 Residents confirmed they are able to chose where they spend their time and are able to receive visitors at times that suit them in their own accommodation or in the lounge; one visitor said they were pleased they could bring their pet dog in to visit and the resident was equally as enthusiastic about their visits. The hair dresser was in attendance during the inspection and residents told the inspector that they enjoyed her company and felt much better for having their hair done. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People feel safe living in this home. Poor formal communication systems between the registered provider and senior care team may pose a risk to residents because issues and concerns raised by residents and or visitors to the home are not always discussed openly and formally addressed in accordance with the homes complaints policy/procedure. EVIDENCE: The complaints procedure is displayed in the home. Despite a recommendation to update the document (following the last inspection) to ensure people have the means to refer a complaint to the Commission at any time, it had not been done. Residents told the inspector if they had issues or concerns they would speak to the matron or her deputy who are ‘very approachable’, and ask regularly if residents have any problems. The commission has received 3 complaints about this home since the last inspection these were passed to the matron and then on to the registered provider for investigation using the homes own procedure. These have been fully investigated and responded to and action has been taken to improve practise where required. Staff files provided written evidence that staff have read and understand the homes policy regarding the protection of vulnerable adults and the nurse on duty at the time of the inspection confirmed she had attended external training on this subject recently. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26, Some areas of the home are not well-maintained and bathing facilities meet the needs for some, but not all, residents. Some improvements to the décor and structure of the home have been made; the communal space can get too hot to be comfortable and so is not always available for use. EVIDENCE: There was some visual evidence that paintwork in some areas has been cosmetically touched up since the last inspection. Some rooms are well decorated and furnished, others require refurbishment; one person admitted for short- term care only, said that the bed in their room was uncomfortable and the décor in the room was plain with paint on walls chipped. Some floors in private accommodation are covered with vinyl, others with carpet some carpets were looking stained. One resident told the inspector they had been unable to bathe for months because following a moving and handling assessment it had been decided that the bathrooms in the home were not safe for their use. The resident confirmed that they receive a full assisted wash in their bedroom daily but that they really are missing the experience of having a bath or shower.
Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 16 The lounge on the ground floor is a conservatory type structure, a record of temperatures in this room is maintained and was found to have been as high as 102 degrees centigrade in July – the staff told the inspector the room was not used on days when it was too hot. A leak to the roof in the conservatory (problematical for a number of years) appears to have been fixed but there was evidence of staining to the ceiling possibly by water ingress just out side the door to the conservatory (kitchen end). A smaller lounge on the first floor was not in use at the time of the inspection. The home does not provide a separate dining area/room. The home was clean and odour free and adequate supplies of disposable gloves where in evidence however these were not latex as now recommended by the health protection agency. Liquid soap dispensers and alcohol rub was found by every wash hand basin with notices requesting that visitors use before and after visits. One communal bathroom had soap bars in a soap dish attached to the bath; this poor practise was discussed with the registered provider at the time of the inspection. One person told the inspector that a recent fault had meant there had been no central heating in the home for a period of 9 days and that because the registered provider had been on leave this had not been addressed in a timely fashion. The temperature in the home at the time of the inspection was comfortable. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 The procedures for the recruitment of staff are robust and offer protection to people living in the home. The deployment and number of staff on duty during the inspection met the needs of the residents. EVIDENCE: Residents spoke of the kindness and helpfulness of the staff, One said they are ‘polite and cheerful’, another ‘they couldn’t do more’ another their ‘looking after us marvellous’ another told the inspector ‘there are no bad ones, but some are nicer than others’. Most residents said they felt there was always enough staff on duty, one commented that some weekends there did not seem to be as many staff as at other times and they were rushed and slow to respond Four staff were spoken to they said that there was usually enough staff on duty the only time there wasn’t was when people went off sick. The inspector examined the personnel files of 2 recently employed members of staff these contained all of the information and documents required to safeguard the welfare of residents. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 The home has changed management 3 times in 2 years, which has lead to inconsistencies in leadership. The current manager has been in post for 12 months. The lack of formal communication between the administrative management team and care management team poses a risk to the health, safety and welfare of people using this service. EVIDENCE: There is an acting manager who has been in post for 12 months the nursing home has lacked a registered manager therefore a requirement to register a manager with the commission was made at the time of the last inspection with a timescale for it to be done by 1st September, despite this the application was withdrawn. A further 3 months has been given for this requirement to be met, and the registered provider has been advised that the commission may take enforcement action if not it is not met. Poor formal communication systems between the matron and the registered provider may pose a risk to residents as issues brought to the attention of one
Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 19 party may not be passed on to the other for discussion and resolution. One relative/visitor told the inspector that they had raised a concern about the lack of a suitable bathing facility to the attention of the manager who had advised they put their concern in writing to the registered provider or the Commission because the registered provider had not done anything about it when the matron had discussed it with her. Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 20 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 1 1 1 x X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X X X X 2 Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 21 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 OP31 Regulation 8(1)(a) Requirement The registered person must appoint an individual to manage the care home who is registered by the commission as required by this regulation. This requirement has been extended from 01/09/05. Medication administration records must be accurate. Medication no longer in use must be recorded and disposed of in a safe manner. Written information should be provided to all people living in the home on how to refer a complaint to the Commission at any stage should they wish to do so. A bathroom must be provided to suit the needs of residents who are unable to weight bare. Safe hold open devices (approved by Devon fire and rescue department) should be in place for all doors to private accommodation where the resident requests the door to be open. Timescale for action 01/02/06 2 OP9 13(2) 01/11/05 3 OP16 22 01/12/05 4 5 OP21 OP38 23 13(4) 01/04/06 01/12/05 Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 22 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. 3. 4. Refer to Standard OP7 OP8 OP10 OP12 Good Practice Recommendations Care Plans should be reviewed on an at least monthly basis and updated to reflect changes in need. Where a change in health is identified e.g. unexplained sudden rise in B/P this should be monitored and reported. All staff should treat the accommodation of residents as private and therefore should have permission before entering (Wherever possible). The activities programme should be varied and stimulating to meet the needs of all residents, on an individual and group basis. Residents and their representatives should be involved in planning activities. A revised plan for the improvement to the environment (including predicted timescales) should be submitted to the commission regarding an application to vary received in 2003 The above plan should include the provision of a dining facility to cater for people living in the home. Temperatures within the conservatory lounge must be controlled to ensure residents can use it 365 days of the year. A plan including timescales to redecorate and refurbish all those bedrooms which have not been done should be provided to the Commission to ensure an equitable standard of accommodation is available to all those living in the home. To prevent the risk of cross infection soap bars should not be left in bathrooms. Latex gloves should be available to staff when in contact with body fluids. Regular meetings and systems for formal communication and feedback should be held between the Senior nursing team and the administrative team to ensure cohesive working and ensure the needs of both staff and residents are understood and met. 5. OP19 6. OP20 8. OP24 9. OP26 10 OP32 Three Corners Nursing Home DS0000028760.V261137.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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