Inspection on 30/06/09 for Uplands Nursing Home

This inspection was carried out on 30th June 2009.

CQC 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 07/01/09

Uplands Nursing Home 02/04/08

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

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Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Uplands Nursing Home Church Road Maisemore Gloucester Glos GL2 8HB Lead Inspector Sharon Hayward-Wright Unannounced Inspection 10:20 30 June & 1stJuly 2009 th DS0000016643.V375812.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Uplands Nursing Home DS0000016643.V375812.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 Manager post vacant 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.V375812.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. 7th January 2009 Date of last inspection Brief Description of the Service: The care home is an extended house within the village of Maisemore, near to the River Severn. It sits back directly off the main road and has car parking to the front and rear of the building. There is a small enclosed garden within the centre of the building, and 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. Current fees are £469.15 to £768.50 per week. The Registered Providers have a system in place to manage the Funded Nursing Care Contribution (FNC). People who fund their own placements have additional services included in the fees and these include toiletries, newspapers and chiropody. People who have their care funded by the local County Council are able to arrange, on an individual basis, different payment options for these additional services. 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 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.V375812.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. This inspection was carried out by three inspectors over a two day period in July 2009. We did not request an Annual Quality Assurance Assessment (AQAA) prior to this inspection. We have included in this report the findings of a random inspection we undertook in May 2009. We looked at other information we have received from or about the service from other stakeholders. This includes where the home notifies us of any incidents that affects the well being of people who use the service. As part of this key inspection one of our (the Care Quality Commission) pharmacist inspectors looked at some of the arrangements for the handling of medicines to follow up concerns about medication reported at the last key inspection on 7th January 2009. We looked at some stocks and storage arrangements for medicines and various records about medication. We saw how staff administered some medicines in various areas of the home and we went to some bedrooms. We spoke to the acting nurse manager, deputy nurse manager and two members of staff. We gave full feedback following the inspection to the deputy nurse manager and one of the directors about the medication issues we found. This part of the inspection took place over a seven hour period on a Tuesday. Because people with dementia are not always able to tell us (the Care Quality Commission) about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing four people who live in the home for two hours and recording their experiences at regular intervals. This included their state of wellbeing and how they interacted with staff members, other people living in the home and their environment. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. We also spoke to a number of people who use the service and any visitors, and we have used any comments in this report. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 6 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. What the service does well: Uplands Nursing Home provides an adequately maintained environment for the people who use the service. People who are living in the dementia care unit are able to move around safety. There is a small and inclusive lounge in the nursing unit. There is a good standard of nutritious food and people are offered choices at each mealtime. People spoken with all seemed very satisfied with the food provision. Staff made positive comments regarding the teamwork and peer support that they experience. People and visitors spoken with praised the staff saying they are very good. Medicines needed for people living in the home were in stock and stored safely. People have access to external health professionals to include Dentists, Opticians, Community Nurses, Chiropodists and General Practitioners. What has improved since the last inspection? The arrangements the home has in place to monitor people who are assessed as being nutritionally at risk has improved. People are having their weight monitored. The staff need to be mindful that as they are recording the weights of people in a number of places and this could lead to mistakes taking place, as we did find that people’s weights in the care plans were not up to date. The cook is now aware of which people require therapeutic diets and this is recorded on a notice board in the kitchen. High calorie and protein milkshakes are served to people who are assessed as being nutritionally at risk most days and snacks are now offered to all people by the staff. This is good practice. Information about how some of the pressure relieving mattresses operate is stored in the office for staff to read and this is good practice, especially if a fault should occur. There have been some changes to the arrangements for managing medication. New and improved storage for controlled medicines is provided. Some audit checks of medication have been introduced. More detailed records and correspondence about any complaints received is in place and this is being audited. With reference to any verbal complaints more details about the actions taken need to be recorded. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 7 All staff have received training either in-house or externally in safeguarding vulnerable people. Changes have been made to the induction training and the home is now using an external training provider. Staff attend a 3 day course and this is based on the Skills for Care common induction standards. Quality assurance auditing of the service has started to take place with a number of audits in place. Records were seen of some of the auditing. The home need to consider developing this area further. Regulation 26 visit are now taking place monthly as required and a report of this visit is being sent to us. This is where the Registered Providers or a representative on their behalf visit the home unannounced and carry out an assessment of the service. We saw evidence that fire training and drills are taking place. All qualified staff have undertaken first aid training. What they could do better: The home needs to finish off transferring care plans to their new format as a matter of urgency. They need to make sure care plans reflect people’s individual needs and choices. Care plans need to be linked to the appropriate risk assessment and provide staff with the same directions. Following the random inspection in May 2009, we highlighted one person’s care plans as needing to be updated especially in relation to wound care. We were disappointed to see they had not been done. We identified several shortfalls in relation to peoples health and personal care needs not being met, for example the home needs to demonstrate that people receive mouth care and have access to baths or showers. In relation to wound care management we would have expected to see a description of the wound, grading and mapping. This was not in place. One person was on an alternating pressure relieving mattress that was set by the person’s weight. We found that the mattress was set far too high for their weight and could potentially place this person at risk of harm. People’s ‘end of life’ wishes were not recorded in their notes, and there were no specific plans of care in place. Although we saw examples of respect being shown towards people, we did observe times were staff did not respect people’s privacy and dignity. We discussed with the deputy manager the use of ‘seat covers’ on armchairs in communal areas as this is outdated institutional practice and must cease. Accurate and complete records of prescribed treatments applied to the skin need to be kept consistently. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 8 Improved protocols for the use of medicines prescribed for use ‘when required’ need to be in place for all medication prescribed in this way. Some improvements to recording medication are also identified in the report. The medication policy and procedures need reviewing and improvement. Arrangements need to make sure that medicines are given at the right time particularly when doses are due at less frequent intervals such as once a week. The home is still looking to appoint a full time activities coordinator to provide people with stimulation and activities based on their abilities and choices. The home also needs to make sure that all people are included in this and that people are not subjected to the same repeated activities unless they request it. There were some very good examples of a sound recruitment process; however, a full employment history is required with written verification of any gaps. More specific dates are needed on employment histories other than ‘years’. Arrangements are starting to be put in place to provide staff with structured and meaningful supervision and appraisal. The home is actively recruiting for a new manager and once in post they must apply to us to be considered for registration. The Registered Providers have a detailed action plan in place to address all outstanding requirements. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Uplands Nursing Home DS0000016643.V375812.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.V375812.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the planned changes to the admission process any shortfalls with the previous systems will have been addressed. EVIDENCE: Following the last key inspection where the home was rated as 0 stars which meant poor outcomes for people who use the service the Registered Providers made an agreement with us that they would not admit any new people to the home. This was to enable the management team of the home and the Registered Providers the opportunity to make improvements. The last person to be admitted to the home was several days prior to our random inspection that took place on the 11th May 2009. The home is in the process changing the care planning format and as part of this a new pre admission assessment is included. At the last key inspection in Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 11 January 2009 some shortfalls were identified with the admission procedure for some people, and the plan is that with the new format these shortfalls will be addressed. Uplands Nursing Home does not provide intermediate care. Uplands Nursing Home DS0000016643.V375812.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always having some of their health and personal care needs met. Care planning documentation for some people does not provide staff with clear instructions on how to meet people’s needs. The principles of respect, privacy and dignity are not always put into practice. Conclusion about medication: On the whole there were suitable arrangements in place for the management of medicines but the inspection highlighted some weaknesses where improvements in these arrangements were needed so as to always protect people living in the home from unnecessary risks with medication. EVIDENCE: This outcome group has been scored using our ‘Klora’ guidance as ‘adequate’, however we found significant shortfalls in people having some of their health and personal care needs met and this need to be addressed as a matter of urgency. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 13 A case tracking exercise was not undertaken at this inspection. (This is where we would examine the care of a number of people in details). This was because the staff in the home had not completed the transfer of all care records to their new format. We did examine a number of care records to include care plans. We looked at two randomly selected care records that had been transferred on to the new format. Each person had an assessment of needs in place. From this care plans are devised. Some care plans contained specific information about that person where as others tended to be more ‘task’ orientated. Where the care plans contained personal information about peoples needs some also contained details about people’s choices which is good practice. We examined one person’s care plan regarding personal care but it did not contain any details about bathing or showering. We asked staff if people were offered this and they said they have a weekly rota in place but records to support that people had actually received a bath or shower were not in place. Staff also said that if a person refused they would go back to them and ask them later or the next day. One person’s night care plan was very descriptive and listed their times of going to bed and their individual routine, which is good practice. During the tour of the home were we inspected a number of rooms belonging to people and we also checked the equipment they had in place for mouth care. In a number of rooms we randomly selected we found that people’s toothbrushes for example were dry. We asked to see records that people are offered mouth care but none were in place. We also found one person’s dentures on top of the cabinet in their en-suite. When we asked the deputy manager if the person had put them up there themselves we were told they are not able to mobilise. This is poor practice and not respectful to that person. Staff must make sure that people’s dentures are placed in the appropriate container when they are not being used. We undertook a random inspection in May 2009 where one person’s care plans were examined in relation to wound care. We examined these again at this inspection. We were disappointed to see that this person’s care records had not been transferred onto the new format. On checking the wound documentation the only change we could find was that a new sentence had been added stating the dressing had to be changed every 4 days. We would have expected to see a description of the wound and a grading and also wound mapping. None of this was in place. On checking the records for the changing of dressing one entry was 6 days apart, but the care plan states 4 days, no explanation could be found in the care records as to why this had not been changed for 6 days. The daily records for this person describes at time they display challenging behaviour and can be resistive to care. No care plan for this need was in place. We were told by the deputy manager that this person is receiving palliative care, however no care plan was in place regarding how the home is meeting this need or the person’s and family’s wishes. This needs to be addressed urgently. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 14 On reading the care records consideration needs to be given to the terminology used for example one person was described as being “difficult”. Staff must be respectful to people and realise this is part of their disease process and not a deliberate act. Also one care plan states “staff to be aware of this person’s whereabouts at all times”, this cannot happened unless the home provides one to one care. We also recommend not using the words “sufficient” or “regularly” as these are not descriptive enough. The home still has a large number of care plans to transfer onto the new format and this needs to be done urgently but whilst completing this staff must make the care plans individual to each person. We witnessed one example of people being able to make choices about their daily lives and this related to one person continuing to smoke and drink alcohol with support of the staff. When this person’s care plans are transferred to the new format the staff must include how they enable this person to do this and record this person’s choices. Appropriate risk assessments must also be included. At the random inspection in May 2009 we examined how the home monitors people who were deemed as being nutritionally at risk. The system they had in place was not insufficient and did not monitor people effectively. Since that inspection a more robust system has been devised and records of monitoring people’s weight were in place. However one concern we found was that the staff have to record the weight on a number of forms and the weights in the care plans were not up to date as no weights for June had been written in. We examined one person’s care plan for nutrition and it was written in the care plan that they need to have weekly weights, but on the nutrition risk assessment it said monthly weights. Care plans and risk assessments must state the same instruction for staff to follow. It needs to be clearer about where people’s weights are to be recorded, especially if the care plans states weekly but the weights recorded in the care records are monthly as the home uses another form to record people’s weights. Care staff said they do write in peoples care records as they complete the daily records. Qualified nurses write in the care plans but care staff said they do have input into these. On checking one person’s alternating pressure relieving mattress we found that it was not set at the correct weight setting for them. It was set at 100kgs to 110kgs when in fact this person weight was recorded as 45.5kgs in June 2009. Setting this type of mattress at a higher weight setting can potentially place this person at risk. The nurse and deputy managers were immediately informed about this and they also found the mattress had a fault. A system needs to be put in place to make sure that if people are placed on mattresses set by people’s weight they are set correctly. We found that one person had bed rails in place but no risk assessment or consent form was in place and no recording of frequent checking of the Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 15 bedrails. ‘Bumpers’ were in place but these were damaged and needed to be replaced as they were an infection control risk. This was reported to the Registered Providers. The home needs to devise a bed rail management system and we would recommend they either contact the Health and Safety Executive directly or use their website. During the sofi tool observation staff were observed supporting people to transfer from wheelchairs to ordinary chairs using either a portable hoist or handling belt. Two and three members of staff were involved in this process. Staff clearly explained what they were doing to people throughout the process. One person was hoisted in a sling which appeared too large with most of their lower body unsupported by the sling. Other people had walking frames or tripods and staff were clearly monitoring people at risk of falling. One person with a visual impairment was observed to make sure the environment was clear when they were walking through the lounge. Staff ensured that any obstacles were moved or they were given information about them. One person being observed left the room to have an appointment with a Community Nurse. We found evidence in care records of people having access to external health professionals to include, General Practioners, Community Nurses, Chiropodists, Opticians and Dentists. We spoke to several people who use the service and they were overall happy with the level of care they receive. Pharmacist inspector’s report about the arrangements for medication (Standard 9). At the time of this inspection no people living in the home were assessed as able to self medicate and look after their medicines so they were totally dependent on the staff for this part of their care. Registered nurses were responsible for handling and administering most medication to people living in the home. Carers were responsible for the application and recording of some prescribed creams and ointments. During the inspection we saw the nurses administering some medicines to some people living in the home; they had all received their morning doses by about 11.15am. We saw that another nurse began administering lunch time medicine doses at about 1pm. We discussed with this nurse the importance of there being at least a four hour interval between doses of some medicines and of achieving an even spread of doses throughout the day as this helps get the best effect from medication particularly painkillers and antibiotics for example. On this occasion we did not find there were any medicines given both in the morning and lunch time where this interval would be critical but it is an issue that must be properly managed if morning doses are given later than anticipated. Since the last inspection the home has taken various actions to Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 16 help with the time taken for the large number of medicines due in the morning. An extra nurse is on duty each morning for five days in the week and a second medicine trolley was in use so that two nurses can be involved (although this was not the case on the day of the inspection). The times of some medicines have been adjusted following advice from a pharmacist from the Primary Care Trust (PCT). There were arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person in the home. Accurate, clear and complete records about medication are very important in a care home so that people are not at risk from mistakes with their medicines and so that there is a full account of the medicines the home is responsible for on behalf of the people living there. We found that routinely administered medicines were signed as administered or an explanation was provided if not. This indicated that people living in the home were receiving their medicines as prescribed. Checks or counts we made of medicines in the medicine trolley also confirmed this. The records also indicated that the medicines needed were in stock. Since the last inspection the acting nurse manager has introduced a monthly audit of medication records. This appeared to have helped improve the standard and accuracy of these important records. Staff had not always recorded what dose of a medicine they had given to people where variable doses (one or two tablets for example) were prescribed. Some eye drop directions needed to include which eye or eyes were to be treated. Records made for the application of prescribed external products, which carers generally applied, were variable and not consistently kept so it was not possible to tell if people had received the treatment they should have. We were told about actions being put in hand with the pharmacy to improve this situation and saw some example records the PCT have suggested. We were particularly concerned about the absence of records of application for one person who was prescribed a complicated regime of a number of different skin treatments. There were detailed written instructions in the care plan about how these were to be used. We looked at the containers in the bedroom that were being used for this person and saw that they either had no opening dates or had been opened for a while now. One ointment that had been specially made for this person had been dispensed on 5th November 2008 so would almost certainly be beyond its shelf life. We had to point out to staff that records for one person living in the home indicated that pain relief patches that should have been changed the evening before the day of the inspection had not yet been changed. The deputy nurse manager immediately made arrangements to apply the new patches and told us that this person had not been in pain as a result of this. It is important that when medicines are given at longer intervals between doses (every seven days in this case) there is a system in place (such as highlighting the medicine chart Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 17 or marking in the home diary) to make sure this treatment is given at the right time. The medicine records were not always up to date about the medicines in use as some had details of medicines that were in fact no longer in use. The deputy nurse manager told us this was part of an ongoing review of all medicines that a pharmacist from the PCT was helping with and liaising with the supplying pharmacy so that when future charts were printed they would be up to date. In the meantime we advised that the nurses clearly wrote on the charts about this. The allergy section on the medicine charts were not completed yet. The acting nurse manager told us they are working with the pharmacy to get these completed. She was aware of two residents with a particular allergy to medication. Although this information would be in their care plans it is also best on the medication records as these are used each time a medicine is administered. Since the last inspection we saw that there were some written protocols with the medicine charts to help guide staff with making decisions about using medicines that were prescribed to use when required or with a variable dose. This information needs to be in place for all medicines prescribed in this way but we found this was not the case or sometimes the records that were in place lacked enough detail to be useful. This is important so that all staff understand how such medicines are to be used to meet each person’s identified needs in a consistent way. The pharmacist from the PCT has also provided advice about this and systems in place to manage these medicines have been revised. We checked the controlled medicines record book as at the last inspection there were a few anomalies that needed further investigation in order to clarify what was recorded. A new record book had recently been brought into use and we found the recorded stock balances agreed with the amount of these medicines in the cupboard. We found that there were still stock balances showing on pages 27 and 29 in the old record book that needed explanation. It appeared one entry may have been duplicated and another transferred to the new record book. There was still no explanation about what had happened for a dose on 03.12.08 of one medicine recorded on page 15 in the old record book where the stock level had still been reduced by one patch despite the line being crossed out. The improvement plan sent after the last inspection indicated the anomalies identified at the last inspection were corrected immediately but this does not seem to be the case with entries on page 15 and 29. The improvement plan also said the controlled drugs would be monitored on a weekly basis and the acting nurse manager confirmed this should be the case. We saw that although checks were written in the record books these were not on a regular weekly basis. We discussed with the deputy manager about also using the record book as good practice for a schedule 3 liquid medicine used for one person for a particular emergency that may arise. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 18 There were suitable arrangements provided for storing the medicines safely and there was a separate medicine fridge. The storage arrangements for controlled medicines were enlarged and upgraded since the last inspection and this group of medicines were stored correctly. We found that some containers of prescribed creams and ointments were kept in the bedrooms of the people they were being used for. Staff told us this was safe and would not pose a risk to anyone. The improvement plan from the home indicated that this was subject to risk assessments but we did not see this written down in the documents we looked at and staff we spoke to did not know about this. The eye drop containers we looked at had opening dates and were changed every month in order to reduce risks of contamination. The practice of writing opening dates on other medicine containers was variable. We strongly recommend homes to write the date on any containers of medicines when they are first opened to use. This helps with good stock rotation in accordance with the manufacturers’ or good practice directions and with audit checks that the right amount of medicines are in stock. The supplying pharmacy should be able to provide advice about the recommended periods for using various medicines once the containers have been opened if the manufacturer does not specify this. The nurses showed us the home policies file in the care office but did not seem too sure about a medication policy. Within the file we found various pages about medication but this was not well indexed so it was difficult to find specific information. What we found was in very general terms and not specific to the home. The improvement plan said the medication policy had been reviewed but we saw this was still on the action plan to achieve. There needs to be a more specific policy for the home incorporating the ongoing changes so that staff have clear direction about how the providers expect medication to be safely managed in this home. This needs to be readily available to staff with the medicines and they should sign they have read and understood this. The acting nurse manager told us that the PCT pharmacist will be providing some additional medication training for staff. At the end of the inspection we provided some feedback to one of the directors about what we had found relating to medication and were shown the action plan for dealing with the outstanding medication issues. We consider that three requirements about medication from the January 2009 were actioned. Some actions have been taken on the remaining three requirements and we saw further action already put in place but we could not judge them as fully met so on this occasion we will repeat these but will expect full compliance at next inspection. We observed staff speaking to people in a respectful manner. The home had ‘seat covers’ on the armchairs in communal rooms. This is institutional practice and must cease. With proper management of peoples continence needs these are not required. Also for visitors to the home it could Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 19 give the impression that the home is not able to manage people’s continence needs. During the sofi tool observation one person fiddled with a seat cover, folding and unfolding it to keep their hands occupied. This is not good practise and the staff should have noticed this and provided this person with some activity. Also during the sofi one person who had left the room reappeared with their catheter bag showing from below their trouser leg. A person living in the home pointed this out to a member of staff who looked as though they were going to attend to this but left it showing. This did not promote the dignity and wellbeing of the person. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can make some choices about their daily life where as others are made by the staff. Recreational interests and social input for some people is improving but this is not the case for all people. EVIDENCE: The home is still looking to recruit a full time activities coordinator: at the time of this inspection they have 3 ½ days cover per week. Outside entertainers visit to include weekly music and movement session. A poster was seen advertising a bingo session that took place several weeks prior to this inspection. The hairdresser was visiting the home on one of the days during the inspection and people were seen enjoying this. However due to confinements of space this has to be done in one of the communal lounges, which is not good practice as people eat meals in this room but we were told the room is cleaned prior to people using it once the hairdresser has finished. The majority of people have had ‘life histories’ completed and the home is going to use these to help plan activities. One good example of this was one Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 21 person used to be involved with the Salvation Army. When the home found out about this from their life history they contacted the Salvation Army and they sent someone to visit this person. The home needs to make sure that they have documented this fully so they demonstrate how the life histories are being used in this way. We did not follow up how people’s spiritual needs are met at this inspection. We were informed by the deputy manager that no restrictions are placed on visiting. We did see several visitors in the home and one visitor did confirm they are free to visit at a time convenient for them. During the tour of the environment we saw a number of people’s belongings on display in their rooms. We did witness staff offering people choices and this is confirmed during the Short Observational Framework for Inspection (SOFI). The results are as follows; It was a very hot day and staff had opened windows and provided a large fan to attempt to cool the room. One person chose to sit outside in the garden and staff monitored them advising use of sun cream or covering up. People had access to cool drinks in addition to their normal tea/coffee break. Staff were observed encouraging people to drink and kept topping up glasses. Staff appeared to be completing fluid charts. Interactions with staff were mostly brief and automatic, asking people what they wished to eat, drink or how they were. Staff were polite. There were some good exchanges when people happily engaged with the member or members of staff or visitors. For instance during the two hours, staff were interacting with people for 35 of the time frame and of these interactions 71 were positive. Overall people were engaged with other residents for 38 of the time frame. The group of people observed were having positive interactions for 54 of the time frame, with one person interacting with others for 26 of the time and another engaging only 10 . This impacted on people’s state of wellbeing and it was evident that some people withdrew from lack of contact with others but when staff or residents engaged with them they became animated. People were observed enjoying the music which was playing with some singing along. There were no activities provided for people during this time. People did not have access to magazines, newspapers or books. One person fiddled with a seat cover, folding and unfolding it to keep their hands occupied. After the observation had finished a member of staff opened a cupboard containing games and puzzles and asked one person if they would like to do a puzzle. It was almost lunch time at this point. Staff were observed giving people choice about their lunch time meal and there appeared to be a great deal of flexibility if they did not want the two meals on offer. Cool drinks and hot drinks were provided. There appeared to be little choice about this as the option was either orange squash or tea/coffee. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 22 Biscuits were provided with a hot drink and staff were observed putting two digestive biscuits on a plate by hand. This has infection control implications in addition to lack of choice. Staff had responsibility for setting the tables for lunch; there was no involvement of people living in the home in this process. During the tour of the environment we observed in another smaller communal room which is through the key coded door near the kitchen two members of staff were sat with people. However one was writing in care records and the other was reading the paper. No interactions were observed at this time with people sat in this room. One staff member was an agency member of staff. We did observe two members of staff eating their meals in the communal dining room/lounge after people had finished their meals. Staff need to take their breaks away from communal areas and the staff are using rooms that are for people who use the service. If the staff members were eating at the same time as people who use the service then this would be viewed as acceptable practice. The nurse office is very small and cluttered and is close to the main entrance where it is difficult to discuss any private or sensitive issues. Since the last inspection the home has designated a private room for this purpose and this room will also be used for relatives at a time of bereavement. This is good practice. We spoke with the cook on the second day of the inspection and she said she is in the process of reviewing the existing menus. On the first day of the inspection people were offered 2 choices and on the second day people were offered 3. But the food records do not accurately reflect this or other snacks that the home is actually providing people. The food records need to also include snack choices, sandwich filings and the flavour of soup that is offered. We tasted a meal on the second day of the inspection and found it to be very tasty and well cooked. We observed a mealtime and people were seen to be enjoying the food provided and we also asked a number of people and they said they enjoy the food. People are able to have a cooked breakfast if they request it. The cook said she is informed about people who require therapeutic diets and these are written up on a notice board in the kitchen. High calorie milkshakes are now provided to people who are assessed as being nutritionally at risk. We observed staff handing out snacks to people on one of the afternoons of the inspection. We did observe staff walking around the home with trays of puddings that were not covered; best practice would recommend from an infection control risk that the puddings are covered. The home has been awarded 3 stars from the local Environmental Health Department. Health and safety checks were taking place. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service or their representative are able to voice their concerns and have access to a complaints procedure. Improvements have been made with the system the home has in place to prevent people from being placed at possible risk of harm or abuse. EVIDENCE: A copy of the home’s complaint procedure is on a notice board of the main entrance and has been amended since the last key inspection. At the last inspection we commented about this policy being positioned high up on the wall and in small print. This was the same at this inspection. A notice is also on this notice board informing people that a ‘comments’ book is available. Auditing of complaints is now taking place by the Registered Providers. We were shown that the home has received 5 complaints since our last key inspection. Records and copies of correspondence were in place for any written complaints but for some of the verbal complaints there was not always any documented details about the actions taken. We spoke to several people who said they did not have any complaints about the home or staff. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 24 Since the last inspection all but one member of staff has received training in safeguarding vulnerable adults. The remaining member of staff does have a date booked for this training. Training provided has been either in-house or external where so far 18 staff have attended the local County Council’s ‘Alerters’ training. Plans are in place for all staff to undertake this course. The home’s policies and procedures for safeguarding vulnerable people were not examined at this inspection as they were read at the key inspection in January 2009. Staff spoken with confirmed they knew about the content of the whistle blowing policy. Following on from the last key inspection where concerns with safeguarding of people were identified the local County Council are aware and remain involved. As part of the new care planning format records will be made of people’s ability to consent and make informed decisions. This process has not yet started and the deputy manager said she has contacted some external health care professionals to assist them with this. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design of part of the home enables people to move about safely and apart from a few minor concerns people live in a comfortable environment. EVIDENCE: A tour of the environment took place with a number of rooms belonging to people seen. The part of the home that is designated for people with dementia had signs to indicate toilets and bathrooms and the doors were all painted in a red. On people’s doors were pictures of them to help people recognise their room and their names. The home has both assisted baths and showers which enables people to make a choice. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 26 The home has 49 rooms, 5 of these are classed as doubles and 33 have ensuite facilities. All bedrooms we saw were adequately decorated and furniture and fittings were in reasonable order. The carpets in the main entrance and into the communal lounge were heavily stained in places and the Registered Providers said these will be steamed cleaned and they are looking to replace these as they have redecorated some of the ground floor corridors. On both days of the inspection hoists were left in the main entrance and we were told this was for servicing; however it could give the impression to visitors that the home is cluttered. We found in a number of shower rooms bars of soaps which may have been left behind after people have been showered. However staff need to make sure they return these to people as they are an infection control risk if left and other people use them. Several bathrooms had equipment stored in there for example the bathroom by room 32 had a picture and commode, the shower room by room 45 had the carpet cleaner in it. We found a few bedrooms with mild odours and but room 31 was very strong. The person in this room was also watching the television but the reception was very poor. In room 47 the carpet finishes about one metre from the doorway but we could not find out the reason for this. We inspected the laundry room but the assistant was on a day off. The room is small and is cluttered. A system is in place to manage soiled linen. We saw evidence that the home has a contract in place for the disposal of continence products. Staff have access to protective clothing to include gloves and aprons and we observed staff using them when necessary. The days we visited the home we were experiencing a heat wave and people were being provided with fans in their rooms and in the communal areas. We spoke to a number of people and they said they were happy with their bedrooms. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that the numbers of staff on duty are meeting the needs of people who use the service. However not all staff as yet have undertaken all training pertinent to their roles and this can lead to shortfalls in people’s needs being met. EVIDENCE: Some of the staffing duty rotas were examined with the deputy manager. The numbers of staff have increased by an extra qualified nurse every weekday morning until midday. As at the last inspection an extra carer is on duty at weekends to help with the laundry as no laundry assistant is available. During this inspection the laundry assistant was on leave and this meant the care staff having to undertake this additional duty without an extra person. The deputy manager said this is shared amongst all staff including the qualified nurses. Agency staff is used to cover any vacant shifts. If the home does not meet their set staffing numbers then they must inform us under Regulation 37 of the Care Home Regulations 2001 as this could impact on the welfare of people who use the service. The deputy manager was confident that the numbers and skill mix of staff were meeting the needs of people. Staff are allocated to three areas in the home and this is recorded on the notice board in the office. Staff have to check with the nurse in charge before going to breaks to make sure Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 28 each area has staff cover, especially the communal lounge in the dementia section of the home. The duty rotas did not have a cook down for weekends but the deputy manager said they always have a cook on duty, this needs to be added. Staff spoken with said they enjoy working at the home and they feel there is a good team spirit. They felt that some staff need more guidance from senior staff than others. They also said that they felt the home has improved since January with staff taking more pride in their work. We spoke to a number of people who said the staff were very good. The number of staff with an NVQ 2 or above in Health and Social Care was not examined at this inspection. At the January inspection the home had not met this standard but they are looking to achieve this. The recruitment files of two recently appointed members of staff were examined. Both staff members had a POVA (Protection of Vulnerable Adults check) and Criminal Records Bureau Disclosure (CRB) in place prior to starting work at the home. Both had an application form in place. Written references were in place but for one member of staff one was lost in the post and a second had to be requested. The Human Resource Manager had verbally contacted the referee whilst waiting for the written reference and had made a record of this. Records of interviews are now being undertaken. We found there were gaps in the employment history of one member of staff as they had used years but more specific dates are required. The home is looking to put a documented system in place to appoint a suitably qualified and experienced staff member to supervise new staff members where they are waiting for the return of the CRB. A system needs to be put in place for all new staff to have a suitably experienced and qualified member of staff to act as their ‘mentor’ during their induction period. Where possible the mentor should work with the new member of staff. Records of this would also need to be maintained to demonstrate this is taking place. Since the last inspection the home has reviewed their induction training. An outside training provider is used and new staff attend a 3 day course. We were informed that this induction is based on the Skills for Care common induction standards and we were shown a copy of one of the booklets used by staff. All existing staff will also be attending this induction course. One new member of staff confirmed they had undertaken this course and one existing staff said they are due to undertake this course in a couple of weeks. At the random inspection we undertook in May we looked at training for staff in a number of areas to include challenging behaviour and dementia. We also saw records for some staff that had completed training in moving and handling and continence care was due in June. The training for staff remains ongoing in all areas and the last Regulation 26 visit report we received listed a number of Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 29 training sessions that have taken place to include; fire training, tissue viability, nutrition and first aid for qualified nurses. The home needs to consider training for staff in the Mental Capacity Act 2005 and Deprivation of Liberty. Records are maintained of each training session but the training matrix is still being devised. Staff confirmed they have access to training courses. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To help address the shortfalls within this service a competent and appropriately qualified person needs to be appointed to make sure the health, and welfare of people who use the service is promoted and protected. EVIDENCE: An applicant had applied to us to be considered for registration, however they were not successful. The Registered Providers have been actively recruiting a new manager and they are down to the final shortlist of candidates. Once appointed the new manager must apply to us to be considered for registration. The deputy manager is acting as the manager until a new manager is able to Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 31 start at the home. She told us they do have supernumerary time each week to undertake management tasks. Following the last key inspection the Registered Providers have been actively involved in the home to help with improving the outcomes for people who use the service. We did receive a detailed improvement plan following the inspection in January 2009 and regular updates in the Regulation 26 visit reports. However the home has not been successful in meeting all their planned target dates for addressing all the requirements we issued at that inspection. The Registered Providers were able to show us their action plan they have devised which is very comprehensive and covers all the outcome areas in our reports. They have also benefited from external input they have received into moving the home forward to make sure it is being run in the best interests of people who use the service. Surveys were sent out to relatives/representatives in January this year and they are in the process of collating the results and from this an action will need to be devised of any areas that are of concern to people. Regulation 26 visits (where the Registered Provider or a representative on their behalf visits the home to undertake an unannounced inspection and completes a report) are taking place and we are receiving copies of these. This must continue until we notify the Registered Providers otherwise. Audits of some of the services provided by the home have started to take place and these include care plan review, complaints, medications, accidents and night time activity. This needs to be progressed further to include for example the environment, activities and food provision. Policies and procedures are in the process of being reviewed and any additional ones will be added. Staff are being sent memos to update them on any changes and they are asked to sign them once they have read them. The system the home has in place to manage peoples monies could not be examined at this inspection due to unforeseen circumstances. At previous inspections no issues have been found with how these are managed. Staff supervision is underway with 13 staff having received a session since May 2009. A matrix will be devised to indicate when a session is due. Staff who are supervising other staff have received training but more is required. We followed up at this inspection any concerns from the inspection in January 2009 in relation to maintenance issues. We saw records of fire safety training and drills. The homes fire risk assessment was in place but we did not examine it in detail. Each person needs to have an evacuation procedure devised as this is not included in the new care planning format. We were informed that the portable appliance testing is due in July this year and the home does not have gas boilers as they are oil and these are serviced but we did see any records of this. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 32 Qualified nurses have undertaken first aid training. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 33 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 N/A X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 N/A 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 2 X 2 Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 34 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 The registered person must complete the review and implementation of the new care planning system for all residents. This is in order that residents’ needs can be clearly identified so that they can be met in full. This requirement remains outstanding since the last two inspections. The registered person must revise and update the care plans on the basis of regular reviews, so that residents’ changing needs are reflected and can be appropriately catered for. This requirement remains outstanding since the last two inspections. The registered person must make sure that detailed care plans are in place for the management of wound care that includes ongoing evaluations. This will help to monitor peoples health needs and determine if Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 35 Timescale for action 01/10/09 2. OP8 15(2b) & 12(1a) 01/10/09 3. OP8 15 15/08/09 the wound is improving or not. This requirement remains outstanding since the last inspection. The registered person must make sure that any pressure relieving equipment is used safely and that staff have the knowledge and skills on how to use them correctly. This will help to make sure people are not placed at unnecessary risk. This requirement remains outstanding since the last inspection. The registered person must demonstrate that people are receiving mouth care based on their individual needs. 4. OP8 12(1) 15/08/09 5. OP8 12(1a) 15/08/09 6. OP9 13(2) This will help to make sure that people health and welfare are being monitored and that people are receiving mouth care. 31/08/09 The registered person must ensure that when any medication (including prescribed treatments for external use) is administered or applied to people who live in the home it is always clearly and accurately recorded. (This particularly relates to the shortfalls in records seen at the inspection and included in the text of the report). This is to help to make sure people receive their prescribed medication correctly and to help reduce risks of mistakes. Repeated from previous inspection when timescale for action was 28/02/09. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 36 7. OP9 13(2) The registered person must 31/08/09 ensure that the home tells us the outcome of its investigations to determine the reasons for the discrepancies noted in the controlled drugs record book. This is to make sure that these arrangements fully and accurately account for all medicines and there is a robust audit system in place. Repeated from previous inspection when timescale for action was 28/02/09. The registered person must ensure that for any medication labelled for use when required, as directed or with a variable dose, there is always clear written direction for staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. Repeated from previous inspection when timescale for action was 15/03/09. The registered person must ensure that there are full arrangements in the home to ensure the privacy and dignity of all people who use the service in all areas. (At this inspection this particularly relates to the use of seat covers in communal rooms, a persons dentures left on top of a cabinet in their en-suite and DS0000016643.V375812.R01.S.doc 8. OP9 13(2) 31/08/09 9. OP10 12(4a) 15/08/09 Uplands Nursing Home Version 5.2 Page 37 one person’s catheter bag on show and the staff did not attempt to rectify the situation.) This requirement remains outstanding since the last key inspection. The registered person must ensure that peoples’ needs and wishes are ascertained regarding their ‘end of life’ care, and recorded in specific plans of care. This requirement remains outstanding since the last key inspection. The registered person must ensure that care records are made and kept regarding residents’ ability to consent and make informed decisions, so that their rights and interests can be upheld at all times. This requirement remains outstanding since the last two inspections. In circumstances where new staff commence employment pursuant to the receipt of a Criminal Records Bureau disclosure the registered person must: Appoint an appropriately qualified and experienced ‘staff member’ to supervise the new worker, pending receipt of a satisfactory disclosure So far as is possible, ensure that the ‘staff member’ is on duty at the same time as the new worker; and Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the ‘staff member’. DS0000016643.V375812.R01.S.doc 10. OP11 12 (1,2,3) 01/10/09 11. OP18 13(6) 01/10/09 12. OP29 19 (11) 31/08/09 Uplands Nursing Home Version 5.2 Page 38 This is to ensure that only suitable people are employed to work with vulnerable residents and to promote their safety. This requirement remains outstanding since the last key inspection. The registered person must make sure that all the required recruitment checks take place prior to the new member of staff starting work at the home. This is with particular reference to a full employment history with written verification of any gaps. This will help to safe guard people against possible risk of harm or abuse. The registered person must make sure that for the duration of the new workers induction training they; Appoint an appropriately qualified and experienced ‘staff member’ to supervise the new worker, So far as is possible, ensure that the ‘staff member’ is on duty at the same time as the new worker; and Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the ‘staff member’. This is to help make sure that the new worker is monitored and that people who use the service are placed at unnecessary risk. The registered person must provide us (The Care Quality Commission) with a training plan for all staff for the next six months. This is with specific DS0000016643.V375812.R01.S.doc 13. OP29 19 31/08/09 14. OP30 18(2b) 31/08/09 15. OP30 18(1ci) 01/10/09 Uplands Nursing Home Version 5.2 Page 39 reference to all staff receiving training in dementia care, challenging behaviour, moving and handling and other subjects pertinent to the needs of people who use the service. This will help to make sure that staff are appropriately trained and skilled to meet peoples needs. The registered person must appoint a suitably experienced and qualified person to manage this service. This person must also apply to us to be considered for registration. This will help to make sure that the home is run in the best interest of people who use the service. The registered person must ensure that a structured staff supervision programme is implemented, so that staff can receive clear direction and support in their work, and so that their performance can be monitored for the benefit of the residents. This requirement has been partly met since the last inspection. 16. OP31 8 01/10/09 17. OP36 18(2a) 01/10/09 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 The home should devise a bed rail management system to DS0000016643.V375812.R01.S.doc Version 5.2 Page 40 Uplands Nursing Home 2. 3. 4. OP9 OP9 OP9 5. OP9 6. 7. 8. 9. 10. OP11 OP16 OP16 OP28 OP30 11. OP36 12. OP38 make sure people are not placed at risk. We recommend the home contact Health and Safety Executive directly or use their website. Make sure that the allergy box on each medicine chart is always completed accurately. Where creams or ointments are stored in bedrooms carry out written risk assessments to make sure the arrangements are safe for everyone in the home. Write the date on containers of any medicines when they are first opened to use and record the quantity of any stocks of medicines that are carried forward to the next medication cycle. This is to help with good stock rotation in accordance with the manufacturers’ or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. Review and update the medicine policy and local procedures and make sure this is readily available so as to provide all staff with clear direction about the way medicines are safely managed and handled in this home. The registered person should ensure that all staff are given training in ‘End of Life’ care for dying residents. The registered person should ensure that the Complaints’ procedure is displayed more accessibly on the notice board. Detailed records should be made of any actions taken following verbal complaints. 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 there is: Ongoing competency assessments for staff, particularly for new staff A training matrix to plan, implement and monitor a suitable training and development programme for all staff Training for staff is sourced from accredited external training providers. The registered person should ensure that staff supervision being given at least 6 times each year and a matrix being devised to plan and monitor the progress of the programme. The registered person should ensure that clear records are maintained and available of all maintenance undertaken and of all checks on utilities and equipment. Uplands Nursing Home DS0000016643.V375812.R01.S.doc Version 5.2 Page 41 Care Quality Commission South West PO Box 1251 Newcastle Upon Tyne NE99 5AN National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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