Inspection on 14/08/07 for Turfcote Nursing Home

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 17/05/06

Turfcote Nursing Home 01/02/06

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 14th August 2007 09:30 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.V348804.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 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.V348804.R01.S.doc Version 5.2 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. 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 is 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. Information about the home is sent out to anyone making enquiries about admission. Copies of Commission for Social Care Inspection reports are available from the home manager on request. At 14th August 2007 the weekly fees ranged from £342.50 to £517.00. There is supplement of £15 per week for a single room. Additional charges are made Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 5 for toiletries, hairdressing, newspapers, transport and staff escorts to hospital appointments. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Turfcote on 14th 15th August 2007. Two inspectors carried out this visit. At the time of the visit there were 61 people living at the home. The inspectors met with some of them and asked about their views and experiences of living at Turfcote. Some of their comments are included in this report. There were a number of people who, because of memory and communication difficulties, could not talk to the inspectors. Therefore, one of the inspectors spent a two-hour period closely observing of a small group of people on Grane View. The inspector observed how they spent their time, how staff communicated with them and their reactions to what was going on around them. Six people living at the home, eight family carers and three health care professionals returned surveys prior to the inspection. Their views about various aspects of the home were mainly positive. During the visit discussions were held with the owner of the home, the registered manager and several other members of staff. The inspectors also spoke with four visitors. A partial tour of the premises took place and a number of documents and records were viewed. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: The manager visited people thinking of moving into the home to assess what care they needed and to make sure that their needs could be properly met at Turfcote. Most of the people who returned surveys indicated that they were given enough information about the home to help them to make a choice about whether it was the right place for them. Over half of the people living at the home who returned surveys indicated that they usually received the care and medical support they needed. Most relatives also said that the home always gave the support they expected. One wrote, “Mum has 24 hour care and that is the most important care for her.” Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 7 During the visit staff were seen to treat people with respect. One relative wrote, “The care home still treats my mother with care and courtesy even though her dementia means that her behaviour can be challenging.” Visitors said they were made to feel welcome and were offered refreshments. Most of the people who filled in surveys and who spoke with inspectors said they usually liked the meals. They said that there was always a choice and they could always have something that wasn’t on the menu. The routines in the home centred around the people using the service. People said they could make choices and there were no rules. One person said, “I can choose what time I get up and when I am ready to go to bed I just tell them.” Another person said that she was not going to have her usual lie down in the afternoon because she wanted to play bingo instead. All complaints were recorded and responded to. This meant that the people living at the home could be confident that their concerns would be listened to and acted upon. There was a very low turnover of staff, which meant that people received care from staff they knew and who knew them. There were some very positive comments about the staff. One family carer wrote, “Staff are very hard working, professional and pleasant and always willing to help.” A health professional wrote that staff were caring and pleasant, and during the visit people living at the home described the staff as kind, patient and helpful. Over 90 of the care staff held an NVQ in care, which is a nationally recognised qualification. What has improved since the last inspection? There were improvements in the way medicines were recorded and given out. Staff were carrying out regular checks which meant that if there were any problems they would be picked up quickly and dealt with. Two people had been employed to draw up a programme of activities. Although it had only just started, people using the service were already finding some benefits. One person said she liked the activities, particularly the cake making. Another said, “they have started with more activities and I am enjoying that.” There had been further improvements to the environment. Lounges and bedrooms had been, or were in the process of being, refurbished. When completed the refurbishments will add to the comfort of people living at the home. People said they were satisfied with their rooms, which they described as large and containing everything they needed. The cleanliness and odour control had both improved since the last key inspection. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 8 Opportunities for staff to take further training had improved. Most health and safety training was up to date, which helped to protect both people living at the home and the staff. All staff had attended a dementia care course and those people working on Grane View were going to do further training. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process was thorough enough to ensure that people had enough information to make an informed choice about the home and staff had enough information about the individual’s needs and how they were to be met. EVIDENCE: The service user’s guide had been updated to include information about the lack of organised trips in the home. The guide was sent out to anyone making enquiries about moving into the home. People were also given a welcome pack when they moved in, which told them more day-to-day details about the home. Most people who completed surveys said they received enough information about the service. One visitor to the home said, “I was given a brochure on my first visit. I viewed about 5 homes at first but I liked this, it was a definite choice.” Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 11 Anyone thinking of moving into the home was assessed by one of the senior staff from Turfcote to make sure that their needs could be met at the home. The manager was trialling a new pre-admission assessment tool. The example seen provided the reader with detailed information about the individual’s personal, health and social care needs. Standard 6 is not applicable because intermediate care is not provided at the home. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of consistency in health and personal care planning and delivery could compromise people’s safety or result in their needs not being met. EVIDENCE: Five care plans were looked at as part of the case tracking process. The plans were pre-printed with some standardised directions. All of the plans contained some information about the individual but they were not completely personalised, which meant that there was a potential for everyone to be treated in exactly the same way. The manager spoke about how very specific distraction techniques were used with one person who frequently became agitated, but the care plan only gave vague, standardised directions on how to assist them. This meant that staff referring to the care plan would not be getting the right directions. All the plans seen had been agreed by family members and the manager said they were aiming to involve relatives in reviews every six months. One Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 13 relative confirmed that care plans were completed jointly and another said that they had read and signed care plans that that told them what their relative, “does and needs.” Family carers who returned surveys indicated that staff always kept them up to date with any important issues. Care plans were reviewed every month. The evaluation methods had improved and the summaries usually gave some indication of whether the planned care was effective. Some assessments and plans showed evidence of updates when the person’s care needs had changed but others did not. Advice given by a healthcare professional had not been added to a nutritional plan, which could result in out of date care being given. The Annual Quality Assurance Assessment (AQAA) submitted by the manager indicated that the number of falls at the home had been reduced through close working with the Falls Project Team. All the care plans seen included a falls risk assessment and plan. Other healthcare assessments were carried out and reviewed every month. There were care plans in place to reduce risks, for example, of pressure sores. There were assessments for the use of bed rails but one had not been reviewed for some considerable time and another had not been acted upon. Regular maintenance checks were not carried out on bedrails. There were records to show that people were referred to other professionals whenever necessary. Health care professionals who completed surveys indicated that the healthcare needs of people living at the home were usually met and most of the people who returned surveys confirmed that they usually received the care and medical support they needed. The majority of relatives were also satisfied with the level of care provided. One wrote that staff identified problems immediately and another commented that staff were responsive to any concerns they had about their mother’s health. Staff received training on core values during their induction and NVQ training. One visitor remarked that his relative “always looks clean and cared for.” During the course of the visit staff were heard to address people respectfully and there were some elements of good practice seen. For example, staff put privacy blankets over people’s legs when they were using the hoist. During the visit all personal care and treatment was provided in private. However, more than one healthcare professional commented that they were sometimes asked to see people in communal areas. There were at least two bathroom doors that did not lock. Staff working with people with dementia were observed to communicate with people and try to explain what they were going to do. For example before using the hoist or giving a drink. Staff were also observed using a calm and quiet approach to someone who was agitated and verbally abusive. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 14 There were improvements in the way medicines were managed by staff. The manager carried out a regular audit and ensured that any problems were put right immediately. People who administered some of their own medicine had regular checks to ensure that they were still safe to do so. Records of medicines received and administered were complete and accurate. Stocks levels of medicines were correct except in one case and this had already been identified on the audit. Two people who were prescribed “when required” medication had very clear plans to direct staff when it should be given but another two had no detail at all. Handwritten entries on Medication Administration Record (MAR) charts accurately reflected instructions on the prescription and were double signed. Everyone living at the home had their own stock of oral medication but there were a number of dressings that had no names on which indicated that they may still be being shared. Medication awaiting disposal was stored in the contractors waste bin in an unlocked cupboard in the medication room. Although there was a notice on the door to keep the room locked, on arrival at the home the inspectors found the door to be unlocked, which meant that there were large amounts of medicines accessible to anyone. Controlled drugs were recorded, stored and administered safely. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines were in the best interests of the people living at the home. Improvements in the level and range of activities meant that more people were being assisted to meet their social and recreational needs. EVIDENCE: Most of the people who completed surveys, including relatives and healthcare professionals, made negative comments about the lack of appropriate activities in the home. However, since the surveys were received two activity coordinators had been appointed. One of the co-ordinators discussed their plans to produce an activity programme to ensure that everyone would have an opportunity to join in something. Although the programme was not completely up and running, people living at the home made positive comments about the activities that were available. One said, “I hope they keep it up, there is a few of us sit together and do them and we have some fun.” Another said that she usually had bed rest in the afternoon but was going to join the bingo that afternoon instead. The detailed observation period for the group of people on Grane View took place in the morning when staff were mainly engaged in helping people with Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 16 personal care tasks. Staff were seen to acknowledge people as they passed them but they did not always wait for the person to respond. There were no negative interactions. People using the service said they had a choice about what time they got up and went to bed, their meals, and what they did with their time. Care plans included information about people’s likes, dislikes and preferences. This information helped staff to make choices and decisions on behalf of people who were unable to do so themselves. Most of the care plans seen also included a memory diary, some of which had been completed by relatives. Some diaries were very detailed and gave rich information about the person’s personal, social and family history, which meant that staff had some background knowledge to help them to reminisce with individuals. Care plans for religious needs were in place but none of those seen specified individual needs or interventions. There was a church service on the day of the visit, which several people attended and said they enjoyed. There was an open visiting policy. One visitor said that the staff were very pleasant and made him feel welcome. Some people went out with family members but others had few opportunities to go out unless to a health care appointment. The lack of organised trips out was commented on by three people. The information was included in the service user’s guide. Thee was a choice offered at each mealtime and alternatives to the menu were also readily available. Records of meals showed that people were offered a varied and balanced diet. There were fresh vegetables, fruit and salad in the store cupboards. People’s views about the meals varied. Most people who returned surveys or were spoken to indicated that they usually liked the meals. One person said, “There’s always a choice and if you don’t like it they will make you something else.” Another said, “I generally like the food. We have nice sandwiches.” However, there were a few negative comments, such as, “the food’s not so good. I don’t like it much.” There were plans to review the meals again. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were safeguarded by the complaints and protection procedures applied in the home. EVIDENCE: Information included in the AQAA indicated that the manager was working to reduce the number of complaints by increasing written and verbal communication with family carers. Records showed that there had been a reduction in the number of complaints about the service. Both complaints made directly to the home had been investigated and were unfounded. The Commission had received one complaint from a family carer, which the manager had investigated and responded to. Some of the issues were confirmed. Most of the people who completed surveys said they knew who to speak to if they were not happy. Most family carers indicated they knew how to make a complaint and that the service had responded appropriately if they had raised concerns. One person living at the home said, “I think they’d listen to me and sort things out.” A relative said, “I’ve had one or two niggles and when I’ve gone to them they’ve explained things to me or taken action to sort it out.” New staff received training in safeguarding vulnerable adults during their induction training. Other staff had regular refresher training and there was Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 18 written guidance available for reference. All the staff spoken with during the visit were aware of their responsibility to report any allegation to the manager. One person said that if necessary they would report to the Commission but another was not sure about reporting outside the home. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Turfcote was a comfortable and homely place to live. EVIDENCE: Information included in the AQAA indicated that the registered person had commenced an extensive programme of redecoration and renewal. From looking around the home it was evident that improvements had been made in several areas. For example, the middle lounge on Grane View had been redecorated and refurnished and looked more homely and comfortable. Several bedrooms had been redecorated and there was new carpet being laid in various areas of the home. The shower room on Grane View had been refurbished and was no longer being used as a wheelchair store, which was safer for people using the room. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 20 Bedside lamps had been placed in all but one of the rooms that had the light switch outside the door so that people could control the lighting themselves. Several people had personalised their bedrooms with pictures and ornaments. Those people who were asked said they were satisfied with their bedrooms. Two people commented that their bedrooms were large and contained everything they needed. At the time of the visit the home was clean and free from unpleasant odours. People who completed surveys indicated that it was always or usually this way. Staff had access to written guidance about hygiene and infection control and were due to start refresher training in the near future. Protective clothing was used when necessary. Healthcare waste was handled safely and the buckets identified as a potential hazard during the random inspection were clean and had lids fitted, which reduced the risk of spread of infection. The laundry was adequately equipped for the size of the home and there were sufficient hours allocated to laundry staff. There were no negative comments about the laundry service during the inspection. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home benefited from a stable staff team who had appropriate knowledge and skills and who were fit to work with vulnerable people. EVIDENCE: The registered manager said that staffing levels were calculated according to the needs and dependencies of the people living at the home and the qualifications and experience of the staff on duty. People indicated on their surveys that staff were usually available when they needed them. Staff themselves said that unless someone rang in at short notice there were sufficient staff on duty at all times. A number of people made positive comments about the staff. A family carer wrote, “They are caring, patient and very kind and aware of residents’ needs.” A GP also described the staff as generally very caring and happy. During the visit people living at the home said the staff were nice, kind and patient. One person said, “the girls are very kind, always smiling and pleasant, it cheers you up.” Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 22 There was very little turnover of staff. The files of two new members of staff were inspected. All pre-employment checks had been carried out and both had the required information and documents on file. The induction training programme met the Skills for Care Common Induction Standards. However, the registered person continued to recruit staff from overseas, most of whom were qualified and experienced nurses in their own country. These staff undertook a shortened induction programme, mainly to orientate them to the service. Staff from overseas took a course in English especially designed for speakers of other languages. A few people commented on the potential difficulties in communicating with staff whose first language was not English but others said they had no problems. One person said, “The girls from Romania have really made an effort about learning English and I understand them well. Some of the other staff are a bit harder to understand but I’ve not had any real problems communicating.” Opportunities for training had improved. All refresher training for the safe working practice topics was up to date or the courses were booked. Other courses, in topics relevant to the needs of people living at the home, were available. All staff had completed or were booked on a short course for dementia awareness. Staff working with people on Grane View were enrolled on a level 2 course. The AQAA indicated that 90 of the care staff were trained to NVQ level 2 and several had achieved level 3 and 4. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was run in the best interests of the people living there but minor shortfalls in health and safety practices could place people at risk of harm. EVIDENCE: The Manager of the home is a Registered Nurse with many years experience of caring for older people. She holds a management qualification and regularly attends courses to keep her clinical and managerial skills up to date. The manager is supported by the responsible individual and the deputy manager. A family carer wrote, “The staff and management are friendly and approachable.” The manager audited the quality of the service using the Registered Nursing Home Association Blue Charter Mark. She had drawn up an action plan to Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 24 address any shortfalls identified in the audit. People living at the home and their relatives had opportunities to make their views known. They had recently returned general questionnaires that were being analysed at the time of the inspection. The manager was also planning to do a specific audit, including people’s views, about the admission process. The service held the Investors in People award. Staff had opportunities to make suggestions for development of the service during their monthly staff meetings. The manager was also aiming to improve the level of staff supervision to every eight weeks. Staff commented that they found both the meetings and one to one supervision useful. The registered person did not act as agent or appointee for anyone living at the home. Relatives were requested to pay any regular expenses, such as hairdressing, directly by cheque. Records were kept of any money or valuables handed over for safekeeping. There was a fire inspection on the day of the visit. No recommendations were made and the owner said the fire officer verbally agreed that the lounge doors could be wedged open during the day for ease of access. With the exception of one corridor door, all other fire doors were closed. Fire prevention training was incorporated into the fire drills. Although there was no record of the content of the training the registered person said the level of training was sufficient. Staff spoken with during the inspection were aware of what to do in the event of a fire. Despite a previous requirement, unlabelled cleaning substances were found in spray bottles in two unlocked bathrooms. This potentially hazardous substance was accessible to anyone who went into the bathrooms, including people who would not recognise the danger of ingesting it. Staff were observed moving people in wheelchairs that had no footplates. One person was being tipped back, which, in addition to being uncomfortable and frightening could potentially cause an accident. Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 13(4) Requirement To ensure the safety of people using the service, the use of bedrails must be assessed and the assessment must be kept under review. In line with the latest Department of Health guidelines bedrails must be checked regularly to ensure that they remain safe. 2. OP9 13(2) The registered manager must ensure that dressings prescribed for one person are not given to anyone else. The registered person must ensure that residents’ privacy and dignity are respected. This would include putting working locks on all bathrooms and toilets and ensuring that all care and treatment was carried out in privacy. The registered person must ensure that potentially hazardous items are stored DS0000022473.V348804.R01.S.doc Timescale for action 31/08/07 31/08/07 3. OP10 12(4)(a) 31/08/07 4. OP38 13(4) 31/08/07 Turfcote Nursing Home Version 5.2 Page 27 safely. This would include storing hazardous items in their original containers. (Timescale of 30/01/07 not met) 5. OP38 23(4)(c) In order to protect the health and safety of people living and working at the home fire doors must not be wedged open unless agreed by the fire officer. 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should be more personalised so that staff have information about people’s individual needs and what care they need to meet them. Care plans should be amended when needs or interventions change so that people can be sure they are receiving up to date care. The criteria for the administration of when required medication should be clearly defined and recorded for anyone prescribed such items. This will reduce the risk of people being under or over medicated. The container used to store medicines ready for disposal should be kept in a locked cupboard to ensure that it is not accessible to everyone. The registered person should continue with the plans to develop the programme of activities to meet the social and recreational needs of people living at the home. To promote comfort and reduce the risk of accidents wheelchairs should be used with footplates unless the individual has a risk assessment stating otherwise. 2. OP7 3. OP9 4. OP9 5. OP12 6. OP38 Turfcote Nursing Home DS0000022473.V348804.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V348804.R01.S.doc Version 5.2 Page 29 - 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. 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