Inspection on 15/04/08 for Turfcote Nursing Home

This inspection was carried out on 15th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Turfcote Nursing Home 07/05/09

Turfcote Nursing Home 14/08/07

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

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Chirnside House

Keer Sands Residential Home

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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 15th April 2008 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.V360161.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.V360161.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 (30), Mental disorder, excluding registration, with number learning disability or dementia (30), Old age, of places not falling within any other category (46), Physical disability (46) Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD (maximum number of places: 46) Mental disorder, excluding learning disability or dementia - Code MD (maximum number of places: 30) Dementia - Code DE (maximum number of places: 30) Old age, not falling within any other category - Code OP (maximum number of places: 46) The maximum number of service users who can be accommodated is: 76 Date of last inspection 14th August 2007 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 for to up to 30 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. From April 2008 the weekly fees ranged from £366.00 to £552.00. Some single rooms carry a supplement Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 5 of £15 per week. Additional charges are made for toiletries, hairdressing, newspapers, transport and staff escorts to hospital appointments. Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Turfcote Nursing Home on the 15th and 16th April 2008. At the time of the visit there were 60 people living at the home. The inspector 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. Four people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to people living at the home, their relatives and staff working at Turfcote. Comments received on the surveys were taken into account when compiling the report. During the visit discussions were held with the registered manager, members of the staff team and visitors to the home. The inspector looked round the home and viewed a number of documents and records. 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: Most 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 suitable for them. People were able to visit at any time to have a look around. One relative said that this was one of the reasons he chose the home. Before anyone moved in the manager visited them to assess what care they needed and to make sure that their needs could be properly met at Turfcote. Everyone who completed a survey indicated that they received the care and support they needed. A family member said that their relative was very well looked after and another wrote, “generally the care given is good and the residents are happy and content.” During the visit staff were seen to treat people with respect and not to try to hurry them. One person wrote that staff were “considerate.” Another said Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 7 that staff respected her privacy and always knocked on her bedroom door before entering. There was an open visiting policy, which meant that people could see their friends and relatives at any time. Visitors said they felt welcome in the home. There was always a choice at mealtimes. There were a few who said the meals could be better but most people said they enjoyed their food. One said, “The meals are nice, especially Sunday lunch.” The cook had recently attended a course about nutrition. She said that she would be adding a healthy option to the menus. People living at the home, and their relatives, knew how to make a complaint if they were not happy about anything. One person said that he would feel able to air any grievances. Staff had received training to help them recognise and respond if they thought anyone living at the home was being mistreated. The home was well maintained. It was decorated and furnished in a homely way. People living at the home said they were happy with their bedrooms. The home was clean and free from odours. Some people made positive comments about the cleanliness of the home. Family carers and people living at the home were very complementary about the staff team. They described them as “friendly, caring, helpful and hardworking.” The manager made sure that new staff had background checks before they started work. This helped to protect people living at the home. There were good opportunities for staff to attend training courses. As well as courses in health and safety topics they also had training in specialist subjects. This helped them to understand and meet the needs of people living at the home. Over half of the care staff held a nationally recognised qualification in care. What has improved since the last inspection? Although further improvements were still needed, a number of the care plans seen were better than at the last inspection. They contained more information about what help the person needed and how they preferred to be helped. Instructions for staff were also clearer. Although there were still some potentially unsafe practices, there were improvements in the way medicines were managed. Staff were carrying out regular checks which meant that most problems were picked up and dealt with. Locks on bathroom and toilet doors had been repaired so that people could have complete privacy. Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 8 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.V360161.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.V360161.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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to help them understand the person’s needs. EVIDENCE: The service user’s guide had been reviewed and updated and was sent out to anyone enquiring about a place at the home. The manager said it could be made available in different formats on request and she would be available to discuss or clarify any information. Most people who returned surveys indicated that they received enough information about the home to help them to make a decision about moving in. People had opportunities to visit the home. A relative said that one of the reasons they had chosen Turfcote was because the manager had told them Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 11 they did not need an appointment and just to drop in at any time to have a look round. Anyone thinking of moving into the home had an assessment, which helped the manager to decide whether the service provided at Turfcote could meet the person’s needs. The assessment document had been upgraded since the last key inspection. The assessments gave a good indication of the person’s strengths as well as needs, which meant that staff had enough information about the person to ensure a smooth admission to the home. Information included on the annual quality assurance assessment (AQAA) showed that the manager had introduced post admission surveys so that people could give their opinions of the admission process and make suggestions for improvements. Standard 6 was not applicable. Intermediate care is not provided at Turfcote. Turfcote Nursing Home DS0000022473.V360161.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. Although improving, 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: Four sets of care records were inspected as part of the case tracking process and others were viewed in less detail. The format for assessments and care plans had improved since the last inspection. Everyone had an ongoing assessment of need, which was reviewed every month. Staff were going to carry out a full re-assessment every six months, which should ensure that changes in need are identified quickly. Anyone newly admitted to the home had an admission care plan. Staff said this was to provide initial directions for care whilst other plans were being Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 13 developed. However, the plans were not individualised and in one case it did not reflect the care being given. Discussions took place with the manager as to how these plans could be developed to provide more useful information. General care plans had improved since the last inspection. The standardised plans had been phased out. There were some good examples of person centred plans, especially those addressing personal care needs. Some gave staff very specific directions about how the person was to be supported in accordance with their wishes and preferences. However, the improvement was not consistent. A number of other plans were vague and not specific enough to ensure that staff supported people in a way that met their specific needs. For example, one plan directed staff to reassure someone when they became distressed. The plan did not take into account the person’s limited understanding and communication or their preferences for support. Other plans instructed staff to orientate people with profound memory loss and disorientation, without any guidance on how that particular person could be helped. Some plans showed evidence of discussion and consultation with either the person using the service or their relative. One family carer said that the deputy manager had talked them through all the plans. However, this was not consistent. When asked, one person said they would like the opportunity to see their care plans. All plans had records of communication with relatives, which showed that they were informed of any important issues. Relatives who completed surveys also confirmed this. Care plans were evaluated every month. Some gave a good summary and evaluated whether the support provided had been effective. Others just repeated the person’s needs, which did not help staff to make a decision as to whether the plan needed to be altered. All care plans included a set of health care risk assessments, which were reviewed every month. Risk assessments for the use of bedrails had improved, which meant that they were not fitted unless it was safe to do so. Two of the people who were case tracked had lost a significant amount of weight in a short space of time. Neither had adequate risk assessments or care plans to ensure that the situation was monitored and effectively addressed. One person had their blood sugar levels monitored every day. Records showed that the levels fluctuated but very high or low readings were not closely monitored. There was no plan to direct staff what to do if readings were outside the normal range, which could result in the person’s health needs not being met. Despite these shortfalls in health care, people who returned surveys indicated that they received the care, support and medical attention they needed. There Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 14 was evidence on some files that routine health care checks were carried out and advice was sought from other professionals when necessary. The way medication was managed had continued to improve since the last inspection. The requirement and recommendations made after the last inspection had been met. Most of the shortfalls seen during the visit were isolated events but there were some recurring themes that could impact on the health and safety of people living at the home. For example, there were some discrepancies on the Medication Administration Record (MAR) charts, which showed that medication might be given without being signed for, or records might be completed when tablets were not administered. Some of the entries on handwritten MAR charts did not completely match the wording on the medicine packages. For example, Latin abbreviations were used on some charts, which could increase the risk of transcribing errors. Stocks of controlled drugs that were not given on a regular basis were not checked. This had resulted in an out of date bottle of medicine still being in circulation. The annual quality assurance assessment (AQAA) indicated that the staff were working towards making sure that everyone living at the home had regular medication reviews; evidence of this was seen on several files. Two members of staff said they thought that regular medication audits as well as regular contact with the community pharmacist had helped them to improve. Staff received training on core values during their induction and NVQ training. 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 going at the same pace as residents and making sure that they gave eye contact when speaking to people. One person living at the home said that staff respected her privacy and always knocked on her bedroom door before entering. Turfcote Nursing Home DS0000022473.V360161.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 adequate. This judgement has been made using available evidence including a visit to this service. A significant number of people living at the home did not have sufficient choice and control over their lives and their social and recreational needs were not met. EVIDENCE: Some assessments included information about people’s preferred daily routines, meal preferences and social activities. However, this was not always transferred to the care plans to become part of everyday care. None of the people who were case tracked had plans to assist with social contact or to address their social care needs. A relative talked about how important religion was to his wife. This was not identified in her assessment, which stated she was unable to pursue her faith. There was no care plan to assist her to do so. Staff were unclear about whether she saw the priest when he visited every month. Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 16 People who completed surveys had mixed views about the level of activities provided at the home. At the time of the visit one resident said, “there is nothing going on in the way of activities; the TV is on all the time.” Another said, “There was a lot going on before Christmas but it has tailed off now.” The manager stated that there had been some recent difficulties in providing activities because of staff sickness but this was being addressed. Staff said that people living at the home could make choices about their daily routines, what they wanted to eat and how and where they spent their time. People spoken with confirmed that they were able to get up and go to bed whenever they wished and one person said that staff made sure she always got her Horlicks at night. However, the plan for one person indicated that, for safety reasons, they should be directed to sit in the lounge rather than their bedroom, where staff said the person preferred to be. Although staff said that the person’s family would have been involved in this decision, there was no evidence that this limitation to the person’s choice had been risk assessed or discussed with the resident. During the course of the visit a family member remarked that everyone living on Grane View ate their meals with a spoon. In addition to this it was noted that people on the same unit were offered drinks out of plastic cups only. No one was seen to be given a choice of utensils. Staff stated that the reasons for the lack of choice were because of abilities and safety. However, there were no assessments or risk assessments to support this. There was an open visiting policy. Visitors said they felt welcome in the home and at the time of the inspection visitors were seen to be greeted in a warm and friendly way. Some people went out with family members but others had few opportunities to go out unless to a health care appointment. Information about the lack of organised trips was included in the service user’s guide. The majority of people who returned surveys indicated that they always enjoyed the meals and most people who were asked at the time of the visit confirmed this. One person said, “The food is excellent.” Another said, “The meals are nice, especially Sunday lunch.” Records of meals served showed that people were offered a varied diet. The cook had introduced new systems for ensuring safe hygiene and working practices. Following a recent environmental health inspection it was recommended that the home try for the Confidence in Catering award. The cook had recently undertaken a course in nutrition and older people. She said this had helped her to think more about healthy eating and about introducing foods that have known benefits to older people. The AQAA indicated that new menus were to be introduced. The cook had attended a residents’ meeting to ask for suggestions and comments. Turfcote Nursing Home DS0000022473.V360161.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: There was a clear complaints procedure on display and the service user’s guide explained how complaints were dealt with. Staff said they felt the whole team were open to complaints and criticism and management were good at following things through. One said, “Definitely no-one would be victimised for making a complaint.” People spoken with at the time of the visit confirmed that they would be able to make a complaint. One said, “I would feel able to air any grievances.” Another said, “I would be able to talk to manager or staff if I have any complaints.” People who completed surveys indicated that they knew who to speak to if they were not happy about anything. There were information leaflets in the foyer about how to contact an advocacy service. There had been no complaints since the last inspection either to CSCI or directly to the home. Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 18 New staff received training in safeguarding adults during their induction training. Other staff had regular refresher training and there was 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. They were also aware of the whistle blowing policy and how to report bad practice outside the home if necessary. Information included on the AQAA indicated that the manager was trying to source training about the Mental Capacity Act to ensure that the rights of people using the service were protected. Turfcote Nursing Home DS0000022473.V360161.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. The home was clean and well maintained and the standard of décor and furnishings provided people with a safe, comfortable and homely place to live. EVIDENCE: Information included in the AQAA indicated that the extensive programme of redecoration and renewal was ongoing. From looking around the home it was evident that further improvements had been made in several areas, especially on Grane View. The refurbishment of the lounges was complete. New furnishings were of a high standard and a large, flat screen TV had been installed in one to allow better viewing from around the room. One of the toilets near the lounge had been rearranged to make it more accessible to people in wheelchairs. Several bedrooms on Tor View had been re-decorated and there was new lounge and dining room furniture on order. Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 20 A number of bedrooms were highly personalised with pictures and ornaments. Those people who were asked said they were happy with their bedrooms. One said their room was, “nicely decorated,” and another said they were, “very happy” with their room. People shared a room only if they requested to do so. The home was generally well maintained. A few areas were in need of attention, such as the shower room on Tor View. A few double glazed units also needed replacing. The manager confirmed that they had already been identified and were being addressed. 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. A resident and two relatives commented that the overall cleanliness of the home had improved recently. One person, who had previously raised concerns about cleanliness, said it was, “much better.” Information included on the AQAA indicated that the manager had carried out an infection control audit of the home and there were no outstanding actions to be taken. Staff had access to written guidance about hygiene and infection control and most had received infection control training. The laundry was adequately equipped for the size of the home and there were sufficient hours allocated to laundry staff. Two people mentioned that the laundry service was good. A relative said, “They do all the washing and it all comes back eventually.” Turfcote Nursing Home DS0000022473.V360161.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 were supported by staff who received regular training and supervision, which helped to ensure people’s needs were understood and met. Recruitment practices provided safeguards. EVIDENCE: Duty rosters showed that staffing numbers were consistent and there were no obvious shortages. 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. Most people who returned surveys indicated that staff were usually available when they needed them. People spoken with during the visit confirmed this. One person said staff came at night if she used her bell. Staff spoken with said there were generally enough staff on duty. They confirmed that the manager usually arranged cover if staff were sick. People living at the home, and their relatives, made some very positive comments about the staff. One person, who was quite new to the home, said she was getting on with the staff very well. Another said, “Staff are caring Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 22 and considerate.” A relative described the staff team as, “excellent,” and another wrote, “The staff are always friendly and caring.” The files for two recently employed members of staff were examined. These showed that the recruitment practices safeguarded people living at the home and ensured equal opportunities. All applicants completed an application form and attended for an interview. References and POVA first or CRB checks had been obtained before employment commenced. All staff had a copy of terms and conditions of employment. New staff had an initial induction which included an introduction to the organisation, orientation of the building and emergency procedures. Staff without qualifications then went through the Skills for Care twelve-week induction programme. Staff were supervised throughout their three month probationary period and any further training needs were identified during this time. The AQAA indicated that the frequency of staff supervision had improved since the last inspection. Only a small sample of staff training records was looked at during the visit. The manager confirmed that most staff had received refresher training in the main health and safety topics. Staff commented that training opportunities had improved. Several talked about a dementia care course they had attended. Some had attended a one day awareness course and some staff working on Grane View had undertaken the more in-depth course. Several commented that it had helped their understanding of dementia and had changed their approach to care. One said, “Understanding has also led to greater patience with repetitive questions and behaviour.” The AQAA indicated that over half of the care staff were qualified to NVQ level 2. A few staff spoken with during the visit said they had, or planned to, continue to do NVQ level 3. Turfcote Nursing Home DS0000022473.V360161.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 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 has a management qualification and regularly attends courses to keep her clinical and management skills up to date. The manager had supernumerary status. This gave her time for involvement in the development of the service as well as managing staff and systems on a day-today basis. The responsible individual and the deputy manager supported her in her role. Both the manager and the deputy were praised by family carers. Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 24 One said, “Staff and management are excellent I can talk to them and they are helpful.” The service held the Investors in People award. There were also internal systems for monitoring the quality of the service. For example, the manager audited the quality of the service using the Registered Nursing Home Association Blue Charter Mark. Action plans were drawn up to address any shortfalls identified in the audit. People living at the home and their relatives had opportunities to make their views known. Records of a recent residents’ meeting showed that people were asked for their views and suggestions about meals and activities. Questionnaires were sent out every year. There were no records to show how any expressions of dissatisfaction were addressed but the manager stated that she would discuss it with the person concerned and solutions would be looked at during staff meetings. The registered person did not act as agent or appointee for anyone living at the home. A few people gave small amounts of money for safekeeping. There were records of all such transactions. Those seen were clear and accurate and supported by receipts. Fire drills were carried out every month. The manager stated that the drills also incorporated the fire prevention training. There were no clear records to evidence how often each member of staff was involved in a drill. The manager stated that attendance was looked at and she could confirm that everyone had participated in a drill in the past year. As required following the past few inspections all fire doors were closed. However, a number of bedrooms did not have close fitting fire doors and the seals around the doors, designed to delay the passage of smoke, were missing. The AQAA showed that servicing and maintenance of installations and appliances was up to date. Certificates and service documents were seen for the hoists, portable appliances and the electrical installations. The storage of potentially hazardous substances such as cleaning solutions and disinfectant had improved. However, there was still a spray without a label or first aid instructions stored in one of the toilets. This meant it was accessible to people who may not recognise the potential risks of using it. Turfcote Nursing Home DS0000022473.V360161.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 X X 3 X X N/A 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 2 13 3 14 2 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 X X 2 Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must clearly identify health care needs and provide sufficient directions to staff to meet those needs. Timescale for action 31/07/08 2. OP8 13(4)(b-c) In order to protect the health 31/07/08 and safety of people living in the home, risks to health must be accurately assessed and plans to control the risks must be put into place. 13(2) In order to protect the health and safety of people using the service and to provide a thorough audit trail, accurate records must be kept of medicines administered. In order to protect the health and safety of people living and working at the home fire doors must be kept in a good state of repair. 30/06/08 3. OP9 4. OP38 23(4)(c) 31/05/08 Turfcote Nursing Home DS0000022473.V360161.R01.S.doc Version 5.2 Page 27 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 All care plans should be person centred to ensure that staff have sufficient information about people’s individual needs and how they wish to be supported. In order to reduce the risk of transcribing errors, handwritten entries on medication administration record charts should accurately match the information on medicine packaging. Controlled drugs that are not used on a regular basis should be checked to ensure that they remain in date. There should be a regular programme of activities to meet the social and recreational needs of people living at the home. Any restrictions on choice or freedom of movement should be risk assessed and alternatives sought. Limitations should be discussed and where possible agreed with the person concerned or their representative. There should be clear and accessible records to evidence that all staff have received fire prevention training and have been involved in fire drills. Cleaning materials and other potentially hazardous substances should be stored in their original containers or be clearly labelled to show the content and any first aid instructions. 2. OP9 3. 4. OP9 OP12 5. OP14 6. OP38 7. OP38 Turfcote Nursing Home DS0000022473.V360161.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. 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