Inspection on 14/01/06 for Uplands Nursing Home

This inspection was carried out on 14th January 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

Uplands Nursing Home 30/06/09

Uplands Nursing Home 07/01/09

Uplands Nursing Home 02/04/08

Uplands Nursing Home 16/04/07

Uplands Nursing Home 09/10/06

Uplands Nursing Home 20/06/05

Uplands Nursing Home 13/01/05

Uplands Nursing Home 27/07/04

Uplands Nursing Home 11/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Uplands Nursing Home Church Road Maisemore Gloucester Glos GL2 8HB Lead Inspector Mrs Janice Patrick Unannounced Inspection 11:00 14 January 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 Uplands Nursing Home DS0000016643.V269852.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. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Uplands Nursing Home Address Church Road Maisemore Gloucester Glos GL2 8HB 01452 505629 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) Mr Graham James Rigby Mr Michael Welch Care Home 50 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (35) of places Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate four (4) named service users who are under the age of 65 years. When each service user reaches the age of 65 years of age, or leaves the home, the condition of registration will revert to the original category. 20/06/05 Date of last inspection Brief Description of the Service: The Care Home is an extended House within the village of Maisemore, near to the river Severn. It sits back directly off the main road and has car parking to the front and side. There is a small-enclosed garden within the centre of the building and gardens to the front. A number of care needs are catered for, these include personal and nursing care, care of those with dementia and 3 places are designated to the care of those under 65years of age. The Home experiences a fairly consistent turn over of staff, but a committed group remain loyal to the Home and to the care of the residents. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector between the hours of 11.10am and 4.15pm on a Sunday. The Registered Manager was on duty, as was his Deputy. Several residents and three relatives were spoken with to establish their views of the Home. The Inspector spoke with two relatives who’s loved one was extremely poorly and who later passed away during this inspection. The Inspector observed lunch being served within the dementia care unit and particularly watched how this group of residents are able to make choices of their own. A tour of the building was carried out. Staff training and the general management of the Home discussed. The medication system was inspected and medication administration observed. What the service does well: What has improved since the last inspection? Further improvements to the Home’s environment have been made with further evidence of a rolling programme of decoration and improvements. In the period of time between the last inspection and this inspection, steps have been taken to help protect residents from poor practice and abuse. Communication and organisation of particular areas of responsibility between the Provider and Registered Manager have been reflected on and improved. The staffing numbers in the dementia care unit and at night have improved. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 6 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. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 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 the following standard(s): No standards were inspected within this group. N/A EVIDENCE: N/A Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 9 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): 9 The systems for administration of medication are good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. The Home is not able to ensure residents’ privacy and dignity at all times. EVIDENCE: The storage, delivery and disposing of medication procedures met with good practice. A licensed company is now required to remove excess stock at the end of each month, this had been organised and was in place. Medical Alerts are received by the Home and cascaded to down to all staff. Guidance leaflets on all medication are retained for staff or resident/relative information. The Manager and his Deputy regularly audit the system and the records of medication administration and these were correctly completed at the time of this inspection. The Pharmacist from the Primary Care Trust (PCT) has reviewed 21 residents’ medications as part of the PCT’s review on GP prescribing. She is due to return to the Home to complete this piece of work. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 10 The supplying chemist also audits the system every other month. All controlled medication was correctly stored and recorded. The Inspector spoke with staff and the relative of one service user about the problems they were having of locating an adequate stock of a controlled medication, used for pain control, over the weekend, after the dose had been increased. This involved a member of staff visiting four chemists on the Saturday and the relative visiting Gloucester, Cheltenham, Ledbury and Tewkesbury in order to locate sufficient stock for the Sunday. At a difficult time for all, this was far from ideal and has been referred to the CSCI Pharmacist in order for him to discuss with the Primary Health Care Trust. The Inspector saw a tablet crusher within the medication trolley and this prompted a conversation about covert medication practice. The Manager was sure that this was not occurring but will reiterate with his staff group that this is not acceptable practice. He wondered if some paracetamol tablets were being crushed in order to make it easier for residents to swallow. If this is the case then Paracetamol Elixir should be prescribed. One member of staff changed a syringe driver that was in use and on loan from the local GP Surgery. It was identified that all trained staff should be updated in the use of this piece of equipment. Two minor shortfalls were noted: a new British National Formulary (BNF) is recommended as the one in use was dated 2004 and all hand written instructions on MAR Sheets must have two signatures. A requirement made in the previous report, under standard 10 of the National Minimum Standards, has still not been met. This is to ensure locks are placed on toilet doors to provide privacy and dignity to the user. This must be met to avoid further action by the CSCI. If this is considered to be too much of a risk within the dementia care unit, then a specific risk assessment must demonstrate why and how the residents’ privacy and dignity will be preserved in the absence of a lock. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 11 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): 14 & 15 The staff culture predominantly encourages residents to make choices on a daily basis, although for those residents very dependant on the staff, individual preferences need to be met when it comes to being given opportunities to socialise and go out of the Home. The meals in the Home are good offering choice and variety for residents. EVIDENCE: By observing and talking with several residents it was clear that many are able to choose how they spend their time and are given opportunities to make their own decisions throughout the day. This also related to what they ate. Talking to two residents however, who were physically very dependant, although they agreed that they were making some decisions in their lives, they acknowledged that they were very dependant on the staff and the Home’s routine when it came to choices such as being able to go into Gloucester to look around the shops, go to church or just generally out and they felt that these activities were now not really available to them. Other residents do have structured social lives which include various clubs and day centres, but these residents are physically more able and as part of their Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 12 placement at the Home inherited a social life that had been organised and negotiated with them. Observing the interaction of staff and behaviour of residents within the dementia care unit, residents were free to wander, or in one case remain in bed. As this has been very isolating for this individual, staff were seen to be encouraging her into the lounge for lunch, but at no time was she forced or intimidated to do something she did not want to do. Many residents in this unit ate with their fingers despite having cutlery available; one resident was gently reminded of this but reverted to using her fingers. The attitude of the staff was relaxed and they considered it more of a priority for the resident to eat. One resident was fed by a member of staff who sat beside her and who carried this task out quietly and with patience. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Arrangements within the Home for protecting residents from harm or abuse and are good and used where appropriate. EVIDENCE: The Homes Adult Protection Policy and Procedures have been used twice since the last inspection where members of staff have not treated residents in a manner that is acceptable to the resident or the management. The Registered Manager and Provider took this action when it came to their attention that staff were not adhering to the Home’s procedures or requirements. A recent night staff meeting reiterated the practice expected from staff and the Manager continues to monitor some staff where their attitude may not be particularly healthy towards the residents. Residents commented that the majority of staff are very kind and very caring. They also commented that there has been and still is a minority that are not so kind and one resident in particular, commented that some staff can be rough. The Manager is aware of this and is investigating further. He explained that he has a zero tolerance of any abusive behaviour towards residents and will use the Policies and Procedures where required to protect vulnerable residents. One relative spoke to the Inspector about how she had complained about the way her father had been spoken to by a member of staff. She confirmed that the Manager dealt with this straight away. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 14 Residents confirmed that they feel able to approach the Manager and those spoken to were able to say ‘he sorts things out’, ‘he doesn’t accept any messing from the staff’. Uplands Nursing Home DS0000016643.V269852.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 Improvements continue to the decoration and maintenance of the Home in order to provide a pleasant environment for residents to live in. EVIDENCE: The Inspector was shown the work carried out so far in one of the ground floor bathrooms. This is being totally refurbished and refitted. Plans to improve a further ground floor bathroom have been discussed. The older part of the Home has had the corridors decorated. This has made a naturally dark area feel lighter. All external windows have been painted and this was exceptionally noticeable in the original lounge/dining area. The windows had also been cleaned and the room de-cluttered. If this room could be decorated as well, it would be a very attractive room for residents to sit in and watch life outside go by. Several bedrooms in the older house are still very tired, but there is a more organised rolling programme of works in place, which will see these improved in the future. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 16 Some requirements made in the previous inspection report have not been met and are reflected within the requirements section within this report. Uplands Nursing Home DS0000016643.V269852.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): 28 Although staff are receiving training, there are not enough staff in the Home receiving underpinned training at NVQ level to meet the National Minimum Standards and to help improve the level of knowledgeable care being delivered to residents. EVIDENCE: The Manager explained that since the last inspection there has been a fair amount of staff movement for various reasons and some of those staff held the NVQ Award. One senior carer at present is undertaking NVQ Level 3 and the Manager is aware it is an area that needs improvement and planning for the future. The recruitment practices of the Home were due to be inspected as part of this inspection, but could not be addressed during this visit as the main offices were locked. Evidence to demonstrate good practice will be requested in an additional visit to the Home. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 18 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 The Manager is supported well by his senior staff in providing clear leadership throughout the Home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The Registered Manager has managed the Home for two years. He is a Registered Mental Nurse (RMN) and has several years of NHS Management experience in his career. He is well complimented and supported by his Deputy Manager who is a Registered General Nurse (RGN) who has many years of experience in Community Nursing. Both have clear responsibilities and know where their strengths lie. Both were heard to be directing staff in a constructive manner. Relatives spoken with clearly thought highly of both these staff members. One relative had been particularly impressed when he overheard the Manager talking to a member of staff saying that a pair of tights must be found for a Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 19 resident because he felt it was cold that day. This relative said ‘he finds time to bother about the little things that can make a difference’. The relative confirmed that this was not the first time he had heard similar things. The financial viability of the Home and how residents’ monies are looked after are due to be looked at in this inspection. Neither of these were possible to address during this visit. Evidence of the Home’s financial viability will be requested outside of this report and residents’ monies will be inspected in an additional visit. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 X 28 1 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The Registered Manager must ensure that all hand written instructions on the MAR Sheets are accompanied by two signatures. The Registered Manager and Provider must fit appropriate locks to all toilets or demonstrate within a risk assessment, that this is considered detrimental to the residents’ safety and demonstrate how their privacy is to be maintained. (Timescale of the 25/2/05 & 31/8/05 not met). The Registered Manager and Provider must provide ample opportunity for those residents who are physically more dependant to go out or to church if they wish to. The Registered Manager and or Provider must provide the keys to the lockable top drawers within bedrooms where residents wish to keep money or valuables. The Registered Provider must provide a new floor covering in DS0000016643.V269852.R01.S.doc Timescale for action 28/02/06 2 OP10 12(4)(a) 28/02/06 3 OP12 16(2)(n) 31/03/06 4 OP19 16(2)(l) 28/02/06 5 OP19 23(2)(b) 28/02/06 Uplands Nursing Home Version 5.1 Page 22 6 OP28 18(1)(c) (i) bedroom four. (Timescale of 30/9/05 not met) The Registered Manager must demonstrate how he plans to work towards meeting the National Minimum Standard of 50 of the workforce holding NVQ Level 2 or equivalent. 28/02/06 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 Refer to Standard OP9 OP12 Good Practice Recommendations An up to date BNF should be provided. That the Provider should provide the Home with its own Mini-Bus or equivalent transport to meet the needs of all residents and employ a full time activities co-ordinator. Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Uplands Nursing Home DS0000016643.V269852.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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