Inspection on 02/04/08 for Uplands Nursing Home

This inspection was carried out on 2nd April 2008.

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

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 16/04/07

Uplands Nursing Home 09/10/06

Uplands Nursing Home 14/01/06

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 Ruth Wilcox Unannounced Inspection 2nd April 2008 08:45 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.V359810.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 DS0000016643.V359810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uplands Nursing Home Address Church Road Maisemore Gloucester Glos GL2 8HB 01452 505629 01452 307399 uplandsnursinghome@lineone.net 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 To be appointed Care Home 54 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (16) of places Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate three (3) service users under the age of 65 years but a minimum of 55 years in either category OP or DE(E) To accommodate an additional named service user under 55 years. When this service user reaches the age of 55 years or leaves the home, the condition will revert to the original category with the above condition. 3rd October 2007 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 side. There is a small-enclosed garden within the centre of the building and gardens to the front. A church and public house are nearby. The home is also on a main bus route from Gloucester City. A number of care needs for older people are catered for in this home; these include general personal and nursing care, and care of those with dementia within a designated unit. The current fees at Uplands at the time of writing this report range from the lowest Local Authority funded rate of £357.90, to the higher nursing rate funded by Continuing Health Care of £700.00. Payments for extra items such as toiletries, newspapers and chiropody can be arranged on an individual basis if wanted, with different payment options available. Information about the home is available in the Service User Guide, which is issued to all prospective residents. The home does not display its previous CSCI inspection report, although does display a notice confirming it is available, and inviting people to request a copy to read if they wish. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Two inspectors carried out this inspection on one full day in April 2008. Care records and the management of residents’ medications were inspected, with the care of six residents being closely looked at in particular. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Uplands. The deputy manager and Care Services Manager were present, each being helpful and cooperative throughout, with other staff also interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished; very few responses were actually received, with 3 residents, 3 relatives and 1 healthcare professional returning their comments about the home to CSCI; some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. CSCI issued an Annual Quality Assurance Assessment (AQAA) for the home to complete, as was required, but the Proprietor stated it had never been received, and therefore an AQAA did not inform any part of this inspection. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 6 What the service does well: Uplands provides care to residents with varying needs, and the environment has been extended and adapted to accommodate these. The home was clean and odour free throughout this inspection. Residents are admitted here on the basis of a pre-admission assessment in order that the home can be sure they will be able to meet their needs prior to them coming into the home. Visitors are welcomed into the life of the home, and in the main were generally positive about the way in which they viewed the home and the care their relative received. Residents themselves, where practicable, also confirmed their general satisfaction with the way in which they were cared for here. We found evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of residents receiving a satisfactory standard of care and support. The home generally had a calm and organised atmosphere throughout this inspection, and some positive relationships were witnessed between residents and staff. In the main staff strive to maintain residents’ privacy and dignity, however there were instances where this could be compromised, especially when the hairdresser visits and at meal times. Residents are free to make choices here, but there were many particularly vulnerable people for whom this might not be so easy, and in many cases staff seemed to be mindful of this. Social opportunities were made available to residents, but social activity records were only superficially maintained and did not provide a great deal of evidence. Some staff in particular, though not all, appeared mindful of the need for social interaction with residents alongside the care they were providing. The competence of the staff group is developed through a structured induction-training programme, and through ongoing training in topics relevant to the needs of the residents, including the protection and safeguarding of the vulnerable residents. The home has procedures for dealing with complaints and concerns, and has a system for monitoring the quality of its services, which takes account of the views of the residents and their families. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although some improvements have been made with the assessment and care planning documentation, further improvements are still required with certain aspects of the recording procedures, in order to ensure that planning to meet needs remains as robust and relevant as practicably possible. Improvements are also required in relation to the management of residents’ medications, in order to ensure that they are managed more robustly and safely as well; a previously issued requirement had to be repeated in this area on this occasion. Improvements will also help to ensure that all residents receive their medications consistently as prescribed. A nutritious diet is available for the residents, and some spoke positively about the quality and choice of it. However, improvements are needed in relation to the choices for diabetics, and the ways in which residents are supported to eat their meals in terms of dignity and comfort. The home now needs to source information and implement training for staff regarding the Mental Capacity Act, as this piece of legislation has a significant bearing on how the home will uphold the rights of the vulnerable residents. Changes are needed in relation to the way in which certain types of clinical waste are handled and disposed of, as the home’s current practice does not take account of wound dressing waste. Although an additional carer has been provided during the mornings in order to meet the needs of the increased number of residents, staffing provision is considered to be at the minimum level, particularly in the evening and Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 8 overnight; this will need ongoing review in the home to ensure the level is not posing any risks and continues to meet the needs of the residents. Recruitment procedures have been satisfactory in many cases, however there was the potential for this to be occasionally inconsistent and pose risks to the vulnerable residents, and this issue has been addressed in a letter to the proprietor separately to this inspection. Although there is some focus towards the National Vocation Training programme (NVQ) for care staff, with seven on a training programme, progress has been slow in this area and there is currently only one member of the care team so qualified. The home’s manager recently left, and the home is currently without a registered manager. The impact of this in terms of consistency and continuity for residents is being minimised as much as possible, but arrangements are temporary until a new manager can be appointed. 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 DS0000016643.V359810.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: Uplands is participating in The Partnership for Older People Project (POPPs) support scheme, and as such should reflect this in the home’s statement of purpose; information was sent to the Care Services Manager immediately after this site visit to assist them with this task. Copies of pre-admission assessments carried out on two more recently admitted residents confirmed that the assessment had been conducted and recorded in full before their admission to the home was agreed. In one case the admission had come from an out of county location, meaning that a representative from the home could not conduct an assessment in Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 11 person. In this instance the prospective resident’s family, the hospital ward staff, the district nurse and general practitioner involved in their care and treatment had contributed to the assessment process. Appropriate local authority care assessments and Registered Nurse Care Contribution assessments were also on file where applicable. Uplands does not provide intermediate care. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home have their health and care needs met appropriately, although omissions in documented care planning and medication management are posing a degree of risk to residents in this regard. Privacy and dignity is largely upheld for them, but certain factors could adversely impact on this for a few. EVIDENCE: Each resident had their own personal plan of care, which had been devised on the basis of their assessed needs, each of which was being reviewed. Some cases showed clearly that the resident’s family had been involved in developing their care plan. Six were chosen for closer scrutiny and to feature as part of a case tracking exercise. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 13 Individual needs had been identified on a general assessment form and also as part of a risk assessment process in relation to vulnerability to pressure sores, safety and moving and handling needs. In most cases care plans went on to demonstrate how the assessed needs were to be met, but there were some omissions in this regard. There were at least two cases where a risk of the resident developing pressure sores was evident, and despite specific care and support being delivered in these cases, there was no care plan actually documented; also in cases where support equipment had not been introduced, there was no recorded rationale to support their decision not to do this. Likewise, another resident had particular continence needs, had been assessed by the continence specialist and was receiving the necessary support and equipment, however there was no recorded plan of care associated with this. In this same case, the level of pressure relieving support needed reviewing, as we were concerned that what was being used was insufficient for their particular level of risk. A care plan relating to a sacral wound dressing in this case was out of date and was no longer relevant, and would have been better had it been removed. Although the home had not used a specific risk assessment tool for issues such as the risks associated with the resident’s nutritional needs or their risk of falling, the care plans did take account of them where relevant; it would be a more robust process if specific risk assessment tools were used however. In one case the resident had lost a significant amount of weight in recent months and subsequent care plan reviews were not reflective of this, and consequently were meaningless. Some records did not contain base line observations taken on admission such as the person’s original weight. Records demonstrated that residents have access to necessary medical support, with advice and treatments from a variety of community resources as necessary. The doctor had referred one resident to the community psychiatric team some time previously, but the requested review did not seem to have taken place and staff were unable to explain why this was; it was agreed that they would now follow this up. Staff were seen as readily available throughout this visit in many locations, with the home appearing calm and organised most of the time. A resident commented that staff were ‘very caring and kind’ but there were an isolated ‘one or two’ on nights who could be a ‘bit more helpful on occasions’ than they were being. One commented that some were ‘particularly tender when attending to her dressings’; she also said that she got pain relief tablets to help with this. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 14 One relative said that ‘staff do care here’, and similar responses were received in surveys. A visiting health care professional wrote positively regarding the ability of the home and its staff to meet the residents’ needs and the care they delivered. There was no-one who was currently managing their own medications, and the home provided safe storage for those that they were managing. Medication administration charts were printed by the supplying pharmacist and as such were largely very clear and adequately maintained by staff in the home. However, there were no clearly printed directions for the use of external preparations such as prescribed creams, and neither were there signatures to confirm they had been administered. This had been raised before in this home, and in order to address it the home had introduced an individual care plan system to the residents’ concerned rooms, which provided details of administration and on which staff could sign for having applied. A random sample of this system was inspected, and the document had not been recorded for two months, with no evidence that the prescribed creams were being used as they should. In another case two external preparations appeared on the medication administration chart but were not being given, and had in fact been discontinued some time previously, and in another, the directions for the use of some eye-drops was inaccurate and needed reviewing. A medication error was identified for which the nurse responsible provided some explanation. However the outcome for the resident concerned meant that they did not receive one of their prescribed medications at the correct time, but only after a twenty-four hour delay. Three random medication audits were carried out and there was a slight discrepancy identified in one for which both staff involved could not provide an explanation, both being sure they had administered the drug as prescribed. Residents’ care plans directed staff towards the consideration of individuals’ privacy and dignity, and these core values featured in staff induction training. Residents were receiving care in the privacy of their own rooms, and staff were witnessed interacting discreetly with them. One resident said that staff were ‘respectful to her’. The hairdresser was doing a number of residents’ hair, and this appeared to be a cosy and sociable time for them. However, the activity was being carried out Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 15 in a part of the main lounge in front of other residents, and staff should be aware that this might possibly compromise dignity for some. There was no door lock on one of the first floor bathrooms, which had recently been refurbished, and which the proprietor indicated had been an oversight. A small number of the bedrooms here continue to provide shared accommodation rather than single, and door locks have not been fitted as standard to residents’ doors. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 16 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 living in this home are afforded opportunity to maintain social contact, exercise choice and have a nutritious diet, however there are isolated factors that are having an adverse impact for a few in this area. EVIDENCE: A designated social activities coordinator visits the home twice each week, spending time with small groups of residents or with individuals, organising or supporting socially active or quiet, more personal social time for them, according to need or choice. Social activity records had not been maintained consistently, and this made it difficult to evidence events and activities that had occurred in recent weeks and months. Records that we did see showed group activities had taken place, such as music and movement, quizzes, games and jigsaws. A planned trip for the week of this visit had to be cancelled due to the shortage of staff to assist with the actual work and commitment involved with a big outing. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 17 Some residents had newspapers delivered; others were watching television or listening to music. One of the residents was playing the piano in the main lounge before lunch. Religious denominations were catered for, with spiritual support available from different priests, according to religious faith. One visitor to the home said that in their view there could be more going on socially for the residents. Some of the residents confirmed that some things were organised socially, with one saying that they didn’t have to join in if they didn’t want to. Although there was a member of staff sitting with the residents in the smaller lounge of the dementia care unit, there was evidently very little social contact existing between the carer and the residents. Despite this there were a number of staff who took particular care to consider the social aspect of the residents’ needs. Visitors were observed coming in and out of the home; two were spoken to directly. In addition to the few visitor surveys, each confirmed that they felt welcome in the home, and could visit as they wished. Survey responses said that they found staff helpful and approachable, provided them with information as necessary, and consulted with them appropriately. Visitors were offered refreshment. A small number of residents said that they felt able to choose how they spent their time, and staff were witnessed offering choice to people in a variety of ways. However, there were some residents who were rather more reliant and dependent on the staff to assist them in this regard, and it was these more vulnerable residents that the staff must remain particularly mindful of. A relative commented that in their view the residents were supported to live how they chose. Advocacy information was displayed in the home for anyone who might need this. Some of the bedrooms appeared slightly different, as residents are supported to personalise their rooms with their own treasured belongings. Residents also have a degree of choice with their meals. Two choices of lunch were offered, and a list of residents’ individual choices had been supplied to the cook for her reference; there were at least two supper options as well. Some residents had chosen to have a cooked breakfast. Despite this, one of the visitors said that, although they had made it clear that their relative disliked fish, this was persistently served on a Friday with no other choice available. The visitor said that they had resorted to taking their relative out for lunch on a Friday instead so as to avoid the fish. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 18 Furthermore, pudding alternatives for diabetic residents seemed to consist primarily of yoghurts, and the cook did confirm this when asked. One of the visitors expressed some concern about this. Residents generally spoke very positively about the quality and choice of food provided for them, with one saying that they had ‘lovely home-made cakes every day’. A small number of the residents were eating their breakfast at 10.30 am, and with lunch served at 1pm this meant that there was little time between each of the meals. The deputy manager and the care services manager both said that this was unusual, and would not normally be acceptable. Staff had to be reminded to provide condiments for the residents at lunchtime, as these had not been placed on the tables for this particular meal. Staff were assisting residents where necessary, although some were doing this whilst standing over them and sometimes moving between a number of different residents, which was not best practice, not only in terms of meeting the dietary needs of individuals satisfactorily, but also in relation to maintaining their dignity. Meals were served in a number of locations, and those residents in the two small ground floor lounges were having their meal at a small ‘over bed’ type table, rather than at a dining table that might have been far more conducive for some. The kitchen had undergone some refurbishment, with new units, tiling and equipment installed. There was still no fly screen fitted to the open external kitchen door, but the proprietor is aware that this must be done following an environmental health inspection. Catering records were maintained. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 19 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. People living in this home are able to express their concerns, and can be reassured by the home’s complaints procedure and the policies regarding the prevention of abuse, although the latter should be made more robust in relation to residents’ rights. EVIDENCE: Uplands had clear policies and procedures to address complaints that were received. These were displayed in the home, but required a degree of updating as they no longer showed the correct contact details for the CSCI. The home had a system for logging and recording any complaints that are received, although there were no recent ones. One issue had apparently arisen, and although the deputy manager said she had made full recording around this incident, this could not be located for inspection. A small number of the residents said that staff were helpful if they had any concerns, and a small number of relatives also indicated that they knew how to raise concerns and could get them addressed by the home. One particular resident had some outstanding concerns, but between the home and her family they were trying to accommodate her as much as possible. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 20 The home also had policies and procedures for the protection of the vulnerable residents. Staff had received training in this area, and those spoken to directly were able to converse about it and confirm their knowledge regarding recognition of abuse and Whistle Blowing procedures. They were provided with the home’s Whistle Blowing procedure, a copy of the local authority information leaflet, ‘The Alerter’s Guide’, and the Department of Health publication ‘No Secrets’. The home, although aware to a degree, had done little towards ensuring its compliance with the Mental Capacity Act, with the Code of Practice not yet sourced and staff training not addressed; the Care Services Manager confirmed her intention to address this as soon as possible. Standard admission documentation contained reference to the person’s circumstances in terms of representation, advocacy and advanced directives, but none of this had been completed in the records seen. Staff disciplinary procedures had been implemented in one case, where a carer’s practice had been deemed as unacceptable. One of the residents spoke of ‘feeling safe’ and to a degree of ‘feeling in control of her circumstances’. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 21 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 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some isolated concerns in this area, people living in this home are provided with comfortable and pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: A refurbishment and building extension programme has been taking place, and since the last inspection CSCI has registered the home to provide care and accommodation to an additional four residents. Parts of the new build were still ongoing, and a new front entrance was awaiting completion. The home is satisfactorily maintained, although one visitor commented that things could be better in their opinion. Most of the bedrooms have laminate flooring instead of carpets. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 22 Records of maintenance were kept. A ground floor bathroom remained in a poor condition, and was reported to be unused. This time last year the proprietor reported that this room was scheduled for refurbishment, and the same was reported again this year. There were a number of items stored in here, one of which was a pressurerelieving cushion, which had a torn cover. This was unusable and an infection control risk, and it was agreed that the home would dispose of it. The home was clean and there were no unpleasant odours detected. One visitor commented that the home provided ‘a warm and comfortable room’ for their relative. There were supplies of liquid soaps, paper towels, gloves and aprons for staff to use as part of the infection control procedures. The laundry room was reasonably organised, with items appropriately segregated and washed in accordance with infection control measures. The laundry assistant stated that a lock was to be fitted to the laundry room door in the near future. A sluice machine has been installed in the home, and despite the proprietor reporting on a previous occasion that it was serviceable, staff were still not using it. Clinical waste was not correctly managed in all cases, with all waste, including used wound dressings, placed into continence waste collection bags. This had been discussed with the home on a previous occasion, and at that time it was reported that wound dressing waste was not being produced. However now that it is, the home must have specific arrangements for its safe collection and disposal. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a competent work force, but the potential to place residents at risk from minimum provision and omissions in the normally robust recruitment procedure does exist. EVIDENCE: Staff rotas were being maintained. Since the last inspection the home had increased its capacity by four additional residents. Staffing had been reviewed as a consequence of this, and to date the proprietor had only increased staffing by one in the morning, with numbers unchanged during the latter part of the afternoon, evening and overnight. An agency nurse was on duty on the day of this inspection, although due to him not completing the shift in its entirety in accordance with the rota, the deputy manager then had to cover the shift. A qualified nurse is on duty at all times, and there were now nine carers on duty during the morning and into the early afternoon, with six for the rest of the day and three overnight. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 24 These numbers are considered to be the absolute minimum, and should remain under constant review in relation to their ability to meet the needs of the residents fully and maintain the safety of the home generally. Staff felt particularly that three carers with one nurse at night was not enough. The care team was supported by catering and cleaning staff, with a laundry assistant on duty for five days of the week; care staff are responsible for laundry duties at weekends, which is not considered ideal, given that these domestic tasks inevitably remove a member of staff from the care of the residents for a time. Staff were very much in evidence during this inspection, and were readily available to the residents at all times. Some of the residents and at least one visitor commented on the language barriers and ensuing communication problems that apparently existed between them and some of the staff from overseas. The care services manager acknowledged this and said that the home was supporting such staff with the commencement of English speaking classes. Progress with the staff National Vocational Training (NVQ) programme had been slow, and the home had not achieved the standard of having at least 50 of its care staff qualified to NVQ level 2, but was making some effort to address this. There was still only one carer so qualified, but there were another seven staff currently on the training course, two of whom were reported to be near to completing it. Personnel files relating to two members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history; reasons for any gaps in the history had been sought. Interview notes were recorded. Two written references had been provided in each case, including one from the last employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Despite these two satisfactorily completed recruitment procedures, the proprietor discussed his plan to commence two other workers’ employment without waiting for their references. We made it clear that this was not acceptable and would be a clear breach of the regulations if he were to do this. A letter detailing the requirements in relation to recruiting new staff was issued to the proprietor immediately following this inspection to ensure there could be no misunderstanding in this area. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 25 Staff had been provided with the General Social Care Council Code of Conduct for care workers. New staff had been inducted to the home, and had gone through an in-house induction training programme, which also included a one day theory based training covering the common induction training standards for care workers. New staff had worked in a supervised capacity, and evidence of their supervisor could be sourced from the staff rota. Training records, though needing some updating, demonstrated ongoing training for the staff in topics relevant to their role. This included adult protection, health and safety matters, manual handling, infection control and dementia care. Staff said that training opportunities were good in the home. Further training in dementia was currently being explored, and training in nutritional risk assessment was also planned. Survey responses from residents’ relatives confirmed that staff were appropriately skilled and experienced for their roles. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home do not currently have the benefit of consistent management, although efforts are being made to ensure as much continuity as possible is provided in this area until a new manager can be appointed. EVIDENCE: The manager has very recently left, and the home is currently without a registered manager. The deputy manager is acting temporarily in this role whilst recruitment of a new manager is underway. The proprietor is keeping CSCI informed of progress in this area separately to this inspection. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 27 As part of the quality monitoring systems questionnaires had been distributed to residents and visitors, in order that the home could assess the quality of its services. Questionnaires gave residents and their families the opportunity to comment on issues that affected them such as care, staff, food, social activities and housekeeping. Results of quality surveys had been collated, and there was some minor recording around how the home would address any shortfalls where an improvement was required. Residents and their families had also been able to attend a meeting to discuss and share ideas, but recorded minutes of this could not be located for inspection. The Care Services Manager has conducted regular visits into the home, and carried out monitoring checks on the standards here; written reports were compiled on this basis, copies of which have been received by CSCI. A number of residents have chosen to place personal money with the home for safe-keeping. Clear and transparent records were being maintained in these cases, and random checks on three such arrangements proved to be accurate. The home has health and safety policies and procedures, and staff had received training in this area. Fire safety training had been delivered, including fire drills, although training records were not seen directly on this occasion. Checks had been carried out on the fire safety equipment. First aid facilities were provided, and nursing staff had received training in first aid; care staff had received a small degree of first aid training and only had basic underpinning knowledge in this area. We gave advice to the Care Services Manager regarding the risk assessment of the suitability of this level of first aid provision for the needs of this home. Accident records were seen during the case tracking exercise. Regular checks had been carried out on the heating, the hot water and the electrical equipment to ensure safety, and records demonstrated that medical equipment and the lift had also been serviced. The Environmental Health Officer had carried out an inspection here, and issues had been identified for the home to address. Health and safety aspects of the new build had also been discussed between CSCI registration team and the proprietor. Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) Requirement Timescale for action 30/06/08 2 OP8 15 2 (bc) 3 OP9 13(2) The registered person must ensure that care plans are recorded in accordance with the delivery of care; with particular reference to pressure area and continence care needs on this occasion. The registered person must 31/05/08 ensure that care plan reviews take full account of any changes to the resident’s care and condition, so that changes can be reflected to inform future care planning. The registered person must 31/05/08 ensure that there are safe systems for the management of medications in the home. Staff must sign consistently to confirm administration of all medications in accordance with doctors’ instructions, including prescribed creams. This requirement is repeated from the last inspection. 4 OP9 13(2) The registered person must ensure that residents’ DS0000016643.V359810.R01.S.doc 31/05/08 Uplands Nursing Home Version 5.2 Page 30 5 OP15 12(1a) 6 OP26 16 (2k) 7 OP27 18 (1a) medications are kept under review, in order that the most appropriate directions for their usage can be recorded and remain current in accordance with the needs of the resident. The registered person must 31/05/08 ensure that residents needing a special diet are fully catered for in terms of their choice and nutrition. This is with particular reference to the needs of diabetic residents on this occasion. The registered person must 30/06/08 ensure that suitable arrangements are made for the safe disposal of all grades of clinical waste produced in the home. This is with particular reference to the disposal and collection of wound dressings on this occasion. The registered person must 30/06/08 review the levels of staffing on an ongoing basis, to ensure that provision is adequate to meet the needs of the residents safely and to ensure the safety of the home over a twenty-four hour period. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations In relation to meeting residents’ health needs staff should: • Record their rationale to support their decision for not introducing pressure relieving equipment in a DS0000016643.V359810.R01.S.doc Version 5.2 Page 31 Uplands Nursing Home 2 3 OP10 OP12 4 5 OP14 OP15 6 7 8 OP27 OP28 OP33 case where a risk has been identified Use specific risk assessment tools to record risks in relation to nutrition and falls • Record residents’ weights as part of their base-line observations on admission. The registered person should provide a more private location for residents to see the hairdresser, in order to promote their dignity. The activities coordinator should ensure that detailed records are kept of consultation with residents, their interests, and their participation in social activities and events. Staff should ensure that choices are made available to all residents in all areas of their life, including their preferences in relation to food. At mealtimes staff should: • Sit down to assist residents with their meals • Provide all residents with the opportunity to sit at a dining table for their meals, where practicable. The registered person should provide a designated laundry worker at weekends. The registered person should ensure that at least 50 of the care staff are qualified to at least NVQ 2 level or equivalent. The registered person should ensure that a written action plan is drawn up on the basis of collated results of resident and visitor surveys, as part of the quality monitoring process. • Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Uplands Nursing Home DS0000016643.V359810.R01.S.doc Version 5.2 Page 33 - 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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