Inspection on 01/02/06 for Turfcote Nursing Home

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Turfcote Nursing Home 07/05/09

Turfcote Nursing Home 15/04/08

Turfcote Nursing Home 14/08/07

Turfcote Nursing Home 17/05/06

Turfcote Nursing Home 14/06/05

Turfcote Nursing Home 13/01/05

Turfcote Nursing Home 18/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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

CARE HOMES FOR OLDER PEOPLE Turfcote Nursing Home Helmshore Road Haslingden Rossendale Lancashire BB4 4DP Lead Inspector Jane Craig Unannounced Inspection 09:30 1 and 2 February 2006 st nd 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 Turfcote Nursing Home DS0000022473.V256850.R01.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. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Turfcote Nursing Home Address Helmshore Road Haslingden Rossendale Lancashire BB4 4DP 01706 229735 01706 229231 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) Marshmead Limited Elizabeth Ford Irwin Care Home 76 Category(ies) of Dementia - over 65 years of age (31), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (31), Old age, not falling within any other category (46), Physical disability (46) Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. A maximum of 46 service users requiring nursing care who fall into category of either OP or PD A max of 30 service users requiring personal care who fall into the category of OP A max of 25 service users requiring nursing care who fall into the category of either MD(E) or DE(E) A Max of 6 service users requiring personal care who fall into the category of either MD(E) or DE(E) Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 24 May 2001 Elizabeth Irwin is registered as manager of Turfcote only The service should, at all times, employ a suitably qualified and experienced person who is registered with the NCSC as manager of Turfcote only. 14th June 2005 Date of last inspection Brief Description of the Service: Turfcote is registered to provide care to a maximum of 76 residents. The home is split into 2 separate units. Tor View provides nursing and personal care to up to 46 adults and Grane View provides nursing and personal care to up to 30 older people who have mental health care needs. Turfcote is a detached, extended building set in its own grounds. Bedroom accommodation is provided on two floors, with the upper floor accessed by two passenger lifts. There are a mix of single and double bedrooms, some with ensuite facilities. There are 3 lounges and 2 dining rooms on Tor View and Grane View has 3 lounges, 2 with dining space. The home is located on a bus route close to the towns of Haslingdon and Rawtenstall. It is close to local amenities such as shops, a post office, a pharmacy, a pub, churches and a sports centre. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by 2 inspectors and took place over 2 full days. The previous statutory inspection was done on 14th June 2005 and information on the findings of this can be obtained from the home or from www.csci.org.uk There had been no additional visits to the home. At the time of the inspection there were 68 residents accommodated in the home. During the course of the inspection the inspectors met with most of the residents and observed their interactions with staff and each other. A number of residents living on Tor View were able to communicate their views and talked to the inspectors about their experiences of living at Turfcote. Due to memory and communication difficulties, most of the residents accommodated on Grane View were unable to make comments about their experience of living in the home. Discussions were held with the responsible individual, the registered manager, 4 members of staff and two visitors to the home. A partial tour of the premises took place. A number of care records, staff records and other documents were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: The residents were satisfied with the flexible routines in the home. There were no set times for getting up and going to bed and they were able to make choices about their daily lives. One resident said, “there are no rules.” Another said “you can please yourself.” Most bedrooms were nicely decorated and furnished. Many residents had brought in pieces of furniture, pictures and ornaments, which gave the bedrooms a homely feel. One resident said, “it’s like home to me, I’ve got lots of my things here.” The manager made sure that new staff had thorough checks before they started work at the home. This provided protection for residents. The residents were happy with the staff team who they described as “lovely girls” and “very hard working.” Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Residents’ care plans did not give a clear picture of the resident’s needs and how they were to be met. This meant that staff did not have any written guidance on how to assist residents. Plans must show what care the resident needs and exactly how staff should provide it. The plans should be specific to the individual resident and they must be updated if the resident’s needs change. Residents or their relatives must have opportunities to be involved in care planning. There were concerns about the way that medication was handled in the home. There had been very little progress made to address the requirements made after the last inspection. The manager must make sure that medicines are handled safely and that good records are kept. Except for an occasional group, the programme of activities for residents on Tor View had ceased. This meant that residents’ social and recreational needs were not always met. One resident said, “there’s nothing going on, we just sit here.” Another said that she would like something else to do other than watch TV. The registered person must consult with residents about what they would like to do and make sure they have opportunities for activity and occupation. Residents’ views about the meals were very mixed. During the last two inspections a number of residents made complaints to the inspectors about the choice and quality of the food. Following the last inspection the registered person was required to act upon the complaints and monitor the situation but Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 7 this had not been done. The registered person must take action to resolve the issue. Some areas of the home were in need of redecoration. This detracted from the comfort of some residents. The registered person did not have a written plan for decoration and refurbishment and so was not able to demonstrate that these areas had been noted and were going to be attended to. Although staff said the opportunities for training had improved, the records were not kept up to date. This meant the manager could not show what training had been completed and what was still outstanding. Staff working on Grane View had still not received training in dementia care. This training is essential to make sure that they understand and can meet the needs of the resident group. Some of the health and safety practices in the home must be improved in order to protect residents and staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 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 Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Written information provided residents with a clear picture of the home’s facilities and services. Pre-admission assessments ensured that residents’ needs were understood and could be met at the home. EVIDENCE: The statement of purpose and service users guide had been revised since the last inspection. As recommended, information about charges for escorts to appointments outside the home, the protocol for shared rooms and bedroom door locks had been added. There was evidence on all the care plans seen that prospective residents were assessed by the registered manager before being offered a place in the home. One resident said the manager had spent quite a long time at her home asking her about her routines and what help she needed. Staff said they discussed the assessments with the registered manager, which helped them to understand the resident’s needs and plan care before they came into the home. Assessments from other professionals were also on files. Residents received written confirmation that their assessed needs could be met. Turfcote Nursing Home DS0000022473.V256850.R01.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 and 9 The care planning process was not thorough. Inadequate recording of residents’ needs and lack of individualised plans may result in residents’ needs not being met. Residents’ healthcare needs were not always recorded or met. Medication handling practices were unsafe and placed residents at risk. EVIDENCE: The care files of 5 residents on Tor View and 4 residents on Grane View were inspected. Several others were viewed in less detail. One resident on Tor View did not have any care plans at all despite her pre-admission assessment and daily notes highlighting areas of need. Care plans for two other residents did not cover their identified psychological needs. One resident who was recently transferred to Grane View because of difficult behaviour did not have a plan to address this. Another resident on Grane View had an ongoing medical condition that should be monitored but was not mentioned on their care plan. Core care plans were still in use. A few had been individualised to provide staff with directions to meet the specific needs of that resident but most had not. This meant that all residents were potentially having their needs met in exactly the same way. A care plan on Grane View identified aggressive behaviour but the directions for staff were not specific to the resident, for example, there was no mention of what triggered the aggression or what intervention the resident Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 11 usually responded to. A care plan to prevent falls for a resident on Tor View did not identify the resident’s anxiety and lack of confidence as a key factor. Care plans were evaluated monthly. The evaluations were brief and did not generally provide information on the resident’s progress towards meeting their goals. The systems for recording daily interventions were not thorough and did not assist in the evaluation process. The system also allowed for information to be entered retrospectively. Care plans were not always updated when changes occurred. For example, one resident’s medication had changed because of a disturbed sleep pattern but there was no mention on the care plan. One resident had signed agreement to their care plans and relatives had signed others some time ago but there was no evidence that this was an ongoing process. Three residents had plans stating that their relatives wished to be involved in their care. There was no evidence that general or specific issues had been discussed or that the relatives had input into the care planning process. With the exception of one, all the care files seen included assessments for moving and handling, nutrition, falls and pressure sore risk. Care plans were generally in place where a risk had been identified but these were not always accurate. Two residents on Grane view were sleeping on mattresses on the floor. Their falls prevention plan made no mention of this. One resident had been identified as high risk of developing pressure sores and their plan specified prevention strategies. However, the daily notes stated that the resident had a sacral break. There was no care plan to direct staff on how to manage this and the information from the daily notes indicated that the treatment being provided was inadequate. There were some good examples of individual risk assessments. For example, one resident had a risk assessment for alcohol consumption. Staff said the use of the hoist had improved and this was seen to be the case at the time of the inspection. Two residents on Tor View were assisted to move with the use of a handling belt. It was apparent from their reactions that they were not used to this. Staff confirmed that handling belts were not always used as they should be. Despite these shortfalls, residents said their health care needs were met. They all said they saw the doctor whenever they were unwell and were referred to the hospital if it was needed. One said, “they see to us very well.” Most of the previous requirements and recommendations with regard to medicines management had not been implemented. The policies and procedures for handling medication were not complete. There was no risk assessment for one resident who was self-administering and she had not been provided with lockable storage facilities. Records of medicines entering and leaving the home were not thorough enough to provide an audit trail. There were gaps on some medicine administration records (MAR) charts with no explanation as to why the medication had not been given. Information on the MAR chart for one resident did not correspond with instructions on the medicine container. Handwritten amendments to MAR charts were not always signed and witnessed. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 12 A number of residents were prescribed ‘when required’ medicines. There were no written criteria with the MAR charts to direct staff when the medication should be given, which may result in over or under medicating. There were good records of variable dose medicines. One resident had been given medication that was not prescribed and was not on the list of homely remedies. Medication prescribed for one resident had been administered to another resident. There was insufficient supervision when medication was being administered. One resident had twice failed to take a tablet given to her by a member of staff and medication for another resident was placed on her walking frame for her to take when she went into the lounge. Storage was not secure. The storage rooms on both units were unlocked and the trolleys on Tor View were not secured to the wall. There was excess stock of medicine for one resident. Storage temperatures were monitored and had not risen above the recommended level. Oxygen was stored safely and appropriate signage was in place. Storage, records and administration of controlled drugs were satisfactory. Staff responsible for handling medication had received training in the past. The registered manager stated that most were due to start a refresher course in the next week. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 13 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, 14 and 15 There were insufficient opportunities for recreational activities for some residents. Residents were satisfied with the routines of the home and said they were able to exercise choices in their daily lives. Residents’ views of the meals were mixed. EVIDENCE: Several residents on Tor View said that the programme of activities had stopped. One resident said, “there’s nothing going on, we just sit here.” Another said that although she liked to watch TV she would like something else to do. Staff confirmed that there were only very occasional activities and said it was because of lack of staff time. One said that although there were no less staff than at the last inspection, there were more residents and they needed more care. Residents on Grane View still had access to a range of activities organised by staff. Residents who were able said they were happy with the routines in the home. One resident said “to some extent your day is planned out for you but that’s ok.” Another said, “there are no rules.” All residents said that they were able to choose when they got up and went to bed. One said, “they are never on at you to get up.” Another resident said she liked to go to bed early and staff Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 14 brought her a drink up to her room. Residents had days allocated for bathing. Those spoken to were happy with the arrangement. One said, “they come round and ask if you want a bath and you can please yourself.” Another said that she was able to have a bath in between if she wanted. Staff said that wherever possible they encouraged residents to choose for themselves but some were not able to. One member of staff said that they got to know residents’ likes and dislikes by talking to their families. Another said that by getting to know the residents she found out what they liked. Some care plans contained information about residents’ preferences in daily routines and activities. However, one care plan, written in March 2005, instructed staff to find out the residents likes and dislikes with regard to food. The plan had not been updated to include that information. There was a requirement made following the last inspection for the registered person to act upon and monitor residents’ complaints about the meals but this had not been actioned. Residents said they hadn’t been asked whether they liked the meals any better and they hadn’t filled in any surveys. Residents’ comments about the breakfasts were very complimentary. However, their views on the rest of the meals were divided. Positive comments included: “I will only eat decent food and I think it’s alright,” “I like the food, it’s very nice,” “lovely soup” and “It’s alright.” Negative comments included, “it’s not cooked sometimes,” “pastry is always too hard,” “nothing right with it,” “too much gravy and the mash is too sloppy,” “always cold” and “I’m not impressed.” One resident mentioned that there was not enough choice in the evening meal. On the day of the inspection the meals served in one of the dining rooms looked hot and appetising. However, by the time the same meal was given to residents in another dining room it looked dried up and cold. There was a lack of supervision of individual residents at mealtimes on Grane View. Residents were seen to be taking food from each other’s plates and mix food debris with their sweets, without the knowledge and intervention of staff. Residents on Grane View were not seen to be offered any condiments as was recommended following the previous inspection. The registered manager said that she was in the process of trying to address the other recommendation, which was to exchange plastic aprons worn by residents with cloth ones. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 15 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): 18 Staff had training and written guidance about adult protection issues, which meant that any allegations should be dealt with appropriately. EVIDENCE: Following a requirement at the last inspection, most staff had received training in the protection of vulnerable adults. They also had access to written guidance, including the “No Secrets” document. All staff spoken with were aware of their responsibilities in protecting vulnerable adults and knew how and when to report any alleged incidents. Discussions took place with the registered manager with regard to extra training for senior staff to ensure appropriate handling of allegations in the absence of the manager. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 16 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, 22, 24 and 26 The communal areas of Tor View provided residents with a clean, comfortable and homely environment but a lack of attention to some areas on Grane View may detract from residents’ comfort. Bedrooms suited the needs and lifestyle of the residents. EVIDENCE: Décor and furnishings on Tor View were generally of a good standard and it was evident from a tour of the premises that some areas had been redecorated. Residents on Tor View were satisfied with the communal areas, which were described as “very nice,” “comfortable” and “very good.” There was no annual plan of redecoration and refurbishment for the home. The responsible individual stated that areas in need of redecoration or refurbishment were identified during his regular inspection of the premises and work was carried out as and when it was needed. However, only two of the areas identified as needing attention during the last inspection had been attended to. The following shortfalls were noted and discussed with the registered person during this inspection: There were scrapes on the wall of the Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 17 main lounge in Grane View and the dado rail was loose in one place. A number of the chairs were covered with food debris. The wallpaper in two bedrooms on Grane View was peeling off in places. The carpet in one of these rooms was frayed and although this did not present a safety hazard it was unsightly. The skirting boards and doorjambs on one corridor were badly scuffed. The walls in the toilet near the middle lounge were stained and dirty. The sink was loose and there was a small hole in the ceiling. The ceiling in the third lounge was bellying and one of the armchairs was ripped and badly stained. Despite a previous requirement to keep fire doors closed, a fire door on the corridor of Tor View was wedged open, which presented a risk to the health and safety of residents and staff. Although the previous requirement to cease storing wheelchairs on the corridor of Tor View had not been actioned, the chairs were not obstructing access to the corridor and did not create a hazard to residents. There were, however, a number of wheelchairs stored in the shower room on Grane View, which prevented residents from using the washbasin and shower. As previously recommended, the service users guide had been amended to inform residents that they were able to have a lock on their bedroom door if they requested one. All the residents spoken with made positive comments about their bedrooms. One said, “it’s like home to me, I’ve got lots of my things here.” Another said, “my room is very nice, quite big.” Most of the bedrooms seen were decorated and furnished to a good standard and many were personalised to a high degree. Three of the bedrooms on Tor View had the light switches positioned outside the door. Because there was no alternative lighting in the room, residents were not able to control the lights without leaving the room. At the time of the inspection the home was clean and tidy. Residents on Tor View commented on the standards of cleanliness in the home. Most areas of the home were free from offensive odours, the exception being the main corridor on Grane View. The odour was intermittent and the registered person had been unsuccessful in locating the source of the odour. A number of residents commented that clothing sometimes went missing in the laundry. One resident said she lost clothes all the time. Several residents said that although clothing went missing it usually turned up. This was discussed with the registered manager who said she would look into it. Most staff had completed update training in infection control procedures. Despite a previous recommendation, non-disposable washcloths were still being used to assist with the personal hygiene of residents with continence needs. Staff said that although they would prefer to use disposable wipes they did not feel the current practice presented any risk to residents. The washcloths were laundered at high temperatures to minimise the risk of cross infection. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 18 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): 29 and 30 Recruitment practices provided safeguards for residents. Training opportunities had improved but the lack of training in dementia care may result in some residents’ needs not being fully understood or met. EVIDENCE: The files of three recently employed staff were examined. There was evidence that POVAfirst checks had been carried out and full CRB disclosures had been returned before they started to work unsupervised. Staff from overseas had valid work permits. There was a system in place to verify the registration status of nurses. All other required information and documents had been obtained and retained. Following the recent recruitment drive the home was fully staffed. There was a stable staff team and use of agency staff had almost ceased. The registered person stated that there had been a positive impact on staff morale. All of the residents spoken with were very complimentary about the staff and their comments included; “all the girls here are lovely,” “marvellous staff” and “very hard working.” Some staff files included records of initial induction, which included orientation to the home, policies and health and safety awareness. There was a supplementary programme for registered nurses. Initial induction was followed up by an on-line induction training programme, which met the standards of the National Training Organisation. This training provided staff with theoretical knowledge but there was no practice component. The registered manager stated that the registered nurse working with the new Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 19 starter would assess their competency to practice but this was not a formal arrangement. Discussions took place as to how practical training and assessment of competency could be linked to the supervision/appraisal system when it is up and running. Staff said the opportunities for training had improved. Those spoken to had received updates in moving and handling, fire safety, protection of vulnerable adults and infection control. However, the training records were not complete and indicated that some training in safe working practice topics may be out of date. Despite previous requirements, staff working on Grane View had not received training in dementia care. The registered manager stated that 10 staff were due to commence a course in the very near future. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 20 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, 33, 35, 37 and 38 The home was managed by a competent and experienced person. Systems were in place to measure and improve the quality of the service but these were not based on residents’ views. Resident’s finances were safeguarded by the practices in the home. Some shortfalls in health and safety practices at the home may place residents and staff at risk of harm. EVIDENCE: The manager, a registered nurse, had many years managerial experience. She held a post registration degree, which included a management and leadership module, and she was in the process of checking whether the qualification she holds is equivalent to the NVQ 4 in management. In addition to undertaking short courses, the manager kept her practice up to date with a programme of self study. Residents said that they saw the manager most days and they Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 21 could approach her if they had any concerns. Staff also said they felt comfortable approaching her. A previous requirement to establish a system for monitoring the quality of the service had been partially met. The manager had conducted an audit of the service using the Blue Cross Mark devised by the registered nursing homes association. Areas for improvement were identified but at the time of the inspection there was no formal plan as to how these would be prioritised or actioned. The style of staff meetings had changed to include reviews of residents’ care. This gave staff opportunities to monitor the quality of care and make suggestions for improvements. Residents spoken with said that although they could talk to the staff or manager if they had any concerns, they had not been asked about their views of the home. One resident said, “I might have filled in a paper a long time ago but I don’t remember what it was for.” Residents’ families generally managed their finances. The registered person handled one resident’s monies. Complete records were kept to demonstrate that the resident’s personal allowance was given over to him every week. Money was not held on behalf of any other residents. The registered person kept a record of fees received from relatives and other funding sources. The records should include the weekly charge to ensure that the correct amount is being paid. As previously required, the procedure to follow in the event of a resident being missing from the home had been altered. It included directions as to who should be informed if the resident was subject to Section 17 of the Mental Health Act 1983. Other records required to be kept were in place but the record of valuables deposited for safekeeping and subsequently returned were not up to date. The registered person verified that the fire safety training included aspects of prevention even though this was not identified on the current record. Fire drills were conducted but records did not include details of the staff involved or the outcome of the drill, which would highlight any further training needs. Testing of fire alarms and equipment was up to date. A sample of hot water outlets were tested every three months but these did not always include baths. There were no environmental risk assessments and working practices, for example, handling the waste medication disposal container, were not assessed. There were no risk assessments to support unrestricted use or storage of plug in air fresheners, denture cleanser and some cleaning materials on Grane View. There was no certificate to evidence servicing of gas appliances. Accidents were recorded and audited every month. One resident’s care routines had altered as a result of the audit and the level of accidents had decreased. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 22 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X 3 X 3 X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 31/03/06 2. OP7 3. OP7 4. OP8 5. OP8 6. 7. OP8 OP8 All residents must have a care plan detailing how their needs in respect of health and welfare are to be met. (Timescale of 31/07/05 not met) 15(1) Residents and/or their representatives must be provided with opportunities for involvement in care planning. (Timescale of 31/07/05 not met) 15(2)(b-c) The residents plan must be reviwed and updated as and when changes occur. (Timescale of 31/03/05 not met) 13(5) Practices for moving and handling residents must be safe for residents and staff. (Timescale of 30/06/05 not met) 13(4)(c) Any unnecessary risks to the health or safety of the resdents must be identified and so far as possible eliminated. This would include nutrition and pressure sore risk and risk of falls.(Timescale of 31/03/05 not met) 13 Strategies used to minimise risk must be recorded on the resident’s plan of care. 15 Care plans must be drawn up to direct staff on the treatment of DS0000022473.V256850.R01.S.doc 31/03/06 31/03/06 28/02/06 31/03/06 28/02/06 28/02/06 Turfcote Nursing Home Version 5.0 Page 24 8. OP9 13(2) 9. OP9 13(2) 10. OP9 13(2) 11. 12. 13. 14. OP9 OP9 OP9 OP9 13(2) 13(2) 13(2) 13(2) 15. OP9 13(2) 16. OP12 16(2) (m-n) 17. OP15 16(2)(1) pressure sores. Any treatment provided should be in accordance with current good practice. Residents who wish to selfmedicate must be assessed to ensure their safety. They must also be provided with lockable storage. Medication supplied to one resident must not be given to any other residents. (Timescale of 16/06/05 not met) Medication must not be given to a resident unless it has been prescribed or comes under the remit of the homely remedies policy. Medication must be stored securely at all times.(Timescale of 28/02/05 not met) Accurate records must be kept of medicines entering and leaving the home. Medication Administration Records must be accurate. (Timescale of 28/02/05 not met) Information on MAR charts must correspond with the information on the medication container labels. Staff must provide adequate supervision to residents when they are administering medication. Following consultation with residents the programme of activities must be revised. There must be sufficient, appropriate activities to meet the needs of the residents on Tor View. Action must be taken to address the complaints raised by the residents, during the inspection, regarding the meals served in the home and the situation must be monitored. (Timescale of 31/08/05 not met) DS0000022473.V256850.R01.S.doc 03/02/06 03/02/06 03/02/06 03/02/06 03/02/06 03/02/06 03/02/06 03/02/06 31/03/06 31/03/05 Turfcote Nursing Home Version 5.0 Page 25 18. 19. OP19 OP19 20. OP30 21. OP30 22. OP31 23. OP33 24. OP37 25. OP38 26. OP38 23(2)(b&d All parts of the home must be ) kept in a good state of repair and reasonably decorated. 23(4)(c) All fire doors must be closed at all times unless held open by a device acceptable to the fire authority. (Timescale of 28/02/05 not met) 18(1) Staff working on Grane View must receive training in dementia care. (Timescale of 30/04/05 not met) 18(1) Records of staff training in safe working practice topics must be brought up to date and any shortfalls in training must be addressed. 9(2)(b)(i) The registered manager must provide confirmation that she holds a management qualification equivalent to NVQ 4 or take steps to commence NVQ training. 24 The registered person must further develop the systems for reviewing and improving the quality of care. This must include the views of residents and/or their representatives. 17(2) Records of valuables handed Schedule over for safekeeping and records 4 of valuables returned must be kept up to date. 13(4) Risk assessments and management strategies must be developed to cover any potential hazards in respect of: the environment, working practices and hazardous substances. 13(4) The registered person must ensure that gas appliances are serviced and maintained. 30/06/06 03/02/06 31/03/06 31/03/06 28/02/06 30/04/06 03/02/06 31/03/06 28/02/06 Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 26 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. 5. 6. 7. 8. 9. 10. 11. 12. 13. Refer to Standard OP7 OP7 OP9 OP9 OP9 OP9 OP19 OP24 OP26 OP30 OP35 OP38 OP38 Good Practice Recommendations Residents daily care notes should provide sufficient information to assist in evaluation of care plans. Core care plans should be supplemented with information specific to the individual resident. Handwritten amendments on MAR charts should be signed and witnessed. There should be clearly defined criteria for ‘when required’ medication. This information should be kept with the MAR charts. There should be a complete set of policies for medicines management Medication no longer in use should be disposed of to prevent an excess of stock. The storage of wheelchairs should not create an obstruction for residents Alternative lighting should be provided for those residents who do not have the main light switch in their rooms. Complaints about the laundry service should be acted upon and monitored in the future. The induction training programme should include an assessment of competency of practice. The records of fees paid on behalf of residents should include the weekly charge. Records of fire drills should include the names of staff involved and the outcome of the drill. Hot water temperatures for the baths should be checked on a regular basis. Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Turfcote Nursing Home DS0000022473.V256850.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!