Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 14/06/05 for Turfcote Nursing Home

Also see our care home review for Turfcote Nursing Home for more information

This inspection was carried out on 14th June 2005.

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.

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

Residents and staff got on well together, which led to a friendly atmosphere in the home. Staff respected residents` privacy and understood that it was important for them to do things for themselves if they could. Residents said nice things about staff. One resident said "they`re ever so good, very caring" and another remarked on how hard the staff worked. Residents said that there were enough staff on duty. Over half of the care staff had done a national training course (NVQ) that led to a qualification in care. The 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 "my room`s nice and the bed is very comfy." Some residents also made comments about how clean the home was. One said, "they are very particular and the beds are changed all the time." Residents were pleased that they could have visitors at any time and were able to go out with relatives. A visitor to the home said the staff were very nice and made them feel welcome.

What has improved since the last inspection?

There had been some new staff employed at the home since the last inspection, which reduced the need for agency staff. Residents said this was better because they got to know the staff and they knew who was going to be on duty. There were more activities going on in the home. A weekly programme was on the notice board and residents said they got to know what was going on each day. One resident said she enjoyed the discussion groups on a Monday and said, "we always talk about interesting things." On the day of the inspection some residents were making greeting cards in the art and crafts group. A "surgery" was held in the home every two weeks. This was an open invitation for residents and relatives to meet with the manager or other senior staff to talk about any concerns they may have or to air their views about the home.

What the care home could do better:

Prospective residents must be assessed to make sure that their needs can be met at the home and to avoid unsuitable admissions. Care plans must be reviewed properly so that staff always have the right directions to follow to meet residents` needs. Not all staff had received the amount and type of training they needed to perform their work. All staff must have instruction in the protection of residents and health and safety training. Staff working with residents with special needs must also have training relevant to their work. There was a lack of fire prevention training, fire drills and fire alarm testing. This must improve as a matter of urgency in order to protect residents and staff. The registered person must develop a way to find out residents` views about the home. This should start with residents` opinions about the meals. Any changes and improvements to the home should be made with the involvement of residents.

CARE HOMES FOR OLDER PEOPLE Turfcote Nursing Home Helmshore Road Haslingden, Rossendale Lancashire BB4 4DP Lead Inspector Jane Craig Unannounced 14 and 15 June 2005 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 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 F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 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 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 with Nursing (N) 76 Category(ies) of Physical disability (PD) 46 registration, with number Mental disorder, excluding learning or dementia of places - over 65 years of age (MD(E) 31 Dementai - over 65 years of age (DE(E) 31 Old age, not falling within any other category (OP) 46 Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 A maximum of 46 service users requiring nursing care who fall into categoryof either OP or PD. 2 A maximum of 30 service users requiring personal care wo fall into the category of OP either MD(E) or DE(E) 3 A maximum of 25 service users requiring nursing care who fall into the category of either MD(E) or DE(E) 4 A max of 6 service users requiring nursing care who fall into the category of either MD(E) or DE(E) 5 Staffing of service users requiring nursing care will be in accordance with the Notice issued dated 24 May 2001. 6 Elizabeth Irwin is registered as manager of Turfcote only. 7 The servise 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 13 January 2005 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 F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by 2 inspectors and took place over 15 hours on the 14th and 15th June 2005. Two additional visits had been made since the previous inspection. These were on 16th February and 21st March 2005. The visits were made in response to two separate complaints. Both of the complaints were partially upheld and the registered person was required to ensure that the areas of concern were addressed. At the time of this inspection there were 70 residents accommodated in the home. A number of residents living on Tor View were able to communicate their views about the home and talked to the inspectors about how their needs were met at Turfcote. Due to memory and communication difficulties, most of the residents accommodated on Grane View were unable to engage in conversation or make comment about their experience of living in the home. Discussions were held with the registered manager, 5 members of staff and five visitors to the home. A number of care records, staff records and other documents were viewed. A tour of the premises took place. What the service does well: Residents and staff got on well together, which led to a friendly atmosphere in the home. Staff respected residents’ privacy and understood that it was important for them to do things for themselves if they could. Residents said nice things about staff. One resident said “they’re ever so good, very caring” and another remarked on how hard the staff worked. Residents said that there were enough staff on duty. Over half of the care staff had done a national training course (NVQ) that led to a qualification in care. The 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 “my room’s nice and the bed is very comfy.” Some residents also made comments about how clean the home was. One said, “they are very particular and the beds are changed all the time.” Residents were pleased that they could have visitors at any time and were able to go out with relatives. A visitor to the home said the staff were very nice and made them feel welcome. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Written information available to prospective residents provided a clear picture of the home’s facilities and services. Not all residents were assessed prior to admission, which may result in their needs not being identified or met. EVIDENCE: The statement of purpose and service user’s guide had been updated. The documents contained comprehensive information to help a prospective resident to understand how the home was run and what facilities were offered. Minor amendments were needed to clarify some issues about extra charges for staff escorting residents to appointments and about shared rooms. The manager confirmed that the service users guide was posted out to all prospective residents. Most residents’ files contained copies of assessments completed by health and social care professionals. The manager stated that it was also usual practice for her to visit and assess prospective residents before offering them a place at the home. Five of the individual care records inspected contained copies of these assessments, which usually provided clear details of the residents’ daily living skills and needs. However, two residents had been admitted over the Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 9 past month without any pre-admission assessments. Discussions took place as to how the systems for providing assessment information to staff could be improved. A previous requirement to provide written confirmation to residents that their needs could be met at the home had only been partially met. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 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 standard(s) 7,8,9 and 10 The care planning process was not thorough. Inadequate recording and reviews meant that staff were following incorrect directions, which could be potentially harmful to residents. Residents’ healthcare needs were not always recorded or met. Some medication handling practices were unsafe and placed residents at risk. Care was provided in such a way as to promote residents’ privacy, dignity and independence. 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 assessment or care plans relevant to this admission and staff were following plans drawn up during a previous admission over 6 months ago. A newly admitted resident on Grane View did not have any care plans at all. The plan of another resident on Grane View was incomplete and not all needs identified on their assessment were being addressed. The new format of core care plans did not give the level of detail of individual plans, but they provided staff with clear directions and there were some personalised elements. Not all residents had plans to address their psychological or social care needs. Care plan evaluations were brief and at times inaccurate. The systems for recording daily interventions were not Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 11 thorough and did not assist in the evaluation process. The system also allowed for information to be entered at a later date. Care plans were not always updated when changes occurred and some of the plans for at least three residents were out of date. Not all plans were signed by staff. Only 2 of the plans showed any involvement or agreement of the resident or their representative. Both of these were signed some time ago and there was no evidence of recent participation. None of the residents spoken with had been consulted about their care plans. One resident said “I don’t know anything about the paperwork.” Care plans to address identified risk were not always in place. One resident was considered to have a high risk of developing pressure sores but there was no plan for prevention. The care plan for another resident had directions for staff to assess a blister on her heel. This had not been carried out and staff were not aware of whether there was still a problem or not. One resident had lost a significant amount of weight over the past two months. There was no plan to address this and their nutritional risk assessment had not been changed. Other significant healthcare information was not always recorded on plans. For example, one resident had a severe allergy that was not recorded and another resident had a long history of depression but there was no plan for monitoring. As previously recommended, some plans contained clear directions for moving and handling residents but others were still lacking. All staff had received moving and handling training and the hoist was used for immobile residents. However, inappropriate moving and handling techniques were observed during the course of the inspection. Despite these shortfalls residents generally thought their healthcare needs were met. One resident said that the doctor was always called if they weren’t well and another said, “I’ve been much better since I’ve been looked after here.” There were some concerns regarding the security, storage, administration and recording of medication. Medication trolleys were found unlocked and unattended in the main dining room on Tor View and the medication storage room was propped open despite a previous requirement to address this. Temperatures of storage facilities were not recorded on Tor View. There were unexplained gaps on Medication Administration Record (MAR) charts. Handwritten MAR charts were not always signed or witnessed. Medication prescribed for one resident was found in the room of another. A risk assessment and self-medication care plan for one resident was out of date and contained inaccurate information. Several care plans made reference to providing care in a way that respected residents’ privacy and dignity. Residents said that staff were always polite and Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 12 respected their privacy and independence. Several residents confirmed that staff always knocked before entering their rooms and provided privacy when they were assisting with personal care. One resident said that she preferred to do everything for herself and that staff respected that. Another person said “they let me get on with it if I can.” On the day of the inspection all residents were dressed appropriately and looked neat and well groomed. One visitor said “they look after him very well, they always have him looking nice.” Staff received training on core values during their induction and those spoken with understood the importance of maintaining residents’ privacy, dignity and independence. During the course of the inspection staff were seen to interact with residents in a friendly yet polite manner. There was evidence of good resident and staff relationships, which led to a good atmosphere in the home. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15 There was an improvement in the level of activities in the home, which provided residents with opportunities for social interaction and stimulation. The open visiting policy ensured that residents could receive visitors at any time. The menus did not provide enough choice and variety for some of the residents. EVIDENCE: Residents confirmed that the routines in the home were flexible to meet their needs. One resident said that he usually buzzed for the nurse to help him to get up before 7 and he stayed up to watch TV until after 11. Another resident said that they were able to go out whenever they wanted. Several residents and staff talked about the improvement in activities. There was a weekly programme displayed on both units, with identified staff responsible for leading each activity. Two residents talked about how much they enjoyed the reminiscence group; one said, “We always talk about interesting things.” During the inspection residents took part in art and crafts, singing and Communion. Residents had access to a small library, which at least two residents said they took advantage of. Several care plans made mention of residents’ spiritual needs and assistance to practice their religious faith. Two staff talked about recently having more time to spend talking with residents, which gave them more job satisfaction. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 14 There was an open visiting policy. Visitors said they were made very welcome and were offered drinks on arrival. One visitor said “they seem to be very relaxed about visitors so I can come when I like.” Residents were able to go out with their visitors. One talked about going out with her daughter and another resident said she had just been on holiday for a week. Although some residents went out with their family or alone if able, there were few opportunities for other residents to go out. Three residents and a member of staff commented on this. Residents had visitors from local churches on a regular basis. The manager stated that action had been taken to address complaints about the meals that were raised during the previous inspection. However, with a few exceptions about the breakfasts, salads and puddings, residents were still generally unhappy with the choice and quality of the food. Comments included: “The food’s no different, no better”, there’s not enough choice, I’m a bit picky and sometimes I don’t like anything,” “not enough variety,” “not enough fresh veg,” “inferior food.” On the day of the inspection neither of the choices on the menu looked particularly appetising and a high proportion of the residents in one dining room did not finish their meals. The manager and chef were made aware of the residents’ comments. New sets of menus with an extra choice at lunchtime were due to be introduced next week. Previous recommendations with regard to the use of plastic aprons, condiments and collection of waste food had been partially met. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 Residents and their relatives were provided with opportunities to raise concerns and complaints. The recording procedures were not thorough and may result in complaints not being dealt with appropriately. The lack of staff training in protection of vulnerable adults may result in abusive practices being unrecognised and unreported. EVIDENCE: An appropriate complaints procedure was displayed in the home. Residents named members of staff they would go to if they had any complaints and they said they thought they would be dealt with. One visitor said “I’ve been coming here for nearly 3 years and I’ve never had to make a complaint.” A resident said, “I haven’t got anything to complain about.” Four complaints records were seen. The person receiving the complaint did not sign two and none were signed to indicate that recommendations were implemented. The Commission had received two complaints since the previous inspection and one was made directly to the home. There was no evidence that any action had been taken to address this one although the inspector was told that the registered person had spoken with the complainant. Action had been taken to improve the complaint process since the previous inspection. Senior staff held fortnightly “surgeries”. The dates were displayed and residents and relatives were invited to air their views and bring up any concerns. Records were kept of any issues raised; these should include actions taken. Staff undertaking NVQ training had received training in the protection of vulnerable adults but there were no training opportunities for other staff. There was a copy of the ‘No Secrets in Lancashire’ document in the home but Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 16 this was not readily accessible to staff. Two of the staff spoken with were aware of reporting procedures but one said they were not sure what they should do. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 17 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 standard(s) 19,22,24 and 26 The home was clean and well maintained. There was a good standard of décor and furnishings, providing residents with a comfortable and homely place to live. Some current practices may pose a risk to residents’ health and safety. EVIDENCE: Several residents commented on the environment. One said “it’s a beautiful building and lovely grounds.” Another commented on the ornate ceiling in one of the lounges. The home was generally well maintained. Minor faults were reported and repairs carried out in a timely fashion. The manager stated that there was a rolling programme of redecoration and refurbishment but this was not available at the time of the inspection. Décor and furnishings in resident areas were generally of a good standard. A few exceptions were pointed out to the manager during the tour of the premises and should be added to the maintenance programme. Several bedrooms and two fire doors in the corridors of Tor View were wedged open. Door wedges were seen in other rooms, indicating they were wedged open at other times. There were 6 Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 18 requirements and recommendations made during an environmental health inspection last week. Despite a previous requirement, wheelchairs were still stored in the corridor in Tor View. This presented an obstacle and potential tripping hazard to residents using walking aids. There was a variety of equipment around the home to assist residents with mobility difficulties to maintain their independence. All the residents spoken with were happy with their rooms. One said “my room’s nice and the bed is very comfy.” Another commented that she was very comfortable in her room. Bedrooms were decorated and furnished to a good standard and many were personalised to a high degree. Residents confirmed that they were able to bring in their own furniture, pictures and ornaments. All en-suite facilities were a good size to allow wheelchair access. One resident commented, “my toilet room is so large that I was able to put a chest of drawers in there that I thought I wouldn’t have room for.” Not all bedrooms had door locks or lockable storage facilities. Residents’ comments regarding this were mixed. One said they had a lock but had been told not to use it at night and so far no-one had entered their room. Another person said that she had complained to staff that someone had been in her room and through her belongings. The manager stated that anyone who asked would be provided with a lock but this was not made clear in any of the written information about the home. At the time of the inspection the home was clean and tidy. A resident said “it’s a nice place, always very clean,” another said “they’re very particular and beds are changed all the time.” An unused shower room in Tor View was malodorous; all other parts of the home were fresh smelling. Residents were generally happy with the laundry service. One commented that she always got her laundry back on time and another said that sometimes things got lost but usually turned up. The laundry room was organised and well equipped. There were procedures for handling laundry and waste. Staff were undertaking training in infection control procedures. There were no disposable wipes and non-disposable washcloths were used to assist with the personal hygiene of residents with continence needs. This may potentially increase the risk of spread of infection. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There were sufficient numbers of staff on duty to meet the needs of the residents. Staff shortages had been addressed and as a result residents were receiving consistent care from regular staff. Recruitment practices had improved. Pre-employment checks were carried out, providing safeguards for residents. The current level of staff training in some areas was not sufficient, which may place residents at risk of harm or result in their needs not being met. EVIDENCE: Examination of duty rosters showed that on occasional shifts the staffing levels exceeded the agreed minimum. The deputy manager had also been provided with some supernumerary hours to address various issues, including setting up the activity programme. Two residents said that at some times during the day they may have to wait to have their calls answered but acknowledged that staff may be busy with other residents. Other residents spoken with said there were always enough staff around. Many residents made complimentary remarks about the staff. Comments included: “very nice girls,” “they work very hard, too hard at times,” “they’re ever so good, very caring” “he will do anything for anybody.” Visitors also commented on the staff saying, “they look after (him) very well” and “the staff are always kind.” Several overseas staff had been recruited since the last inspection. Some residents said they had communication problems at first but this was getting better. The recruitment of new staff had provided stability in the team, a reduction in the use of Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 20 agency staff and lower sickness and absence levels. Staff and residents mentioned these issues. The files of three recently employed staff were examined. Whilst CRB disclosures were on file, there was no evidence that POVA checks had been carried out prior to the employees starting work at the home. Staff from overseas had valid work permits. All other required information and documents had been obtained and retained. New staff had received induction training within the first two weeks of employment. The training programme did not cover all the recommended topics, including protection of vulnerable adults. However, most staff had attended a further course that met the National Training Organisation specifications. Staff were provided with a handbook, which covered aspects of practice and important policies and procedures. Training in safe working practice topics was not up to date. A previous requirement to provide Grane View staff with dementia care training had not been met. The manager had sourced appropriate training in dementia care and protection of vulnerable adults and this was planned for September. One staff member said that training opportunities had improved. They were due to attend courses over the next few weeks covering first aid, continence awareness and understanding swallowing difficulties. Significant progress had been made in NVQ training. 67 of care staff were trained to NVQ level 2 or above and a further 7 carers were undertaking training at the time of the inspection. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,37 and 38 There were inadequate systems for consulting residents about the quality of services and facilities offered by the home. Therefore, changes and developments in the service were not planned with regard to residents’ views and wishes. The lack of attention to fire safety in the home meant that residents and staff were placed at risk of harm. EVIDENCE: There were some aspects of quality monitoring in place. The home had the Investors in People Award. Accidents were audited monthly and actions were taken to reduce risk where any patterns occurred. Other audits included infection control and cleaning rotas in the kitchen. The fortnightly surgery provided residents and relatives with a forum to air their views and opinions. Regular staff meetings were held and one member of staff said that the meetings were quite open and anyone could bring up issues. Resident satisfaction surveys were displayed and could be filled in at any time. However, there was no formal system for routinely reviewing and improving Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 22 the quality of care in the home, with the involvement of residents. One resident said “I have not been asked my opinion about anything since I have been here.” The procedure for staff to follow in the event of a resident going missing had been reviewed as previously required. However, the new procedure still needed some amendments to include actions to be taken with regard to residents who may be on Section 17 of the Mental Health Act 1983. Other records required to be kept were discussed with the registered manager. Not all measures to protect the health and safety of the residents were in place. Staff training in fire safety was not up to date. There were no records of practice drills. Fire alarms and emergency lighting were not tested regularly. Potentially hazardous substances were generally stored safely, however, a tube of Steradent was found in an unlocked cupboard in one of the bathrooms. Certificates to evidence servicing and maintenance for some installations and appliances were seen at the time of the inspection. Others were not accessible and will be looked at during the next inspection. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x 2 x 3 x 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 2 x x x 2 2 Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? 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 3 Timescale for action 14(1)(aResidents must be assessed prior 31/07/05 b) to being offered a place in the home. (Timescale of 28/02/05 not met) 14(1)(d) The registered person must 31/07/05 provide written confirmation to the resident that their needs can be met at the home. (Timescale of 28/02/05 not met) 15(1) All residents must have a care 31/07/05 plan detailing how their needs in respect of health and welfare are to be met. Residents and/or their representatives must be provided with opportunities for involvement. 15(2)(b-c) The residents plan must be 31/07/05 reviwed and updated as and when changes occur. (Timescale of 31/03/05 not met) 13(5) Practices for moving and 30/06/05 handling residents must be safe for residents and staff. 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 nutritional and pressure sore risk and risk of 31/07/05 Regulation Requirement 2. 3 3. 7&8 4. 7 5. 8 6. 8 Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 25 7. 8. 9. 10. 9 9 9 15 13(2) 13(2) 13(2) 16(2)(i) 11. 18 13(6) 12. 19 23(4)c)(i) 13. 22 13(4)(a) 14. 30 18(1)c)(i) 15. 33 24 16. 37 17(2) Schedules 3&4 falls.(Timescale of 31/03/05 not met) Medication must only be supplied to the named resident. Medication must be stored securely at all times.(Timescale of 28/02/05 not met) Medication Administration Records must be accurate. (Timescale of 28/02/05 not met) 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. The registered person must ensure that all staff receive training in the protection of vulnerable adults. (Timescale of 31/03/05 not met) 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) Wheelchairs on Tor View must be stored so as not to present a hazard to residents. (Timescale of 28/02/05 not met) Staff must receive training appropriate to the work they are to perform. This includes training in safe working practice topics for all staff and, for staff working on Grane View, dementia care training. (Timescale of 30/04/05 not met) The registered person must establish and maintain a system for reviewing and improving the quality of care, which includes the residents. (Timescale of 30/04/05 not met) The missing person procedure must include action to be taken should a resident on Section 17 of the MHA 1983 leave the 16/06/05 16/06/05 16/06/05 31/08/05 30/09/05 30/06/05 31/07/05 30/09/05 30/09/05 31/08/05 Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 26 17. 38 18. 29 home. All records outlined in Schedules 3 and 4 must be kept. 23(4)c)(d) The registered person must (e) ensure: that all staff receive training in fire prevention. By means of fire drills and practices that staff are aware of the procedure to be followed in the event of fire. All fire equipment must be maintained. (Timescale of 31/03/05 not met) 19 Staff must not start work at the home until a satisfactory POVAFirst check or full CRB disclosure has been obtained. 30/06/05 30/06/05 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. Refer to Standard 1 7 7 9 9 15 15 16 18 19 Good Practice Recommendations The service users guide should be amended to include information about charges for escorting residents to appointments and about the protocol for shared rooms. Residents daily care notes should provide sufficient information to assist in evaluation of care plans. Care plans should be signed by staff. Handwritten amendments on MAR charts must be signed and witnessed. Temperatures of medication storage facilities must be monitored and recorded daily. Residents should be offered condiments when being served their meals. The use of plastic aprons at mealtimes for residents on Grane View should cease. Cloth aprons should be provided. Complaints records should include actions taken to resolve the complaint. Staff should have access to written information about the protection of vulnerable adults, including the No Secrets in Lancashire document. Areas identified as needing attention during the inspection F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 27 Turfcote Nursing Home 11. 12. 13. 24 26 30 should be added to the maintenance programme. The service users guide indicate that residents can have a lock fitted to their bedroom door if they wish. The use of non-disposable washcloths to assist residents with continence needs should be reviewed. The induction training programme should meet the National Training Organisation specifications. Turfcote Nursing Home F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-moors Accrington Lancashire. 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 F57 F07 S22473 Turfcote V224084 140605 Stage 4.doc Version 1.30 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. 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!