Inspection on 19/12/07 for Uplands Nursing Home

This inspection was carried out on 19th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Uplands Nursing Home 43 Upland Road Selly Park Birmingham B29 7JS Lead Inspector Lisa Evitts Unannounced Inspection 19 & 20th December 2007 09:35 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 DS0000070137.V350363.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. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uplands Nursing Home Address 43 Upland Road Selly Park Birmingham B29 7JS 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) 0121 471 3816 0121 415 5519 uplands43@tiscali.co.uk None Mr Jayantilal James Bhikhabhal Patel Mrs Norrian Jane Pritchard Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (27) of places Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category (OP 27). - Dementia, over the age of 65 (DE (E) 27) The maximum number of service users to be accommodated is 27. 2. Date of last inspection New Service Brief Description of the Service: Uplands Nursing home is a three storey traditional detached residence that offers to provide care and accommodation for 27 people who may also have Dementia. The home is situated approximately three miles from Birmingham City Centre and there is easy access to shops and public transport. The home is well established however new providers took over the home in August 2007 and this is the first visit to the home since the change of ownership. Accommodation is provided on the first and second floor and the third floor is used for administration purposes. The home has a mixture of single and shared rooms, there are 6 double rooms and six single rooms have en-suite facilities. There are also communal bathing facilities at the home. There are two lounges and a dining room and ancillary services are situated in the basement area of the home. Corridors are spacious and have handrails to enable people to move freely around the home with any mobility aids they may require. The home has a passenger lift enabling people to access all areas of the home and the building is accessible to people who may need to use a wheelchair. There is adequate parking to the front and side of the building and the home has a wellmaintained garden to the rear of the property. In the reception area there are articles, which may be of interest to people. A copy of the last inspection report is available for people to read if they choose to. The current scale of charges for the home are not included in the service user guide but can be obtained directly from the home. Additional charges include a “top up fee”, hairdressing, chiropody, and dry cleaning. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home, over one and a half days and the Registered Manager assisted us throughout. The home did not know that we were visiting on that day. There were 24 people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Three people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out in order to gain peoples views about the service. Four people who live at the home, one healthcare professional and four relatives returned questionnaires. These contained positive comments about the service provided and are included within this report. Two people who live at the home, two staff and two relatives were spoken to. It was not possible to gain feedback from a number of people living at the home due to their Dementia. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. No immediate requirements were made at the time of this visit. What the service does well: People are provided with current information about the service offered to enable them to make an informed decision about whether they would like to live at the home. People can visit the home to sample what it would be like to live there. People have access to a range of Health and Social Care professionals and this ensures that health care needs are met. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 6 The management of medication ensures that people receive their medication as prescribed. External people visit the home to provide activities and people are encouraged to go out of the home, as they are able. There is an open visiting policy and people are made welcome in the home. The home rarely receives any complaints and people told us that concerns were addressed. People receive a choice of a wholesome and nutritious diet, which meets any dietary, cultural needs or preferences. People are provided with a homely and comfortable environment in which to live where privacy is maintained. There is a pleasant atmosphere. People told us: “The home is outstanding” “I am very happy at Uplands” “As a spouse I am made to feel part of the caring package” “I’m invited to eat here and the food is very palatable”. “We had new menus this week and today lunch was excellent” “Staff always listen to us and act promptly when able to do so” “The home provides a friendly, safe and comfortable environment” “I like the atmosphere” “Staff are very friendly” “Staff come in frequently to check we are ok” “The manager does that extra little bit for patients” “I am content to leave my wife in the care of a dedicated matron and her staff” What has improved since the last inspection? What they could do better: Some care plans require further development so that they provide staff with specific details about how people should be assisted to have their needs met. This will ensure that people’s needs are met in a way that they prefer. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 7 Records of individual activities should be developed so that people have opportunity to participate in activities that they enjoy. The bathing facilities in the home must be reviewed as part of the refurbishment programme to ensure adequate facilities are offered to enable people the choice of a bath or shower. The recruitment process must be reviewed to ensure that all the appropriate checks are in place prior to people commencing employment, in order to safeguard the people who live there. The Registered manager must ensure that all staff receive training and fire drills to ensure they have the knowledge and skills to meet people’s needs. A review of the manager’s role should be undertaken to ensure that there is time for her to conduct the management of the home. This will ensure that the home is run in the best interests of the people who live there. 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. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 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 Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre admission assessments ensure that people know their needs can be met prior to moving in. EVIDENCE: The home has a comprehensive statement of purpose and service user guide, which have both been updated in July 2007 to ensure they provide current information about the home and the services provided. The service user guide does not include details of fee rates and it is recommended that this information is included so that people have all the information about the home. In addition to this the home has a brochure and each room has a “Welcome booklet” which provides basic information about the home. These documents are not currently available in alternative formats but the manager has Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 10 identified this as an area to improve on in the Annual Quality Assurance Assessment. Only one page of the certificate of registration is displayed and this was brought to the attention of the manager, as both pages should be displayed so that people can see conditions of registration. A copy of the previous inspection report is displayed so that people have access to this information. Comprehensive pre admission assessments are undertaken prior to people coming to live at the home. There was evidence on one file of the Manager ensuring that appropriate equipment was in place prior to accepting one person into the home. This should ensure that individual needs can be met when moving into the home. People or their relatives are able to visit the home before admission so that they can sample what it would be like to live there. People told us: “Its nice here” “A very caring home” “The home is outstanding” “I am very happy at Uplands” Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 11 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans require further development so that staff have specific details to assist people to meet their needs. The management of medication ensures that people receive their medication as prescribed. EVIDENCE: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. Three care files were reviewed. Care plans were found to reflect the current care needs of the people who live at the home and had been updated as changes occurred. The plans were core care plans but they had been personalised for the individual person. Some care plans required more details for example, one plan for diabetes stated to monitor the blood glucose but did not say how often or when. There were no details of signs and symptoms of high or low blood sugar for staff to follow. There was good detail of the person needing snacks prior to going to bed and Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 12 when first waking in order to prevent a low blood sugar. There was evidence that actions are taken on the advice from external healthcare professionals and this means that people receive appropriate care. Other plans provided details such as “uses blue pads during the day”, “likes one blanket and two pillows”, “Can manage to wash face”. Personal hygiene care plans required improving as did not give details of personal likes and dislikes. There was no preference of bath or shower and when people liked to have this. The manager confirmed that people were given a day to be assisted with this but they could be assisted at a different time if they chose not to have a bath or shower when assisted. People were only able to use the bathing facilities on the ground floor. This must be addressed to provide people with a choice of how and when they chose to have their hygiene needs met. Moving and handling assessments were detailed with the type of equipment to be used. Monthly skin sore assessments were completed and details of specialist mattresses were recorded for people who were at risk from sore skin. On the day of the visit there was no one in the home who had any skin sores. One person who spent most of their time in bed was to have two hourly turns to prevent skin soreness but there were no charts in place for these to be recorded, to show that they had been done and this is required. Daily records were detailed with changes in condition, visitors and how the person had spent their day. There was evidence of family involvement in the care planning process and care plans were evaluated each month. There was evidence of people receiving visits from external healthcare professionals including General Practitioners, chiropodist, psychiatrists, hairdresser and dentist. People appeared to be well supported by staff to choose clothing appropriate for the time of year, which reflected individual cultural, gender and personal preferences. Many of the females had their fingernails polished with nail varnish. People told us: “As a spouse I am made to feel part of the caring package” “Most of the time we have full support and care” “Staff are vigilant to his extensive needs” The management of medication was reviewed and was well managed. Copies of prescriptions are checked so that staff can check the correct drug is brought into the home. Medication is signed into the home upon receipt. Eye drops and insulin were dated when opened so that they are discarded at the appropriate times therefore reducing the risk of cross contamination. The medication fridge was not always at the appropriate temperature and it is recommended that this is closely monitored to ensure that medication is stored within its product licence. The home did not have any Controlled Drugs at the time of the visit. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 13 One care plan had a hospital wristband enclosed, which suggested that the person was allergic to paracetamol, however no allergies were recorded. It was recommended that this was checked with the GP and the records updated to ensure that the drug was not administered in error. One person was having their medication disguised in food. A consent form had been signed by the relative, however this should be a decision that includes the GP and pharmacist and as a last resort if alternative medications cannot be prescribed. It is recommended that this is discussed with the relevant healthcare professionals. There is a payphone situated in the reception area and people can have incoming calls on the homes telephone. People can have their own telephone lines installed in their bedrooms at an additional cost. Staff were observed to knock on bedroom doors prior to entering and this promotes peoples privacy and dignity. There was a lack of privacy in shared rooms as there are no dividing curtains and this is discussed further in the environment section of the report. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to choose some activities that they participate in which promotes their individuality and independence. People are offered a choice of meals to meet their dietary, cultural needs or preferences. EVIDENCE: There is no dedicated activities coordinator at the home and staff assist in the organisation of activities. Activities offered include singalongs, gardening and film shows. External entertainers provide activities and these include progressive mobility, an organ player and a craft person who visit once a fortnight. Two people at the home have newspapers delivered so that they can keep up to date with current affairs, which are of interest to them. The library visit and change peoples books so that they can continue to read. A hairdresser visits once a week, a monthly church service is held and Holy Communion is given each week for those people who wish to participate. Due to the Christmas season, a local church had been to the home to sing Christmas Carols and had also sang to people who had had to remain in their Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 15 rooms. A pantomime was arranged for the second day of the visit. Minutes of a resident meeting in November showed that people were asked what activities they would like over Christmas, and this enables them to voice their opinions. Two people at the home have been on holiday with family and people are supported to go out of the home to local shops and the pub and this encourages people to maintain links with the community. There is an activity assessment in place, which asks people about likes and dislikes. In addition to this there is a record of activities offered to the home, however this is not specific to individual needs and does not clearly show that people have been involved in activities of their choice. It is recommended that this is reviewed. There is an open visiting policy so that people can see their visitors as they choose and people confirmed that they were able to visit as they chose and that they were made welcome in the home. Visitors can have a meal with their relatives and one relative said, “I’m invited to eat here and the food is very palatable”. The home has a four weekly rolling menu. A hot meal is offered at lunchtime. The lunch menu does not provide a choice but there are various choices for the evening meal. The dining area is spacious and tables were nicely presented. Some people had chosen to have their meals in their rooms and staff were observed to assist people who required help, whilst promoting their dignity. The home can cater for dietary, religious needs and individual preferences. People told us: “We had new menus this week and today lunch was excellent” “I requested Toad in the Hole which I now have on a regular basis” “The food is much better, absolutely different” Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and is accessible to people should they need to make a complaint. The home has some policies and procedures and some staff have had training, which should safeguard people from harm. EVIDENCE: The complaints procedure is included in the statement of purpose, service user guide and the welcome booklet so that people know how to make a complaint if they need to. The home has recorded one complaint since the new providers took over the home. There were good details recorded of actions taken to resolve the complaint and the outcome. We have not received any complaints about the home. There is a “niggles book” in the reception area of the home where people can write any concerns in before they escalate into a complaint. The manager reviews this and writes in what action she has taken. There is also a suggestions box so that people can raise any ideas or suggestions for improvement. One person told us “Staff always listen to us and act promptly when able to do so”. This suggests that people are confident that they can raise concerns and that they will be dealt with appropriately. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 17 The home has an adult protection policy but this requires some amendments to ensure that staff are aware that Social Care and Health take the lead role and that the home only investigates when advised to do so. The policy referred to local Multi Agency Guidelines however the home did not have copies of these relevant authority guidelines for staff to refer to. The administrator requested these documents from the relevant offices on the day of the visit. There have been no incidents of adult protection nature at the home and staff spoken to were aware of the action to take in the event of an allegation of abuse. Some staff have recently had training in adult protection and the manager should ensure that all members of staff receive this training so that they have guidelines to follow and up to date knowledge in order to protect people from harm. The recruitment procedure followed by the home does not ensure that people are safeguarded from harm. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a homely, clean and comfortable environment in which to live where their privacy is maintained. Bathing facilities may not meet the individual needs of people living at the home. EVIDENCE: Access to the home is via a doorbell, which staff have to answer and this ensures that people know who is accessing the building to ensure that people are safe. A partial tour of the home was completed to review areas which were relevant to the people we case tracked. The home was pleasantly decorated for the Christmas period and there was a calm and friendly atmosphere. The home was of comfortable temperature, clean and odour free. Since the new providers have taken over the home, there have been many changes to the environment and equipment within the home. There is a refurbishment programme in place and each month two bedrooms are being Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 19 redecorated and new carpets fitted. New curtains have been ordered and two mattresses are being replaced each month. New chairs are planned for the New Year. There is a designated smoking area outside of the home should people choose to smoke, and a pleasant garden area for use in the climate weather. The home has only one bath and one shower room which people are able to use, on the ground floor. Other bathrooms and shower rooms are out of use and are not suitable to meet the assessed needs of the people living at the home due to the size of the room or the equipment. The manager informed us that this was part of the refurbishment plan and would be addressed. This will be reviewed at the next visit to the home, as there are currently not enough facilities to meet the assessed needs of people at the home. The home has two hoists to assist people who have mobility problems and have specialist mattresses for people who are at risk from sore skin. The provider has purchased four profiling beds, which enable people who are nursed in bed to alter their position. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. It was noted that the shared rooms did not have dividing curtains to promote peoples dignity. The home has one portable screen but has six shared rooms and it is recommended that this is addressed. Bedrooms have a lockable facility but bedroom doors do not have door locks and it is recommended that this is reviewed in order to promote peoples privacy while enabling them to choose to lock their room if they are able. Each room has a nurse call bell so that people can summon help, as they require. The laundry and kitchen are located in the basement of the home and are adequately equipped to meet the needs of people living at the home. People told us: “Things have greatly improved” “The new owner has done so much since he took control” “The home provides a friendly, safe and comfortable environment” “I like the atmosphere” Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are supported by staff who receive some training to ensure that they have the knowledge to meet individual needs. The recruitment procedure does not ensure that people are safeguarded from harm. EVIDENCE: There are two trained nurses and five care staff on duty throughout the morning, one trained nurse and four care staff during the afternoon/evening and one trained nurse and two care staff on duty throughout the night. The home currently does not have any staff vacancies and does not use any agency staff. This means that people know who will be assisting them to meet their needs. In addition to the nursing and care staff the home also employs, domestic, kitchen, laundry, maintenance and administrative staff. 33 of the staff have achieved a National Vocational Qualification (NVQ) Level 2 in care. It is recommended that at least 50 of staff have this qualification and a number of staff were enrolled onto courses to complete this training. This should ensure that staff have the knowledge and skills to meet the needs of people living at the home both individually and collectively. People told us: “Staff are very friendly” “Staff come in frequently to check we are ok” Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 21 “The staff work as a team and are much happier now” Three staff files were reviewed and it was of concern that some of the information required was not present or had not been acted upon. Reasons for leaving last employment had not been documented although the manager was able to say why people had left. This information should be recorded. One member of staff had started employment at the home without a Criminal Records Bureau Check (CRB) and there were no references on file. The CRB had been returned and a caution was recorded but no risk assessment was in place to ensure the safety of people living at the home. The manager was unaware of the caution. The person had not declared this on the application form. There was no identity photograph. A third file reviewed did not have a work permit for the home and the manager was to check this with the home office to ensure that the person was able to work there. The manager has advised us that a new permit has been applied for and the member of staff is not working at present. It is required that the manager reviews the recruitment process to ensure the safety of people living at the home. It is recommended that all staff files are audited to ensure that they have the correct information in order to protect people living at the home. There was evidence that some staff had received recent training in fire, manual handling, health and safety, dementia awareness and abuse. There was no training matrix available and this is recommended for ease of checking training requirements and to enable the manager to plan future training. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally run in the best interests of the people who live there. There is a need for clarification of the manager role to ensure the best possible outcomes for the home and the people who live there. EVIDENCE: The Registered Manager has numerous years’ experience of working at the home and was previously the senior nurse of the home until becoming the manager. She is a Registered Nurse and is working towards the Registered Managers Award. This will assist her in the effective management of the home and in leading a team who are working towards meeting people’s best interests. The manager is very keen to learn and was receptive to suggestions made throughout the inspection. The manager also works as the nurse during Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 23 the morning and attends to managerial work during the afternoon. While it is good practice to have some “hands on” with people at the home and staff, it is recommended that the manager review her role. She has a clear vision of how to move the home forward but does not have enough time to undertake the manager’s role fully. This was partly reflected in the poor recruitment of staff. The new providers are supportive and visit the home each week. They are available to contact at anytime. There was only one Regulation 26 visit report available and these must be completed monthly and be available as they form part of the quality assurance programme. People were very positive about the management of the home and told us: “Things have improved out of all recognition” “The manager does that extra little bit for patients” “I am content to leave my wife in the care of a dedicated matron and her staff” “The new owner has done so much since he took control” Staff and residents meetings are held and minutes of these meetings were seen. These meetings provide people with an opportunity to discuss and share ideas for improvement. Satisfaction questionnaires are sent out to residents, staff and professionals twice yearly to gain peoples views about the service provided. The manager has implemented a number of audits. The manager is aware that this information needs to be written in an annual report regarding the quality of the service, including an action plan with timescales. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. The home does not hold monies on behalf of people who live there and people are invoiced for items such as chiropody, newspapers and hairdressing. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Work was being undertaken for the five yearly wiring checks and verbal confirmation was sought on the day of the visit regarding the Gas safety certificate. Water temperature checks are recorded fortnightly, however one room had temperatures of 46 degrees with no evidence of action being taken and this was brought to the attention of the manager as may result in people accidentally scalding themselves. Maintenance checks are completed on the fire system and equipment and staff receive fire training. It was not clear that all staff had been involved in a fire drill and this must be undertaken at least twice a year so that people should be safe in the event of a fire occurring. Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 24 Accident records were completed and are audited every six months. The manager was working on a new audit tool, which would be completed more often and would enable easier monitoring of trends. We are informed of accidents and incidents as per Regulation 37. Uplands Nursing Home DS0000070137.V350363.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 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 3 X 2 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 2 Uplands Nursing Home DS0000070137.V350363.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. 2. 3. Standard OP7 OP7 Regulation 15 12 (1) 17 (1) 13 (6) Requirement Care plans must detail personal needs and preferences so staff have guidelines to follow. Changes of position must be recorded so that skin can be monitored. The adult protection policy requires updating and all staff should receive training in the adult protection procedure so that they have the knowledge and skills to safeguard people from harm. The recruitment process requires review to ensure that people are safe from harm. Regulation 26 visit reports must be completed each month and be available to reflect the quality of service provided. All staff must receive a twiceyearly fire drill to ensure that people are safe in the event of a fire. Timescale for action 29/02/08 31/01/08 14/02/08 OP18 4. 5. OP29 OP33 19 Sch 2 26 25/01/08 31/01/08 6. OP38 13 (4) (c) 22/02/08 Uplands Nursing Home DS0000070137.V350363.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. 2. 3. 4. 5. Refer to Standard OP1 OP7 OP9 OP9 OP9 Good Practice Recommendations Fee rates should be included in the service user guide so that people know what charges they are expected to pay. People should be asked about bathing preferences and given a choice so that they make decisions about their care. Fridge temperature should be between 2 – 8 degrees so that medication is stored within its product license. Any allergies to medication should be confirmed with the general practitioner to ensure staff have the correct information. Medication administration should include input from all healthcare professionals to ensure that people receive their medication in the most suitable way to meet their needs. Activities should be offered to meet all peoples needs and records should be available to show what activities people have participated in. Bathing facilities should be reviewed to ensure they meet the needs of the people living at the home. Door locks should be provided on bedroom doors so that people can choose to lock their room. Dividing curtains/screens should be provided so that privacy is maintained for people at the home. 50 of staff should have achieved National Vocational Qualification in care to provide the knowledge and skills to meet the needs of people living at the home. All staff files should be audited to ensure that the correct information is available to protect people from harm. A matrix should be devised to enable monitoring of training so that staff receive updates in order to provide them with up to date knowledge. A review of the manager’s role should be undertaken to ensure that the home is run in the best interests of people who live there. 6. 7. 8. 9. 10. 11. 12. 13. OP12 OP21 OP24 OP24 OP28 OP29 OP30 OP31 Uplands Nursing Home DS0000070137.V350363.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Regional Office 77 Paradise Circus Queensway Birmingham West Midlands B1 2DT 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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