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Inspection on 05/11/09 for Throckley Nursing & Residential Home

Also see our care home review for Throckley Nursing & Residential Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Throckley Nursing & Residential HomeDS0000040481.V378278.R01.S.docVersion 5.2The home is clean, homely and comfortable and the lounge areas are well furnished to meet the needs of the people living in the home. Residents’ bedrooms were well personalised and those spoken to were happy with the way they have been supported to make them comfortable. The residents were happy with the food, which they said was always hot enough and looked nice. This was confirmed by the inspector who sampled it and found it to be tasty. Residents are encouraged to visit the home for a look around before they were admitted and there are good records to show that staff had assessed their needs before admission to make sure they could be cared for safely. Good staff personnel records contain the required information to make sure residents remain safe. Residents and relatives are consulted through a series of meetings. Residents told us that they would talk to a nurse or the manager if they had any problems or complaints.

What has improved since the last inspection?

Six requirements were identified at the last key inspection. Three of these had been met and were removed at the random inspection carried out 24th August 2009. The three requirements outstanding since the last random inspection have been met. These were to:• • Provide staff with training in the recognition of complaints, this has been provided including one to one sessions during supervision sessions. Review the bathing facilities. Residents must have access to suitably adapted baths and showers. The home has sufficient numbers of baths and showers, however staff were not using all of the facilities as they presented some practical problems for some residents. By the second visit of the inspection there was a new assisted bath and shower installed. Conduct a review of infection control practice to take account of the comments in this report.•Throckley Nursing & Residential HomeDS0000040481.V378278.R01.S.docVersion 5.2

What the care home could do better:

The care plans must show in detail the way that specialist needs are being assessed and how the staff plan, deliver and evaluate the care delivered. This will make sure that the staff are kept informed of the individual residents needs and can demonstrate the way that these needs are being met. The specialist needs of the individual people living in the home must be addressed, particularly those who have dementia. This will improve the outcomes for service users and made sure that they have chosen lifestyles in line with their clinical needs. People living in the home must be offered support to be involved in social or recreational activities in line with their choices, abilities and previous lifestyles. This will improve the quality of life for the residents so that they can live active and fulfilled lives. Additional nursing and care staff must be recruited to ensure that there are sufficient numbers to care for the people living in the home. This will make sure that consistent and effective care can be given to all residents. Staff must be given training to meet the specialist needs of the residents living in the home. This will make sure that effective and safe care can be given to all residents.

Key inspection report CARE HOMES FOR OLDER PEOPLE Throckley Nursing & Residential Home Ponteland Road Throckley Newcastle Upon Tyne Tyne & Wear NE15 9EP Lead Inspector Suzanne McKean Key Unannounced Inspection 5th November 2009 09:30 DS0000040481.V378278.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Throckley Nursing & Residential Home Address Ponteland Road Throckley Newcastle Upon Tyne Tyne & Wear NE15 9EP 0191 267 5655 0191 229 1119 throckleygrange@highfield-care.com www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited 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) Manager post vacant Care Home 48 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (48) of places Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 category: Old age, not falling within any other category - Code OP, maximum number of places: 48 2. Dementia - Code DE, maximum number of places: 18 The maximum number of service users who can be accommodated is: 48 26th November 2008 Date of last inspection Brief Description of the Service: The home is purpose built and located in the centre of Throckley. It is close to all local amenities and is on a local bus route. The home caters for up to 50 older people and has a maximum of 35 nursing care beds. There are spacious communal areas, dining rooms and a separate smoking lounge. A passenger lift services all areas. The home has 44 single bedrooms, some with en-suite facilities. Externally there are accessible gardens, patio areas and car parking is available. The home has access to a shared mini bus for outings. Fees vary and more information is available from the home. The home provides information about the service through the service user guide and statement of purpose. A copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit: We looked at: • Information we have received since the last visit to the home on 24th August 2009. • How the service dealt with any complaints & concerns since the last full inspection on 26th November 2008. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service. The Visit: An unannounced visit was made on 26 November 2008. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • We looked at care plans for five people and case tracked two. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the manager what we found. What the service does well: Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.2 Page 6 The home is clean, homely and comfortable and the lounge areas are well furnished to meet the needs of the people living in the home. Residents’ bedrooms were well personalised and those spoken to were happy with the way they have been supported to make them comfortable. The residents were happy with the food, which they said was always hot enough and looked nice. This was confirmed by the inspector who sampled it and found it to be tasty. Residents are encouraged to visit the home for a look around before they were admitted and there are good records to show that staff had assessed their needs before admission to make sure they could be cared for safely. Good staff personnel records contain the required information to make sure residents remain safe. Residents and relatives are consulted through a series of meetings. Residents told us that they would talk to a nurse or the manager if they had any problems or complaints. What has improved since the last inspection? Six requirements were identified at the last key inspection. Three of these had been met and were removed at the random inspection carried out 24th August 2009. The three requirements outstanding since the last random inspection have been met. These were to:• • Provide staff with training in the recognition of complaints, this has been provided including one to one sessions during supervision sessions. Review the bathing facilities. Residents must have access to suitably adapted baths and showers. The home has sufficient numbers of baths and showers, however staff were not using all of the facilities as they presented some practical problems for some residents. By the second visit of the inspection there was a new assisted bath and shower installed. Conduct a review of infection control practice to take account of the comments in this report. • Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.2 Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Throckley Nursing & Residential Home DS0000040481.V378278.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 Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home have their needs assessed before they are offered a place in the home. EVIDENCE: There has been no change to the admission procedure since the last inspection. Care records showed that residents’ care needs are assessed before admission. This information was sufficient for staff to judge if they could meet the needs of each resident. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 10 One resident told us that she had been told about the home before she came in but that her family had visited the home to make sure that she would be “happy” there. She said that she was pleased that this home had been chosen as she was settled and that she was happy in the home. A relative spoken to was complementary about the staff and said that she was surprised how quickly her relative had settled into living in the home. Another resident said that her daughter had looked at the home for her as she could not do it herself and that she had decided what items of furniture and person items that she wanted to bring in with her. One visitor was unhappy with the way that their relative had been cared for and was disappointed that the staff who had been working in the home when she had looked around, who had specialist dementia care experience was no longer working in the home. An up to date statement of purpose and service user guide is available in the home. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met, however specialist care needs are not always fully identified to make sure that people living in the home receive the individualised care they need. EVIDENCE: All residents have a care plan which includes an assessment of their needs and a plan of how these should be met. These were generally up to date and contained information necessary to care for the residents safely. They are now completed in detail to show the changing and needs of the residents. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 12 The company documentation includes a variety of risk assessments for prevention of falls, wound care, and moving and assisting as well as assessment tools for clinical areas such as continence promotion. These have been improved recently and are completed to a good standard. They are in enough detail to tell the staff who are giving the care how to do it safely. The care plans around general care are up to date and had been reviewed regularly. Reviews are carried out regularly and note family involvement and GP’s attendance. Care plans do refer to ‘making decisions’ and mental capacity, which is good. The home has only one person with a pressure ulcer and that is being managed appropriately. The records for this are up to date and were completed in sufficient detail to allow the staff to manage it safely. The care plans do not sufficiently detail peoples specialist care needs: particularly where people have dementia and need specialist support. They also contain entries which suggest that current best practices are not being followed. Examples of this is the use of phrases such as the aim of the care being that the staff should “endeavour to re-orientate **** to time place and person”. Also phrases such as “well balanced diet and good fluid intake” could be more specific to the person including their likes and dislikes and clearly identify the amount of fluid a person should be drinking in the day. Where a resident presents behaviour which challenges the service behaviour monitoring records to identify triggers/causes for neither the behaviour nor how the staff could manage this are available. One care plan showed that some inconsistency was identified regarding her mobility. Some areas of the care plans described that she was able to “walk short distances” whereas another section said “cannot mobilise but can weight bear”. The visiting relative was concerned that she had been informed by the staff in the home that her Mother was not able to walk however she asked a carer to try her walking and it was discovered that she actually walk using an aide. This is of concern that the mobility assessment should have determined this as part of the process. Care plan audits are being carried out and they show that there is an understanding the further improvements required. The manager confirmed that she and the deputy are working through care records to make the necessary changes to ensure that care plans are more person centred and contain the information that staff can use to care for the people living in the home. None of the nursing or care staff have any specific training in dementia care. They also have not had any experience in providing care to people who have dementia within a specialist unit. This results in them having to rely on their Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 13 general care knowledge when assisting residents. The manager is currently undertaking a course in Dementia. Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents. The home liaises with the General Practitioners who provide care to the residents. The care was being given by staff that were pleasant and courteous and number of residents were enjoying the staffs company. Generally, the staff were friendly toward the residents and were attempting to engage them in conversation. Residents said that they felt well supported by the staff an example was when on resident said that they thought that the staff were “lovely” and that “they always try to help me and were nice”. Medicines management was looked at for the residents whose care plans were examined and these were satisfactory. Ordering was controlled by the Home and photocopies of prescriptions were kept alongside MAR charts. Good waste medicine records were available. The storage was appropriate. The controlled drugs records were good. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities could be improved to give people living in the home a more fulfilled and active lifestyle in line with their choices, abilities and previous lifestyle. EVIDENCE: The staff support residents in ways of taking control of their daily routines, in simple but important ways for example the time they get up, what and what they eat and how they spend their time. Staff confirmed that they assist residents to make choices about how they spend their day, and residents confirmed that this is the case. During the visit some choices were being made although there are further improvements that would be made in this area around the social opportunities. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 15 At the time of the random visit on 24th August 2009 the home had recently employed an activities co-coordinator who has since left. The manager has appointed another activities co-ordinator who is currently working as a carer in the home. This arrangement was planned to start on the following week if staffing levels allowed it, as her care shifts would need to be covered. The residents on the lowest floor were being occupied with a 3D jigsaw and watching television. Generally the opportunities for residents to be involved in social activities have been variable and although some activities have been organised it has not been consistent and does not offer the residents the chance to live active and fulfilled lives in line with their individual choices, abilities and previous lifestyles. There are some inconsistencies in the amount of personal history that was recorded and there are gaps in the records around the way that residents are being supported to participate in social activities. The dependency level of some of the residents means the activities on offer may need to be less active and provided on a more one to one basis. The manager is currently working toward achieving a more detailed social assessment and record of activities participated in by involving the residents and their representatives. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives are given information within the residents guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. Residents were complementary about the food and some described the food as very good. They were observed eating their meal with evident enjoyment. The inspector tried the food and found it tasty and served at the correct temperature. The “tea trolley” was taken around the home mid morning and mid afternoon had tea or coffee available on both floors as well as juice or milk available. Biscuits were being served with plates and fresh fruit cut into bite size chunks which residents could choose if they wanted. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding issues are adequately managed and the service works with the agencies to ensure that people are protected from harm. EVIDENCE: The companys complaints procedure is available in the service users guide and a copy is available at the front entrance and is displayed in the home. The records of the complaints were examined. Staff are continuing to try to resolve small problems at a very local level and for other issues there is a formal process for staff to follow. The staff spoken to were aware of the process of how to report any concerns to a more senior member of the staff team. Relatives who were visiting the home were aware of the complaints procedure and had raised concerns in the past and were satisfied with the response. One had significant concerns but said that they had spoken to the manager and the deputy manager about them but had not formally complained. This was raised with the manager and by the second visit action had been taken to address the issues raised. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 17 There have been fourteen complaints made in 2009. Three of which are still being looked at through the complaints procedure. The manager completes a monthly complaints monitoring and audit form which it sent to the Operational Director for analysis. The company has written guidance in place regarding the protection of vulnerable adults through detailed policies and procedures. These are included in the induction training and ongoing in-house training. The manager and the senior managers in the company have worked with the Safeguarding Adults unit to resolve issues that have been alerted. Staff are given protection of vulnerable adults training both as part of the inhouse training package and from outside organisations. The manager has provided all staff with training in Deprivation of Liberty, Mental Capacity and Safeguarding adults. She has completed Local Authority training suitable for managers of services in October 2009 and has had previous experience of delivering training in these areas for The Btec pre nursing students and NVQ levels 2 to 4 at Bishop Aukland and Dewentside College up until April 2009. Care staff confirmed that they knew about the safeguarding guidance and could identify the action they would take if they were made aware of or had any concerns. Improvements have been recently made as the new manager has a good understanding of the safeguarding processes. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant comfortable place for people to live and infection control practices make sure that it is a clean and safe. EVIDENCE: Throckley Nursing and Residential home is a purpose built home of traditional brick and tiled roof construction. The care is provided over three floors with a passenger lift to all floors. There are also stairs to each floor which are not usually used by the people using the home. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 19 The home is located in the centre of Throckley, close to the roundabout and near to a large supermarket as well as being close to all local amenities and is on a local bus route. The care is provided in three “units” situated on each of the floors. The bottom “ground” floor is named Deneburn. This is the floor on which those people who have dementia live. The first floor (with the main entrance) provides care for those people who have general nursing needs. The top floor provides accommodation for those older people who need residential care. There are spacious communal areas, dining rooms and a separate smoking lounge. The home has 44 single bedrooms, some with en-suite facilities. Externally there are accessible gardens, patio areas and car parking is available. The home has access to a shared mini bus for outings. The homes location and layout is suitable for the current needs of the residents. All of the bedrooms have an en-suite facility and there are bathrooms, shower rooms and toilets close to all resident areas. The bedrooms are all for single occupancy. Residents have brought small items with them making their rooms personalised and homely. The manager has identified the ongoing redecoration plan so that the necessary improvements needed to maintain the home to a good standard. The sluices were locked and there was no disinfector available, this was discussed with the Manager and by the second visit the hot wash steriliser was in the home and was waiting to be fitted on the floor which provides nursing care. The laundry is on the lower ground floor. There are separate areas for clean and soiled linen. The home was clean and tidy and the control of infection practices are being followed with staff using good strategies to reduce the risk of cross infection in the home. Soiled incontinence pad are being placed in plastic bags prior to appropriate disposal. All areas requiring liquid soap, disposable hand towels and waste bins had them provided, making it easier to ensure that staff are able to follow control of infection practices. Some bins need to be replaced with foot operated pedal bins but this is in hand. The bathing facilities were the subject of a requirement from the last inspection. On the first visit there were the following facilities available:• Bottom floor - 1 assisted bath and one shower that is not used by staff as it floods when being used • Middle floor – one assisted bath, on bath that can be used with a freestanding hoist, one shower that is not used by staff as it floods when being used. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 20 • Top floor – one bath that can be used with a free standing hoist (small room) This was discussed with the manager and she confirmed that there plans to improve this situation. By the second visit the showers that flooded had been improved, a new shower had been fitted to the bottom floor and a new Aqua Nova height adjustable bath had been fitted. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good recruitment selection procedures in place, systems around recruitment, selection and training of staff are sufficient to meet the range of needs of the people using the service. However, insufficient staff are employed to make sure that they can provide enough staff to meet the needs of the residents without the use of agency staff or staff from other homes. EVIDENCE: There are only two nurses currently employed in the home, the manager and the deputy. This means that the responsibility for delivering the care or providing training and support to the care staff remains with only two individuals and is not shared with a larger staff team. This also results in staff being temporarily transferred from other homes in the same company or the use of agency nurses. There are currently fourteen residents who require nursing care. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 22 On the day of the first visit the following staff were on duty, the deputy, one senior carer and four carers. There were two domestic staff, laundry and kitchen staff, one handyman, administrator (only employed for eight weeks) The staff were allocated as follows, top floor one carer, the middle floor one nurse and three carers and the bottom floor, which provides care to people who have dementia, one carer for two people. This means that the carers on the top and bottom floors were reliant on the “floating” carer from the middle floor to assist with those people who may need two people or to cover for tea and meal breaks. Relatives spoken to were concerned that there are not enough staff on duty and that there were times when the call buzzers were not being answered within a reasonable time scale. There have been problems in the recent past with changes in the staff team particularly with regard to the qualified nurses. The staffing rotas showed that there are periods when staff shortages resulted in the need for staff to move around into other roles or to work additional hours to cover gaps. The manager told us, that she had recruited three nurses. One of these are already working for the company and one from outside and one is recently qualified. She is waiting for the references and Criminal Bureau Check before they can commence their employment. On discussion with the deputy following the visit it was noted that only one of these have commenced employment with the home and one is working on the homes “bank”. Staff recruitment and selection records were complete including two references and a completed application form. The requirement to have a CRB check in place is applied to all of the staff in the home. The staff are receiving statutory for areas such as fire safety, moving and handling, protection of vulnerable adults, and health and safety at the necessary frequency to safeguard the residents. Although there are some gaps these are for new staff or where staff have been missed for particular reasons. There is now some training opportunities made available to the staff around specialist clinical areas and all staff have recently completed training in infection control. The staff are showing a commitment to improve the practices in line with the training being given. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems are working to make sure that residents are safe and have their needs met and that the home is beginning to be managed in the best interest of the people living there. EVIDENCE: The home has a new manager since the last inspection although she is not yet registered with CQC. She is experienced in nursing and management and has already shown her willingness to make the improvements necessary. She is Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 24 yet to submit her registration application but has confirmed that she intends to do so. The manager was attending training on the first day of the visits, and the deputy manager was in charge of the home as well as being the nurse for a floor. The second visit was arranged for a day when the Manager was available so that we could access records held by her. The company have a number of reporting mechanisms so that the senior managers have the information about the home to be used in the quality review of the service. Weekly reports are sent to the regional management team regarding the day to day issues in the home. This includes those residents at risk e.g. with pressure damage or who are loosing weight, and the care being given to address the risk. There is now an administrator in the home who, although she has worked for a short time in the role was very knowledgeable about her responsibilities. There are a number of audits are carried out in the home. These include auditing of systems, records and care practice. These have been changed to include peer audit. This is when, on alternate months, a manager from another service carries out case tracking of residents to look at the care being provided. The other months the Operational Manager carried out Regulation 26 visits in line with the Care Homes Regulations. Residents and relatives are consulted about the running of the home through meetings. Staff also attend meetings at which new information is shared. Minutes of these were examined. Staff are reminded that the home should be run in the best interests of residents. There has been a recent relatives survey undertaken, the outcome of this is currently being analysed by the company before the information is given to the home. An action plan will then be formulated by the manager. There has also been a client opinion survey and this raised issues regarding the lack of activities and concerns around not being given sufficient choices. Accident reporting in the home is appropriate. Case tracking showed that entries in the accident book were reflected in the daily record within individual files. Accidents are monitored and analysed so that risks can be identified. Safety is promoted for residents by using these systems effectively and by having a staff group that is trained in fire safety, moving and assisting, infection control and food hygiene. Supervision is well planned and they are on target for the requisite numbers to be carried out in the year. The most recent supervision sessions include themes around some of the issues identified in the surveys as well as discussing care practices and training. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 25 Servicing and maintenance agreements are in place for facilities and equipment. These were up to date apart from the electrical installation certificate. This was issued in 2000. These are valid for five years. It is therefore out of date. This compromises the safety of the building and all in it. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. Residents’ personal monies were checked. These are held as computerised accounts. These were being managed effectively and those looked at were accurate. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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 2 9 3 10 3 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 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 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 Requirement Care plans must show in detail the way that specialist needs are being assessed and how the staff plan, deliver and evaluate the care delivered. This will make sure that the staff are kept informed of the individual residents needs and can demonstrate the way that these needs are being met. 2. OP8 12 The specialist needs of the individual people living in the home should be addressed, particularly those who have dementia. This will improve the outcomes for service users and made sure that they have appropriate lifestyles in line with their clinical needs. 3. OP12 16 People living in the home must 01/03/10 be offered support to be involved in social or recreational activities in line with their choices, abilities and previous lifestyles. DS0000040481.V378278.R01.S.doc Version 5.3 Page 28 Timescale for action 01/03/10 01/01/10 Throckley Nursing & Residential Home This will improve the quality of life for the residents so that they can live active and fulfilled lives. 4. OP27 18 Additional nursing and care staff must be recruited to ensure that there are sufficient numbers to care for the people living in the home. This will make sure that consistent and effective care can be given to all residents. 5. OP30 18 Staff must be given training to meet the specialist needs of the residents living in the home. This will make sure that effective and safe care can be given to all residents. 01/03/10 01/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations The manager should pursue her registration application with CQC to be the registered manager. Throckley Nursing & Residential Home DS0000040481.V378278.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@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). 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