Inspection on 17/05/06 for Turfcote Nursing Home

This inspection was carried out on 17th May 2006.

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 14/08/07

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 09:00 17 and 18th May 2006 th 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.V287482.R01.S.doc Version 5.1 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.V287482.R01.S.doc Version 5.1 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.V287482.R01.S.doc Version 5.1 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. 1st February 2006 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. Information received from the home on 15th May 2006 indicates the range of weekly fees is £324 to £547. There is a £15 per week supplement for a single room. Additional charges are made for toiletries, hairdressing, newspapers, transport and staff escorts to hospital appointments. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place over 2 days and was carried out by 2 inspectors. At the time of the visit there were 64 residents accommodated in the home. The inspectors met with a number of residents and visitors to the home. Time was spent observing interactions between staff and residents. Wherever possible residents were asked about their views and experiences of living in the home and some of their comments are quoted in this report. One visiting professional completed a comment card but none of those sent out to residents or visitors were returned. Discussions were held with the responsible individual (the owner), the registered manager and six members of staff. The inspectors made a tour of the premises and looked at a number of bedrooms. Records and documents were viewed. What the service does well: The manager visited prospective residents in their own homes to assess what care they needed and to make sure that they could be properly cared for at Turfcote. One resident said that the manager had left him some useful information about the home. Residents that staff were good at looking after their health. One resident said she felt safer knowing that if she were unwell the staff would get the doctor for her. Relatives also commented that staff kept a close eye on the residents’ health. One said, “they phoned me today because dad wasn’t very well.” Both residents and their relatives were happy with the open visiting arrangements. One relative said that they were able to pop in at any time and were always made to feel welcome. Residents said that staff treated them respectfully and made sure that they had privacy in their rooms. Good relationships between staff and residents were evident from the good atmosphere. Residents’ comments about staff were very positive and included; “if they can do anything they will,” “they are very good and kind” and “I love them here.” There was a clear procedure for anyone to follow if they had a complaint. Two residents said that when they had concerns they had seen the manager who had sorted everything out. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 6 Residents were able to bring in items of furniture, ornaments and mementoes to personalise their rooms. One resident had brought in her own furniture and another said, “I have a lovely room the en-suite is a real bonus.” The manager had kept up the improvement in the way new staff were recruited. All staff had thorough background checks to make sure they were suitable to work with residents. What has improved since the last inspection? What they could do better: Residents’ care plans did not give a clear picture of the resident’s needs and how they were to be met. There was no information about the resident’s usual routines, what they liked to do or what food they preferred. The plans instructed staff to provide the same care in the same way for all residents. If staff followed these plans it would mean that residents’ preferences would not be taken into account and residents would not be treated as individuals. Residents or their relatives must have opportunities to be involved in drawing up plans to make sure that they have a say about how they wish to be cared for. The Pharmacy Inspector looked at how residents’ medicines were managed in the home. She found some areas that were not good and may place residents at risk. The pharmacy inspector has issued a separate report. Residents and relatives said that there was not enough going on in the home. One resident said they had occasional entertainment but comments from others included: “the TV is on all day – nothing else to my knowledge.” “We could do with a bit more entertainment” and “the biggest obstacle is boredom, there is nothing at all to do – just the TV.” Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 7 All staff must receive training in the protection of vulnerable adults to ensure that they would be able to recognise any abusive behaviour and know how and where to report it. Although some maintenance and repairs had been carried out, there were still areas of the home that needed repairs or redecoration. These were mainly on Grane View. There were also some things picked up during the tour of the premises that may present a risk to residents’ safety. Staff training needs to be improved to make sure that staff have enough knowledge and skills to be able to provide care for residents who have specialist needs. Some of the procedures to protect residents’ health and safety were not being followed properly. The manager must make sure that all staff understand the fire procedure. Cleaning products and other items that could be harmful must be stored correctly. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were not offered a place unless they had been assessed and assured that their needs could be met. EVIDENCE: The manager assessed prospective residents to ensure their needs could be met before offering them a place at the home. One new resident said a nurse had visited him at his home to talk about Turfcote. A relative said that the manager had left some brochures, which were very useful and gave him all the information that he needed. However, these documents did not contain completely accurate and up to date information. Staff said they got to know about new residents before they were admitted. One nurse said, “the manager went through the pre-admission assessment so I had a good idea of the resident’s needs and prepared everything.” Residents received written confirmation that their assessed needs could be met at the home. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans did not provide staff with the information they needed to satisfactorily meet residents’ personal and health care needs. The way medicines were managed may create risks for residents. Care was provided in such a way as to maintain residents’ dignity but some shortfalls in the environment may jeopardise residents’ privacy. EVIDENCE: Care plans for six residents, three from Tor View and three from Grane View, were inspected. Others were viewed in less detail. With the exception of one, which was individually written, all the plans seen were core care plans. This meant that the plans directed staff to care for all residents in exactly the same way, whatever their individual needs may be. Despite staff undertaking training in person centred care, all residents with dementia had the same care plan. Some of the plans were inappropriate for the particular needs of the resident. A few plans included information specific to the resident. For example, one mentioned that the resident was very restless at night, but there were no directions for staff on how to manage this. Specialist needs not covered by core plans were not addressed, for example cultural needs. Four of Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 11 the six residents had communication needs but had no care plans to address this. Although staff said they discussed care with relatives, there was no evidence that residents or their relatives were involved in drawing up and reviewing plans. One resident said that he could not recall staff sitting down and talking through what care he needed. Other residents said they had not seen their plans. All but one of the plans were reviewed. The reviews did not give any indication of the resident’s progress towards meeting their goals but some plans had been altered as the resident’s care needs changed. Residents’ daily records had improved. Some were well written and provided information about the resident’s daily progress and care that had been given. Previous requirements made to improve standard 7 have not been implemented, therefore outcomes for residents have been judged as poor. Care plans included assessments for moving and handling, nutrition, falls and pressure sore risk. Plans were put into place when a risk was identified but these were not individual and some were not accurate. For example, plans for aggressive behaviour did not always specify individual triggers or directions to manage the behaviour. Staff stated that residents at risk of developing pressure sores had regular positional changes but there were no records to evidence this. There were no records to evidence that dependent residents were given sufficient fluids. Moving and handling practices had improved. Most residents had an up to date assessment and plan and all moving and handling techniques observed were appropriate and safe. Residents said that staff looked after their health. One said, “They are looking after me. It’s very good here.” Relatives said that they were kept informed of any changes in their relative’s health. One said, “they’ve called out the doctor a few times and they always let me know.” Another relative said they had no regrets about choosing Turfcote because they looked after her relative very well.” The Pharmacy Inspector looked at the management of medications within the home. Although she identified some areas of good practice, there were still major shortfalls in the way medicines were administered and recorded. The pharmacy inspector has issued a separate report. Requirements and recommendations she made to improve practice are included in this report. Staff discussed the importance of maintaining residents’ privacy and dignity. One said that, in order to maintain residents’ standards, it was, “important to know and understand people’s values before they became ill.” Residents who needed help were assisted to dress appropriately and were well groomed. One relative commented that the staff had “worked wonders” with her relative. Staff were seen to speak to residents politely and sensitively. Personal care was provided behind closed doors and residents confirmed that staff respected their privacy. However, there were some issues that compromised residents’ privacy, for example two bedrooms did not have curtains at the windows, several of the communal toilets did not lock properly and items belonging to residents were found in other residents’ rooms. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 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. There were insufficient recreational activities to ensure that all residents’ social interests and needs were met. Daily routines matched residents’ preferences and choices where these were known. Residents received a nutritious diet. EVIDENCE: Residents, who were able, made choices about their daily lives and routines. All those asked said they could choose when to get up and go to bed. Residents who wanted to stay in their rooms could do so and at mealtimes staff were seen to ask residents about their preferences. Some residents had to rely on staff to make choices and decisions for them. One member of staff said that families told them about routines and these were stuck to. Another said that they got to know residents and learned what they liked. However, none of this information was recorded. The plan for a very dependent resident, admitted in 2001, directed staff to find out her likes and dislikes. Nothing had been recorded, and when staff were asked about the resident’s food preferences they were unable to say. Other plans were similarly incomplete which meant that staff did not have enough background information on which to base their choices. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 13 Only one of the plans seen included information about the resident’s past interests or hobbies. No-one had a plan to meet social and recreational needs. Many residents and relatives commented on the lack of activity and occupation in the home. One resident said, “the biggest obstacle is boredom, there is nothing at all to do – just the TV,” another said, “We could do with a bit more entertainment.” A relative who generally praised the home said that the residents would benefit from something going on instead of just sitting.” Staff said that if they had time they made sure the activity programme was followed. There were no activities observed at the time of the inspection and there were no records of activities carried out since February. A concern had been raised to the Commission in April 2006 stating that staff did take residents out because of potential risks and insurance claims. The responsible individual confirmed that they had been advised by their insurance company not to organise trips out but that staff were able to take residents out for walks, or in wheelchairs, into the local area. None of the residents or staff could remember the last time this had happened. Information about the lack of trips must be included in the service user’s guide to make sure that prospective residents were aware of this. Visitors said they were satisfied with the visiting arrangements. One said they were not aware of any rules and that they could “pop in at any time.” Another said, “staff always make us welcome & give us a drink.” Staff said that residents and relatives were able to meet in private. There were few links with the local community. The manager had conducted an excellent survey about meals following comments made at the last inspection. The results had been analysed and used to plan changes to the menus. Residents’ comments were much more complementary than at previous inspections. They included: “I really like the cottage pie – they present it really nicely.” “Friday I have a special tea – chip butties – I love them” “meals have changed, they’re not so bad now, they just came nice,” and “meals are very good.” Some residents still made negative comments but acknowledged that it was often a matter of personal taste rather than poor food. Special diets were catered for. Halal meat was bought in but was not always made up into culturally appropriate dishes. The chef was keen to remedy this when it was pointed out. Records of meals served and food storage and cooking temperatures were kept. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents knew how to make a complaint and expressed confidence that it would be dealt with appropriately. Not all staff were knowledgeable about protection of vulnerable adults which meant that residents were not safeguarded. EVIDENCE: The complaints procedure displayed in the home included all the required information. There had been two complaints since the last inspection and records showed that the manager had investigated and responded appropriately to both. Two residents said that they had made complaints to the manager in the past and she had sorted everything out. Other residents said they would approach her if they had any concerns. Comments made on the meal surveys showed that residents felt comfortable making complaints. Most staff had received training in adult protection and literature was available for reference. The home’s policy stated that any allegations would be dealt with in line with the local authority procedure, “No Secrets in Lancashire.” However, a senior member of staff was not aware of the need to report outside of the home. The use of an inappropriate lock on a bedroom door and the implication for fire safety was discussed with the registered manager and responsible individual. The lock was not being used and the inspectors were told it would be removed. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of residents lived in a clean, comfortable and homely environment and their bedrooms suited their needs and lifestyles. Some practices created risks to residents’ health and safety. EVIDENCE: Some maintenance and repairs highlighted following the last inspection had been carried out, but there were a number of areas that still needed attention. These were discussed with the manager. Some areas on Grane View were not comfortable and homely. The middle lounge was stark and uninviting. Some of the furniture was scuffed and broken. There were no pictures or ornaments and a waste paper bin had been put in the fire place as the focal point of the room. One of the corridors was in need of redecoration and some of the bedrooms along that corridor had wallpaper peeling off. Residents on Tor View made very positive comments about the communal rooms on that unit. One resident said, “there is lots of space, marvellous ceiling.” Another said, “we have beautiful views, the man who does the garden keeps it nice.” Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 16 Residents spoken with were happy with their rooms. A number of bedrooms on both units were personalised and one resident said she had brought all her own furniture. Bedside lamps had been placed in the rooms that had light switches outside the door so that residents could control the lighting themselves. However, two of the lamps were not working. A number of window restrictors had been disengaged or were broken. There were no strategies to minimise the risk to residents on the upper floor falling from a window or residents on the ground floor who may be vulnerable to intruders. Wheelchairs on Tor View were still stored on the corridor but this was not creating an obstruction. On Grane View the wheelchairs were stored in the shower room which meant that some residents could not have access to the toilet nearest their bedroom. Residents who were asked said they were happy with the laundry service. One said, “I like to wash some things myself but the laundry is ok.” The laundry was well equipped and organised. At the time of the visit the home was clean and free from offensive odours. One resident said, “it’s clean enough, no complaints, they do very well.” A high proportion of staff had received training in infection control procedures. They were seen to wear protective clothing when necessary and waste was handled appropriately. The practice of using non-disposable washcloths to assist with the personal hygiene needs of residents who were incontinent continued. The way night catheter bags were stored may also increase the risk of infections. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment practices provided safeguards for residents and there were sufficient staff on duty to meet the need of residents. However, shortfalls in staff training may mean that staff do not have sufficient knowledge and skills to understand and meet the needs of residents. EVIDENCE: The duty rosters showed which staff were on duty and at what times. There were Registered Nurses, carers and ancillary staff in sufficient numbers. Staff said they thought staffing levels were alright. Some residents and relatives said there were not enough staff to provide activities, although one resident said staff made time to go and see him in his room. Residents and relatives were very positive about their relationships with staff. Residents’ comments included, “a young woman gets me up, she’s very nice, very good,” “if they can do anything they will,” and “staff are alright, never any trouble get along quite well, can have a good laugh.” The improvement in recruitment practices, highlighted following the last inspection, had been maintained. All new staff had the required information and documents on their files. Pre-employment checks were conducted. However, one registered nurse, who started work before her full CRB disclosure was returned, was working without supervision. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 18 Two of the three new employees had records of initial induction. This included orientation to the home, fire and emergency procedures and discussion of key policies. There was no evidence that the third member of staff had received any of these. New staff were given a copy of the staff handbook and care staff were supplied with a copy of the General Social Care Council code of conduct. The manager had introduced a new induction training programme which met the standards of the national training organisation and included an assessment of competency. One of the new carers had started the training. A number of staff on Grane View were undertaking person centred dementia care training. A local college ran the course and staff said the content was appropriate and interesting. The manager plans to nominate the remainder of the staff in the near future. None of the staff had received information or training in cultural awareness issues, which were thought to be important for staff working on Grane View. From discussions with staff and examination of training records it was evident that training in safe working practice topics was not up to date for all staff. 66 of care staff held an NVQ level 2 or above. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was managed by a qualified and experienced manager who was keen to involve residents in the development of the home. Some shortfalls in health and safety practices placed residents at risk. EVIDENCE: The Manager of the home was a Registered Nurse with many years experience of caring for older people. Since the last inspection she had obtained external verification that the management qualification she holds is equivalent to the NVQ level 4 in management. She has undertaken training to keep her knowledge and skills up to date. The manager had a job description and was continually developing and refining her role. The manager received managerial support and supervision from the responsible individual. She received informal clinical support from a network of nursing colleagues. Staff were satisfied with Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 20 the management of the home. Residents were aware of the management structure and who to go to with concerns. There had been a significant improvement in quality monitoring systems. The manager was working on an action plan following an internal audit using the Registered Nursing Home Association Blue Charter Mark. However, a number of requirements and recommendations made following the last inspection were not met and have been carried forward. An extensive survey seeking residents’ views about meals had been carried out and action taken as a result. The manager and responsible individual were committed to the quality monitoring and were keen to identify other areas and involve residents. The manager still held fortnightly surgeries where residents or relatives could discuss any areas of concern or make suggestions for improvements. Staff meetings took place every month. There was no development plan at the time of the inspection but the manager said she had ideas of what to focus on. A previous recommendation to record residents’ fees had been actioned. The responsible individual was appointee for one resident. There were appropriate records of all transactions relating to this resident. No money was kept on behalf of other residents. As previously required records and receipts of money or other valuables handed over for temporary safekeeping were in place. Fire procedures were posted. Fire safety training was done at the same time as fire drills. These were carried out regularly and the responsible individual stated that the level of fire safety training was sufficient. However, one member of staff who may have to act as co-ordinator in the event of a fire was not clear about the evacuation procedure. Recommendations made during a recent fire department inspection had been actioned. Servicing and testing of the fire system, equipment and alarms was up to date. Despite requirements from previous inspections a fire door was wedged open at the time of the inspection visit. Maintenance and servicing of other installations and equipment was up to date with the exception of some portable electrical appliances. Denture cleaner was seen in a number of residents’ bedrooms but there was no evidence that this had been risk assessed and found to be safe. Risk assessments and data sheets for other potentially hazardous items were not up to date and did not match the products used. Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 21 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 Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 2 Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1 OP1 4&5 Information about the lack of 30/06/06 organised trips out for residents must be included in the statement of purpose and service user’s guide 2 OP7 15(1) All residents must have a care 31/08/06 plan detailing how their individual needs in respect of health and welfare are to be met. (Timescale of 31/07/05 not met) 3 OP7 15(1) Residents and/or their 31/08/06 representatives must be provided with opportunities for involvement in care planning. (Timescale of 31/07/05 not met) 4 OP7 15(2)(b-c) The residents plan must be 31/08/06 reviewed and updated as and when changes occur. (Timescale of 31/03/05 not met) 5 OP8 13(4)(c) Any unnecessary risks to the 31/08/06 health or safety of the residents must be identified and so far as possible eliminated. This would include nutrition and pressure sore risk (Timescale of 31/03/05 not met) 6 OP9 13(2) POLICIES: The registered 30/06/06 manager must ensure that the medication procedures in place enable all residents to receive their medication in an Turfcote Nursing Home DS0000022473.V287482.R01.S.doc Version 5.1 Page 24 7 OP9 13(2) appropriate and timely fashion. ADMINISTRATION: The registered manager must ensure that medication (including creams and dressings) prescribed for one resident is not given to any other residents. (Timescales of 16/06/05 and 03/02/06 not met) STORAGE: The registered manager must ensure that all medication is stored securely at all times. (Timescales of 28/02/05 and 03/02/06 not met) RECORDS: The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. There must be a full record of all medication currently prescribed for each resident. (Timescales of 28/02/05 and 03/02/06 not met) ADMINISTRATION: The registered person must ensure that nurses take and record the residents pulse prior to the administration of Digoxin. CONTROLLED DRUGS: The registered person must ensure that the receipt, administration and disposal of Controlled Drugs is recorded in a Controlled Drug register. A designated, trained member of staff must witness the administration of Controlled Drugs. The registered person must ensure that residents’ privacy and dignity are respected. Following consultation with residents the programme of activities must be revised. There must be sufficient, appropriate activities to meet the needs of DS0000022473.V287482.R01.S.doc 30/06/06 8 OP9 13(2) 30/06/06 9 OP9 13(2) 30/06/06 10 OP9 13(2) 30/06/06 11 OP9 13(2) 30/06/06 12 13 OP10 OP12 12(4)(a) 16(2) (m-n) 30/06/06 30/09/06 Turfcote Nursing Home Version 5.1 Page 25 14 OP14 15 OP18 16 OP19 17 OP19 18 19 OP30 OP38 20 OP38 21 OP38 22 OP38 residents on both units. (Timescale of 31/03/06 not met) 12(2)(3) Care plans must contain details of residents’ likes, dislikes and preferences about their daily life and routines. 13(6) All staff must receive training in 18 (1) the protection of vulnerable adults. The training for senior staff must include procedures for reporting outside the home. 23(2)(bd) Following an audit of all rooms, the registered person must draw up a schedule for repairs redecoration and renewal of furnishings. The schedule should include timescales for action and must be made available to the Commission 13(4) The registered person must conduct risk assessments with regard to window restrictors. Functioning restrictors must be left on windows where a risk is identified. 18(1) Staff training in safe working practice topics must be brought up to date. 13(4) Risk assessments and management strategies must be developed to cover any potential hazards in respect of: the environment, working practices and hazardous substances. (Timescale of 31/03/06 not met) 23(4)(c) All fire doors must be closed at all times unless held open by a device acceptable to the fire authority. (Timescale of 28/02/05 not met) 13(4) The registered person must ensure that potentially hazardous items are stored safely. 23(4)(d,e) All staff must receive appropriate training in fire prevention and must be aware of the procedure to be followed in case of fire. DS0000022473.V287482.R01.S.doc 31/08/06 30/06/06 31/07/06 30/06/06 30/09/06 31/08/06 19/05/06 31/05/06 30/06/06 Turfcote Nursing Home Version 5.1 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 OP7 Care plan reviews should provide some indication of the resident’s progress towards meeting their goals 2 OP7 Core care plans should be supplemented with information specific to the individual resident. 3 OP9 You should review medication policies and procedures in line with Royal Pharmaceutical Society of Great Britain guidelines to cover all aspects of medicines management. 4 OP9 Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber. A second member of staff should witness all hand written annotations on Medication Administration Record charts. 5 OP9 Medicines should be stored at the appropriate temperature. A record of temperature should be maintained for all areas where medicines are kept (fridge should be monitored daily) The opening date should be recorded on eye drops and other items with a short shelf-life Medication no longer in use should be disposed of and recorded appropriately. There should be a formal system for prompting medication reviews in line with National Service Framework for Older People The storage of wheelchairs should not create an obstruction for residents Alternative lighting should be provided for those residents who do not have the main light switch in their rooms. All staff, including ancillary staff, should have initial induction training. The programme to provide staff with training in dementia care should continue. Staff should have access to information to improve their awareness of cultural issues. DS0000022473.V287482.R01.S.doc Version 5.1 Page 27 6 7 8 9 10 OP9 OP19 OP24 OP30 OP30 Turfcote Nursing Home Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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