Inspection on 09/10/06 for Uplands Nursing Home

This inspection was carried out on 9th October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Uplands Nursing Home 30/06/09

Uplands Nursing Home 07/01/09

Uplands Nursing Home 02/04/08

Uplands Nursing Home 16/04/07

Uplands Nursing Home 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 Janice Patrick Key Unannounced Inspection 02:30 9 & 12th October 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Uplands Nursing Home DS0000016643.V314867.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.V314867.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 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Graham James Rigby Mr Michael Welch Care Home 50 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (21) of places Uplands Nursing Home DS0000016643.V314867.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. 14th January 2006 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 those 65 years and over are catered for; these include general personal and nursing care, care of those with dementia within a designated unit. Three places are allocated to the care of those under the age of 65 years whose illness falls within the skills of the home. The current fees as from August 2006 range from £311.85 to £625.00. The home at the present moment does not display its previous inspection report. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days initially by two inspectors who visited the home at 02.30hrs to 10.15am. On the second day one Inspector completed the inspection and was in the home from 09.15am to 3pm. 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. The Registered Manager was not present during this inspection but other senior members of staff including one of the Registered Providers were all extremely helpful. This inspection mainly concentrated on the care within the dementia unit so Inspectors observed a lot of the interaction between residents and staff, but spoke directly to residents who were able to converse. Several members of the staff team were spoken to throughout the inspection. Residents’ records of care were inspected and these were cross-referenced with the actual care being delivered. Other records also inspected related to the safekeeping of residents’ monies, staff recruitment, training and complaints. The staff duty rosters were also inspected. The homes medication system was inspected and some administration of medications observed. A tour of the premises was carried out. Also inspected during this inspection were specific records relating to a complaint recently received by the Commission. Information gathered in relation to this complaint has been added to the appropriate evidence sections within this report. Any requirements or recommendations made as a result have been included within the requirement section at the back of the report. These will be pursued with the Registered Persons to ensure compliance with the Care Home Regulations 2001. What the service does well: Clear information is given to those responsible for the finances of the residents. The home generally has a low turn over of staff and therefore staff members get to know the residents well. Access to the local GP surgery and Community Nurses is well established. The medication for the home is stored safely and the system is audited well. Residents are helped to make choices for themselves and try to meet the preferences of those who are unable to do this for themselves. The Registered Person responds quickly to any complaint made. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 6 The service provides an environment, which continues to improve and which meets the needs of the residents well. The home is cleaned well and arrangements are in place to reduce cross infection. Correct recruitment practices ensure residents are protected. Residents’ pocket monies are well looked after if handed over for safekeeping. What has improved since the last inspection? What they could do better: Improve accessibility to updated information about the home and that of previous inspection reports. Be clear and transparent about what needs the home cannot meet and only admit residents when there is an agreement that the individual’s needs can be met. A system that provides comprehensive care planning which is inclusive of the resident if appropriate, which takes into consideration the views and wishes of their representative if appropriate and which staff contribute to and make reference to must be introduced. The above system must be correctly reviewed and the content must be relevant and appropriate. Individual risk assessments must provide information that shows staff how to minimise any risks to that person. Staff must have a clear understanding about when relatives are to be contacted regarding the care or health of their loved one. The Registered Person must be sure that staff are competent and trained sufficiently to make decisions regarding residents health care. Communication between senior staff and relatives must improve, particularly if the relative or resident is voicing a concern or is not happy about something. Staff need to be thinking more broadly about how they maintain residents’ privacy and dignity. Certain behaviour can become the ‘accepted norm’ within a care home, which if practiced outside would be viewed as compromising someone’s dignity or privacy. All staff must have their awareness increased as far as elderly abuse is concerned and know how to deal with such a situation or allegation in line with the protocol agreed by other agencies. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 7 Access to hot water at night must meet the needs of the residents and the heating levels need to ensure that all residents are kept warm at all times. The home must aim to have 50 of its work force trained to the nationally accepted level in care. Arrangements to ensure staff have first aid awareness would help to protect residents. The style and effectiveness of the management team must be reviewed. The home must be more imaginative in how it communicates with other interested parties and its staff. A format for planning how the home can improve its services, which demonstrates short and long-term goals needs developing. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not in place to make visitors aware that information about the home is available. The current information that should be available on request is currently out of date. Arrangements are in place to inform residents or their representatives of their financial commitments, what these include and of any contributions they are entitled to. Residents are assessed prior to admission to ascertain what their needs are. However, the Registered Manager may not have full control over the admission process. This home does not provide designated rehabilitation care. EVIDENCE: The home does not advertise that there is a Statement of Purpose available for visitors to read should they so wish to. There was no copy in the reception Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 10 area or any information telling visitors that this document exists. The copy seen in a file in the office was not up to date, however an updated copy has been subsequently forwarded to the Commission. Distribution of the Service User Guide was not discussed. Several examples of the homes invoicing of fees was seen. This included invoicing for extras such as hairdressing, chiropody and newspapers. The fee invoicing clearly states the client contribution and in the case of a resident paying all of their fee independently, the total amount. The homes terms and conditions state what is included in the total amount and what is not. The amount forwarded to residents for their Registered Nurse Care Contribution (RNCC) is stated on a separate letter and amended if the resident’s banding alters following assessment by the RNCC assessor. An example of a pre admission assessment was seen. This was not recorded on a form seen in previous inspections, but was in a free typed format. Most of the information required had been ascertained by the Registered Manager who had carried out the assessment. A past emergency admission did not take place until the Registered Manager had carried out an assessment of needs. However one emergency admission was accepted in the absence of the Registered Manager. In seeking clarification regarding the admission process of three further residents, the Registered Manager confirmed that he had carried out pre admission assessments but had not been happy to admit the individuals as he felt for various reasons the home would not be able to successfully meet their needs. This possible lack of control or confusion over the decisions made during the admission process was highlighted in the inspection report for June 2005 and was then discussed with the Registered Provider and Registered Manager and thought to be resolved. This brings into question again whether the correct decisions are being made during the pre admission assessment process. The decision to admit or not must be based on whether a competent person considers the home able to meet the individual’s needs. This has subsequently been discussed again with the Registered Provider and Registered Manager in order to seek some clarity and reassurances given that the Registered Manager has always had full control over the admission process. Consideration should be given to using a set format again for the pre admission assessment, which meets with standard 3.3 of the National Minimum Standards (NMS) so that all the criteria required is assessed. It would also be of guidance for any other staff that may have to carry this out in the absence of the Registered Manager. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. The assessed needs of the residents are not being sufficiently planned and documented in such a way that gives clear guidance to the staff that deliver this. There appears to be a basic lack of understanding in the concept of care planning. Residents do have access to external health care professionals in order to help their health care needs be met. The medication system is generally well organised, but the instruction to staff about the administration of two residents medication demonstrates that there is a lack of understanding in some areas of ‘good practice’ which if not challenged could lead to a culture of abuse through ignorance. Residents’ privacy and dignity is not always upheld. EVIDENCE: Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 12 The care files of three residents were selected for case tracking and included the care of the resident referred to in the complaint. This person’s care file contained a recognised assessment tool called ‘essential care component’ which was incomplete. This resident has complex needs but there were no care plans giving guidance to staff on how these needs were to be met. There was a very sparsely completed form called a night care plan. This was not relevant or was not being followed as it said the bedroom light should be out. During this inspection it was on. The file also contained a document called a risk assessment, summarising some of the situations that may be of danger to this person, but it did not go on to record how the risks were to be managed and minimised. Other documentation included a moving and handling assessment, but this was not signed or dated. Another residents care file contained the same assessment of needs, again incomplete. This had been completed in April of this year and states it should be reviewed monthly. There were no obvious review dates. This document showed that a pen erasing solution had been used on it, which cannot be legally used in any care documentation. Two records within this file had conflicting information, one said the resident ‘gets up twice a night’, and the other said she was totally immobile. The latter was also not dated. Several other references to assessments and care information were within this file but either not signed or dated. This was a common occurrence in several records within the home. Inspectors noted that this resident had lost 10kgs in weight within 6 months. Although it is understood that this resident is very frail there was no care plan indicating how this weight loss was being managed. This resident also had complex needs, in particular multiple wounds. The documentation for these had several shortfalls. The typed advice sheet detailing what dressings to be used on one specific wound was not signed. The typed account of the state of this wound does not record the dates that these reviews and judgements were being made. Records for another wound of the same resident mentions a health professional visiting but not the state of the wound. It goes onto record when the wound was redressed but not the state of the wound at each dressing. Records of another wound for the same resident has details of when the dressing was changed but again no description of the wound since 23/8/06. Another area being dressed had no description at all. There is no use of wound mapping for any of these wounds. This would provide a detailed description and form the basis of ‘good record keeping’ as required in the Nursing & Midwifery Council Code of Conduct and help staff determine whether their efforts to improve the wound sites are working. Another resident’s file contained the same assessment form but no care plans. A document called a risk assessment highlighted past aggression and a Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 13 tendency to trip, but again did not go on to explain how these risks would be managed. A moving and handling assessment had been completed but had no date. This resident had a rare form of dementia of which there was an explanation within the care file for staff to reference. This could help staff formulate individualised care plans for this resident because although fairly self-caring; there are specific problems associated with the type of dementia that the resident was exhibiting. A further resident’s file contained some care plans, however on crossreferencing these with the resident’s needs they were found to be not relevant, as the needs had increased. These care plans had however been reviewed monthly by a staff member commenting ‘no change’ in the care. This resident had also been assessed as being at high risk of developing pressure ulcers but no pressure relief action was being taken. Over a period of time the Inspector is aware that a lot of hard work has gone into trying to improve the information kept on each resident. After speaking with staff and key external health care professionals who have been involved with the home, there appears to be a misunderstanding in the use and purpose of the assessment format, ‘essential care component’. With this in mind there appears to be a basic lack of understanding in what a care plan is for and the importance of good record keeping. This would also apply to the risk assessments. A large amount of documentation is being generated which in some circumstances is not correct and in others the content is inappropriate. Several care files demonstrated that health care professionals are visiting the home. The District Nurse often visits to attend to some wounds. The local GP will visit when requested by the staff. This was one of the elements of the complaint being investigated during this inspection that a resident fell and was not assessed by a GP following the fall. The evidence gathered suggests that she was treated appropriately at the time and the attending nurse, who was qualified to make the decision, decided that medical intervention was not necessary. Some requirements and recommendations however have been made in this report regarding the care of a resident following a fall. Again there was a shortfall identified in the recording of the treatment given and a requirement has been made to ensure accurate record keeping. Several residents are receiving Chiropody care and the dentist will attend if needed. The home will make arrangements for optical care or residents can attend their own optician. More specialised health care professionals can be and have been accessed by the home. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 14 The storage, administration and recording of medication was inspected and observed. There was evidence to show that the Registered Manager audits the medication system. There was a photograph of most residents to aid identification. There were various ‘best practice’ documents for staff to reference. The homes own medication policy was present but did not show evidence of review since November 2004. There were separate policies for the use of creams and medication brought over the counter. A British National Formulary dated 2006 was available. The temperature of the fridge was within required limits and a record of daily readings was being kept. The room itself was locked, as were all appropriate storage cupboards and trolley. Inspectors were concerned to find a typed instruction to staff from a senior member of staff in the home advising them to ‘break down a resident’s anti biotic capsules and mix it with porridge or cornflakes’. It goes on to explain that the resident will not take this without it being disguised. A care plan had been written relating to ‘medication’ but was not adequate. Unless a multi disciplinary decision is made ‘in the resident’s best interest’ that prescribed medication should be administered in this way and a care plan clearly states why this is necessary and is signed by those in agreement, this is practicing ‘covert administration of medication’. Meaning, a resident is being given medication without their knowledge in a way that does not allow them the right to refuse it. Particularly, when caring for residents who lack mental capacity it maybe ‘in their best interest’ that a decision is made on their behalf. But unless this is correctly managed these residents are then open to abuse. Staff should also be aware that once a medication is not given in the form it was prescribed, its action and effect can alter and it is being used outside of its licence. Another typed message between staff speaks of medication being allowed to spill and it therefore only being given once a day ‘to make it last’ as opposed to the directions which were twice a day. The residents’ privacy and dignity is not always maintained. The following appear small examples, but are where practice could improve. The first was where a resident had pulled his legs up to his chest therefore showing his continence pad and bare legs. The bedroom door was wide open on a main thoroughfare and staff continued to walk by and glance in. The second was a lady who had made her way to the lounge for breakfast in a thin nightdress. Staff made reference to her maybe being cold but did not think to get her dressing gown. The third was during the night when a resident was helped to use a commode. Whilst using this the member of staff stood in the open doorway of the bedroom talking to a colleague. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 15 It was also noted that several female residents had been dressed without tights or stockings on. All toilets doors now have the ability to be secured by the person using the facility. Uplands Nursing Home DS0000016643.V314867.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to make daily choices and decisions within their individual capabilities. Visitors are free to visit at anytime and are able to remain a part of their loved ones lives. Residents enjoy the food provided and are given a choice, but the management of how it is served requires reviewing in order for meal times to be enjoyable for all. EVIDENCE: Many of the residents within the dementia care unit are unable to make many daily decisions for themselves; some are unable to make any. Staff were however, observed to be asking residents what they would like to eat at meal times and where they would like to go at various times of the day. There were examples where staff clearly knew the resident well and were taking the lead in helping the resident achieve their preference. Three residents who were not within the dementia care unit chatted to the Inspectors about what they do during an average day. Two in particular had Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 17 set routines. One was registered blind and partially deaf, so he valued being able to keep to his own set routine. The other resident was up very early in the morning because this is what he had done all his working life. Both confirmed they were content living at the home and felt that the staff understood them. The third resident said his sister visits when she can. He said he can choose what he wants for breakfast and staff ask him early morning what he would like for lunch. There are usually two choices and the food is good. He enjoys walking to feed the ducks and attends church on Sundays. He is also taken to a whistdrive. Several residents were seen to be free to roam in an environment that was safe for them to do this. There are examples of residents being free to form friendships or sit beside a particular favourite person. During this inspection two residents had received an invite to join the day centre next door. They were provided with some money and taken by staff in their wheelchairs. Several residents enjoyed a trip to Bristol Zoo last month. Residents are taken to the local pub for a meal. Staff said they have taken some residents to the local outlet to buy strawberries in the summer. The home had a summer fete. An entertainer comes in on regular basis to sing hymns and other favourite songs. One of the younger residents said he used to attend a day centre but after a while did not enjoy it, but commented it would be nice to be able to go somewhere, he thought the Manager was trying to sort something out. The activities co-ordinator has been in the home for several months now. She visits twice a week. She was not present within the dementia care unit during this inspection and it was evident that many residents would have benefited from some interaction or activity. Staff do provide activities when they are able to do so, but comments on the pre inspection surveys sent to relatives before this inspection would suggest that these are not always adequate or appropriate for their relative. A specific Communion service is held in the home on a monthly basis and the spiritual needs of a practicing Roman Catholic in the home are met separately. The kitchen was not inspected in detail but was seen and appeared very clean and organised. Breakfast and lunch within the dementia care unit was observed. Residents could eat where they wished. An incident at the lunch table resulted in one resident throwing her cutlery at another due to poor management of the situation and a lack of staff presence. Eight residents had been helped to sit at the table and one had been served before the others. Not understanding why this was and interpretating this as being forgotten, the others started to shout at each other, resulting in the Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 18 reaction described above by one very confused resident. The Deputy Manager said she had identified this problem before and had asked the staff to ensure all residents were served at the same time. A staffing shortage on this particular day may not have helped this (see staffing outcome). Uplands Nursing Home DS0000016643.V314867.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to respond to a complaint within the stated time frame, although not all of the recent complainant’s concerns were answered fully. The home has started to improve its staff awareness on elderly abuse, which will ultimately improve their protection. EVIDENCE: A complaint made to the Registered Provider by a relative was responded to within the appropriate time scale. The complainant remained dissatisfied with this response and made a formal complaint to the Commission. During this inspection information has been gathered in order to ascertain if there has been a breach against the Care Home Regulations. There has been and the relevant requirements and recommendations are included within this report. A separate response has been forwarded to the complainant. A summary of the events leading up to this complaint was within the complaint file, but no record of when it was received, when a response was given and by whom. This was the same with previous complaints in the file. One element of this complaint was evident in a previous complaint and further discussions will be held with the Registered Provider and Registered Manager to ensure compliance with the Care Home Regulations 2001. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 20 The home has made some arrangements to ensure residents are protected against abuse and to improve the awareness of their staff on this subject. One member of the senior management team has completed the ‘enhanced alerters’ training, which was provided by the county’s Adult Protection Team. She has begun to cascade this training to day staff, but two night staff confirmed that they have not attended this training. The homes Adult Protection Policy was reviewed in June 2005 and now needs to make reference to the Adult Protection Team, the CSCI and the Department of Health’s document ‘No Secrets’. Uplands Nursing Home DS0000016643.V314867.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 & 26 Adequate The environment is being improved and maintained to provide a pleasant place for residents to live. Arrangements have been made to provide well-appointed communal space for the residents to relax. There are not adequate arrangements in place to ensure hot water is available when needed. The staffs’ awareness is poor in relation to whether some individual residents are warm enough. Adequate arrangements are in place to promote infection control. EVIDENCE: Although this outcome has been assessed as adequate the more specific information gathered relating to the supply of hot water and the use of the heating must be reviewed as soon as possible by the Registered Provider. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 22 The environment of this home continues to improve. A large number of bedrooms now have laminate flooring, a decision taken by the Registered Provider to try and eliminate odours and make cleaning of the home more effective. Some bedrooms in the main house still require decorating. The large main lounge within the dementia care unit has just had a new carpet laid. Refurbishment of the first floor of the main house is now complete. The lounge in the main house has been enhanced with the addition of patio doors onto the front garden area. During a visit to the home earlier this year this room was proving to be a favourite for many of the residents, who were also enjoying being able to look out onto the main road going through the village. Maintenance jobs and ongoing improvement jobs are delegated to the maintenance staff an example of which was forwarded to the Commission. Delegation of the hours and work between the two care homes owned by this provider has yet to be decided. During this inspection the Inspector met the maintenance person. It was explained that many of the health and safety checks that were carried out by the previous maintenance person would recommence once the Registered Provider returned from his holiday. At the time of this inspection the maintenance person was awaiting delivery of two hot water regulators, which are needed to keep the hot water that comes out of individual taps in the home at a safe temperature. Once he had received these they were to be fitted. Hot water tested at three outlets during the daytime hours, within the dementia care unit, was within the advised 43Celcius (to prevent scalding to older skin). It was noted that during the night and very early hours of the morning the staff and residents do not have access to hot water. Inspectors who tried the hot water taps in several bedrooms during the night were unable to access hot water. Staff confirmed that they have to boil a kettle of water if they need to wash a resident who has been incontinent and two residents who dressed themselves on waking before 06.30am were unable to access hot water for a wash. There is a high degree of incontinence within this home and a lack of hot water must compromise the staffs’ ability to give good skin care in a manner that is pleasant for the resident at night. Since this inspection the Registered Provider has explained that he was unaware of any problems with access to hot water at night as he was under the impression the boiler was producing hot water continuously. Since the inspection a different problem was identified with the boiler and a new one has been installed. Confirmation of this work has also been forwarded to the Commission and reassurances given by the Registered Provider that hot water is available 24 hours of the day. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 23 On arrival of the Inspector the second day the heating was off at 09.15 hrs. One resident was extremely cold to the touch in his bedroom, where staff had also opened the window and other residents in the lounge areas were cold to the touch. Staff commented that it had got too hot so some radiators had been turned down. The Registered Provider explained that it is a difficult time of year to know when to have the heating on. Despite all of this some residents, one in particular were cold. Staff must improve their awareness of how easily older people drop their body temperature particularly if they are sitting still, such as the resident in his bedroom. As the weather gets colder it must be remembered that many of these residents wander at night. The heating was switched back on when requested at this inspection and the Registered Provider has subsequently confirmed that the heating is on both day and night. The home has appropriate arrangements in place for the disposal of clinical waste. Cleaning staff were on duty at the time of this inspection and are organised by the housekeeper. The home appeared generally clean The laundry room was fairly tidy and has hand-washing facilities. The laundry person was also on duty during this inspection. The kitchen assistant was observed serving breakfast wearing appropriate kitchen whites, but covered with a blue plastic apron when out and about in the main body of the home. Care staff wear plastic aprons when serving food to residents to reduce the risk of cross infection. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are usually in place to ensure the home is adequately staffed and that all areas of the home have a staff presence. The home has begun to improve its arrangements for training staff to a nationally recognised level in care. A small amount of staff however are not receiving adequate training/updates in basic trainings. Correct recruitment practices are helping to protect vulnerable residents. EVIDENCE: Although this outcome has been assessed as adequate the home must make every effort to ensure all staff receive the training required to perform their tasks competently and safely. On the second day of this inspection during the daytime hours the home was extremely short of staff at the beginning of the shift (08.00 hrs). The Deputy Manager had returned from holiday, the home had six care staff booked to work and two care staff plus the main kitchen assistant went off sick. The staffing levels were improved later in the day. It would appear that the Registered Manager had worked his last day before his holiday, four days prior to the Deputy Manager’s return and following this no one had ensured that the staffing levels were complete. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 25 The Deputy Manager who is responsible for organising the staff rotas strongly believes that the home runs smoothly when eight care staff are on duty in the morning plus a registered nurse. She argues that the nurse should not be included in the main staff numbers as there is medication to administer, other nursing tasks to perform as well as the overall management of a 50 bedded home. In the afternoon until 8pm the home normally has six care staff and a nurse on duty. The complainant was concerned about the numbers of staff on duty at night. Misleading information had been given to this person giving the impression there were only two staff on duty in the home. The home is in fact staffed with four staff at night who work in two teams. On the night in question two staff were located in the dementia care unit and the other two were responsible for the main house. The home has been staffed to these levels since the CSCI made a requirement to this effect in June 2005. There are only two care staff who hold the National Vocational Qualification (NVQ) in care. The home has been let down by colleges in the past who have not been able to provide NVQ assessors. The situation has now improved and the home has its own assessor with a link to a college. Confirmation that five staff will be commencing their NVQ training was given. The recruitment files of three care staff were inspected. All documents required by the Care Home Regulations were present including Criminal Records Bureau (CRB) clearances along with checks against the Protection of Vulnerable Adults (POVA) list. Formal induction training has now begun for new care staff, however newly employed nurses do not receive this training. Completed induction records were seen for two staff and it is planned for all existing staff to go through the process. This will serve as a refresher on policies and procedures including other expectations of the home. The records for the new recruits demonstrated that key mandatory training had been completed. This included fire awareness training, safe moving and handling training and in the case of the kitchen assistant training in food hygiene. One of these staff members had received training in the Protection of Vulnerable Adults. A lot of training on dementia care awareness has been supplied by one of the Community Psychiatric Nurses (CPN) and remains ongoing, although all the night care assistants spoken to had not received this. Included in this training is some awareness of challenging behaviours. Uplands Nursing Home DS0000016643.V314867.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. The home is not always being competently managed, staff are not always receiving correct guidance and residents are not always receiving the correct care. The Registered Manager is not communicating effectively to staff and other interested parties resulting in weak leadership that ultimately puts residents at risk and causes concern to relatives. Arrangements are in place to seek the views of relatives and some residents regarding the services the home provides, although there is no format in place as yet to collate this information and identify areas that need improvement. Residents can be assured that their personal monies are kept safe. Staff are not receiving adequate supervision to ensure the care they are delivering is in accordance with ‘best practice’. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 27 Arrangements are in place to help the home run safely, although some specific areas require review to ensure compliance is being met and residents are protected. EVIDENCE: Following information gathered during this inspection there are serious concerns about the style and effectiveness of the management within the home as evidenced by the significant number and type of requirements made in this report. This is affecting the smooth running of the home and the home’s ability to meet compliance with the Care Home Regulations. This ultimately affects the care being given to the residents and warrants further discussion with the Registered Provider and Registered Manager with the Commission following receipt of this report. Comments on the relatives’ pre inspection survey sent out by the Commission indicated that visitors have a problem locating a member of staff to talk to. One of the elements of the complaint investigated during this inspection was the difficulty a relative had in achieving a response from a senior member of staff when she was seeking information about her relative and then the indifference afforded to her by this member of staff. It has been noted that the home does not organise relative or resident meetings. The residents and relatives views on the care and services provided by the home are sought by the home as part of a quality assurance exercise. Survey forms were sent out in August of this year. The returned surveys seen during this inspection were very complimentary to the home generally and about the care provided. This information has not yet been collated and an action plan has not been compiled to improve any weaknesses that maybe identified. There was a staff meeting at the end of August to which night staff were invited but not represented. There is clearly a ‘them and us’ culture between day and night staff in this home, which has not been conducive to its smooth running. This is evidential in the training records for night staff and is being compounded by the lack of formal supervision being given to this group of staff. The management team need to be more imaginative in how they are going to enable inclusion of these staff. Formal supervision also needs to commence for day staff including qualified staff and serious consideration should be given to recording this. The Registered Persons aim to ensure the home is running safely by adhering to the requirements of the Fire Officer, although it was noted that three corridor fire doors, which were closed at night, were not closing properly and one automatic door closure was indicating its battery was low. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 28 Staff are receiving ongoing training in fire awareness which was confirmed by the night staff on duty. The Registered Person needs to ensure that adequate arrangements have been made regarding First Aid training as the home cares for a high-risk group of residents that are prone to falls and injuries. The Registered Manager audits all accidents and falls the last period being between December 2005 and July 2006. Out of 93 incidents, 53 occurred at night. Although these accidents are being recorded in the home, notification to the Commission has not happened. A senior member of staff in the home was unaware that this was required within the Care Home Regulations. Notification of the incident relating to the complaint was not made to the Commission including two other serious injuries to residents, which have occurred within the last 6 months through falls. Infection control training has been given to some staff but not all. Records of servicing all main utilities have been seen in past visits and were not requested during this inspection. Windows seen by the inspector during this inspection were restricted. All potentially harmful products are securely stored to avoid misuse by confused residents. The Registered Provider will be requested to demonstrate to the Commission that records pertaining to hot water checks, emergency lighting checks, fire alarm checks, call bell system checks and the reduction of the risk of Legionella have commenced with the new maintenance person over a period of the next two months. The information being generated as ‘individual risk assessments’ is not demonstrating how the risks are to be managed and reduced. Serious consideration should be given to further training on this subject. Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 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 2 17 X 18 2 3 3 X X X X 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 1 X 2 Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 01/03/07 2 OP9 13(2) 3 4 OP10 OP15 12(4)(a) 12(1)(b) The Registered Manager must ensure that each resident has a written care plan demonstrating how his or her individual needs are to be met. These must be devised after consultation with the resident or their representative where possible These must also be kept under appropriate review. (Care plans relating to wound care must give an accurate record of the state of the wound and the date the wound is reviewed) The Registered Manager must 01/03/07 make arrangements to ensure the administration of medication is carried out safely and within ‘best practice guidelines’ (This is with particular regard to where a resident lacks mental capacity) The Registered Manager must 01/03/07 ensure the residents privacy and dignity is maintained at all times. The Registered Manager must 01/03/07 make arrangements to ensure DS0000016643.V314867.R01.S.doc Version 5.2 Uplands Nursing Home Page 31 5 OP16 22 6 OP18 13(6) 7 OP25 12(1)(a) 8 OP28 18 (1)(c) (i) 9 OP30 18(1)(c) (i) residents are suitably supervised. (This is with reference to when meals are being served and eaten) The Registered Persons must ensure that each complaint is fully investigated and a full written response is forwarded to the complainant. That a record is kept of the action taken, the date it is taken and by whom. The complaints procedure must be accessible to all residents. (This includes in appropriate format, to the resident who is registered blind). The Registered Manager must ensure that the arrangements in place to protect residents from harm or abuse are known to all staff. (This is with particular reference to night staff or staff who are not responding to a request to attend training). The Registered Persons must make proper provision for the residents’ health and welfare. (There must be adequate hot water available to wash a resident at anytime of the day or night. The heating system must keep the residents warm at all times). The Registered Manager must make arrangements to ensure staff receive training appropriate to the work they perform. (50 of the care staff should be trained to a nationally accepted level i.e. NVQ Level 2 or equivalent). The Registered Manager must demonstrate that all staff receive formal induction training. A suitably competent person DS0000016643.V314867.R01.S.doc 01/03/07 01/03/07 01/03/07 01/03/07 01/03/07 Uplands Nursing Home Version 5.2 Page 32 10 11 OP31 9 12(5)(a) OP32 12 OP33 24(1) (2a-c)(4) 13 14 OP36 18(2) 17 Schedule 3(3)(o) OP38 15 OP38 17 Schedule 3(3)(j) 37 16 OP38 must supervise the newly appointed person for the duration of their induction until they are proven to be competent. The Registered Provider must ensure that the home is competently managed. The Registered Manager must ensure the home is managed in such a way to promote good relations between himself, the Registered Provider, residents and other staff. The Registered Persons must make arrangements to establish and maintain a system for evaluating the quality of services provided. It must demonstrate within a report what measures are to be taken to improve these services and provide a copy of this report to the Commission. The Registered Manager must ensure all staff receive adequate supervision. The Registered Manager must ensure that accurate records are kept of treatment given to residents. (This is with particular reference following accidents or falls). The Registered Manager must make arrangements to ensure all incidents, accidents & falls are accurately recorded. The Registered Manager must ensure all incidents, accidents and falls that adversely effect the resident or the smooth running of the home must be reported to the Commission and any other relevant agency. 01/03/07 01/03/07 01/03/07 01/03/07 01/03/07 01/03/07 01/03/07 Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 33 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 OP3 Good Practice Recommendations A set format should be adopted for the recording of a pre admission assessment, which meets with standard 3.3 of the National Care Home Standards. A recognised form of wound mapping should be used for all pressure related wounds and leg ulcer. All staff administering medication should update themselves on guidelines produced by the Royal Society of Pharmacology on ‘covert medication’ Consideration should be given to commencing resident/relative meetings. A written record of at least six supervision sessions per year should be maintained each year. 2. 3. 4. 5. OP7 OP9 OP32 OP36 Uplands Nursing Home DS0000016643.V314867.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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