Inspection on 29/09/08 for Victoria Highgrove

This inspection was carried out on 29th September 2008.

CSCI found this care home to be providing an Poor 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

Victoria Highgrove 26/02/09

Victoria Highgrove 04/03/08

Victoria Highgrove 11/12/06

Victoria Highgrove 07/12/05

Victoria Highgrove 23/06/05

Victoria Highgrove 04/02/05

Victoria Highgrove 03/08/04

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 06/12/2008.

CARE HOMES FOR OLDER PEOPLE Victoria Highgrove 59 Dyke Road Avenue Hove East Sussex BN3 6QD Lead Inspector Elizabeth Dudley Unannounced Inspection 29th September 2008 07:30 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 Victoria Highgrove DS0000014071.V370598.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. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Highgrove Address 59 Dyke Road Avenue Hove East Sussex BN3 6QD 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) 01273-562739 01273-882818 sueknights.victorianursinghome@virgin.net Victoria Nursing Homes Limited Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability (23), Terminally ill (23) of places Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-three (23) Service users must be older people aged sixty-five (65) years or over on admission Service users may have a physical disability Date of last inspection 30th July 2008 Brief Description of the Service: Victoria Highgrove (the Service) is registered to provide nursing care and personal care for 23 older people. The premises are a detached four-storey property. All of the people in residence have their own bedroom. All of the bedrooms have a private wash hand basin and toilet. All but one also has a private bath or shower. There is a passenger lift that gives step-free access around the accommodation. There is a call bell system. This enables people to contact a member of staff if they need assistance. There are various items of equipment such as hoists to help people who experience reduced mobility. The property stands in its own gardens. It is set back from the main road. There are no shops within easy walking distance. Hove town centre is about one mile away. There is a bus stop just outside the Service and there is some off-street parking. The Registered Provider is a private limited company. It operates four other similar services in the area. People who might want to move in can get information from several sources. There is a Service Users’ Guide. This is a brochure that outlines the principal features of the facilities and services available in the Service. There is also a document called a Statement of Purpose. This gives a more detailed account of the provision in place than does the Guide. The Registered Provider ensures that a copy of the most recent Inspection Report from the Commission is available for reference. The home currently has 15 block contract beds with the Local Authority and Primary Care Trust to admit residents under the transitional care scheme. This means that they provide ongoing rehabilitative care for people that have been in hospital in order to enable them to return home. The range of fees charged currently for each person’s residence in Victoria Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 5 Highgrove runs from £625 to £765 per week. Daily rates are available for short stays. The actual fee charged depends upon the source of funding, the bedroom occupied and the amount of assistance required. The fee includes the provision of accommodation, nursing care, personal care, catering and laundry. It does not include items such as the purchase of toiletries and other services such as consultations with the hairstylist. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took place on the 29th September 2008 over a period of seven and a half hours. The pharmacy inspector, who examined medication records, within the home accompanied the lead inspector. The deputy manager and director of nursing facilitated this inspection. Methodology used to inform the judgements made in this report included examination of documentation which included care plans, medication records and other documents required to ensure the smooth running of the home and to ensure the safety of residents. A tour of the home was undertaken and discussions took place with ten residents, six staff and two visitors to the home. Information about the home was received from health care professionals prior to and following the inspection. The home was not asked to provide an Annual Quality Assurance Assessment prior to this inspection. Residents and staff are thanked for their courtesy, help and hospitality during this inspection. What the service does well: The service provides a pleasant and clean home with all residents being accommodated in single rooms with ensuite facilities. Residents receive newspapers and can make local phone calls free of charge. Residents spoken with generally said that the standard of catering was good: “Very good food and there is some choice” and menus showed that there was a good variety of food offered. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 7 All residents seen appeared comfortable and they spoke well of the attitude and helpfulness of the majority of the staff: “The staff are very good”.” Most of the staff are very polite and helpful”. “The staff work as a team”. The home admits residents for intermediate care from hospitals, which means that residents come to the home to have rehabilitative care prior to going back to their own homes. The Primary Care Trust provides a retained General Practitioner, Occupational Therapists and physiotherapists for these residents. What has improved since the last inspection? What they could do better: There were several areas noted in which improvements are required. The requirements from the last inspection have not been complied with and these have been repeated. The CSCI may take further action. Requirements at this inspection have been made regarding the Statement of Purpose, which does not fully reflect the homes recent changes, particularly in relation to Intermediate care. All residents should be given a copy of the home’s ‘ Terms and conditions of residence and contract’. Care plans did not fully reflect the care which is required to be given to residents or instruct staff in the manner in which this is to be given. There were some practices in the administration of medication which do not fully safeguard the residents. Requirements made at a previous random inspection undertaken to assess medication administration had not been complied with. There is more scope to expand the provision of leisure activities. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 8 Amendments to the adult safeguarding policy are required and the home has not informed the CSCI of issues regarding safeguarding. Some aspects of infection control require to be addressed, these were found to fall short of acceptable levels of practice. Staff training, in particular induction training, requires attention and only one member of staff has the National Vocational Qualification level 2 in care. The majority of training for care staff is provided ‘in house’. Care staff had received insufficient training in the management of the postoperative conditions with which residents were being admitted. Recruitment procedures are not sufficiently robust to safeguard the residents. There were no records of regulation 26 visits in the home since February 2008; these are visits, which the provider is required by regulation to undertake on a monthly basis. There were health and safety aspects, which require addressing. Both inspectors were able to walk into the home through an unlocked entrance door. All rooms including the kitchen and laundry had their doors wedged open, which could put residents at risk in the event of fire. Several windows had their window restrictors broken. Staff are unable to use correct moving and handling techniques in some cases due to the unavailability of variable height beds. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Victoria Highgrove DS0000014071.V370598.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 Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience adequate quality outcomes in this area The Statement of Purpose does not accurately reflect the current admission categories of the home in full or give any information regarding the processes involved regarding the individuals admitted into the contracted beds. The Service User Guide contains information required by regulation and information for residents regarding the routines of the home. All residents receive a copy of this document on their admission to the home The home does not currently assess those residents admitted for transitional care, and in some cases the assessment by the home on admission of the individual and the care planning for this individual have been delayed. The terms and conditions of residence do not provide residents with sufficient information, and would not protect the home or the resident in a legal situation. This judgement has been made using available evidence including a visit to this service. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Statement of Purpose provided by the home requires some amendment to reflect the current staff that work in the home. Whilst this document states that the home is contracted to provide fifteen contracted intermediate care beds for the Local Authority and Primary Care Trust, it does not specify the type of residents that will be admitted under this scheme, or the processes that this will incur including pre admission assessment. The Service User Guide contains the information that is required by regulation and provides information to residents about the daily routines of the home. A copy of this is provided to all residents on admission. The home produces a contract and Terms and Conditions for people admitted for permanent and respite care but does not extend its Terms and Conditions of Residence to those admitted under Intermediate Care, this should commence. The Terms and Conditions of Residence should be expanded into a comprehensive document which includes the contract and a summary of the fees, and which would support the home and the resident in the event of legal action. The home does not assess any of the Intermediate Care residents; the director of nursing said that they relied on the assessment done by the Intermediate Care Team at the hospital, and then they have a specific amount of time to decide whether they are able to admit the individual. It was noted that the homes’ assessment was not undertaken until, in some cases, the day after admission. i.e. one resident was admitted to the home on the 13/08/08 but the admission assessment and care plan was not commenced until 14/08/08 and another resident was admitted to the home on the 3/9/08 but the assessment and care plan was commenced on the 4/9/08 – this gives a time scale of at least 12 hours before care that is identified as required by the registered nurses in the home is commenced. Staff said they did not receive much training on postoperative orthopaedic care but they had one lecture of caring for people with hip replacements. There were no definitive details in the care plan about how to care for people who have had this operation. The home had also admitted a resident with a diagnosis of Alzheimers disease and the home is neither registered for this or has the staff with the knowledge Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 12 to meet the needs of people with this health condition. The care plan did not reflect the specific needs of a person in this instance. The Director of Nursing said that other residents admitted for permanent or respite care do receive an assessment prior to their admission, she stated that a letter confirming suitability for admission was sent to these prospective residents but there was no evidence of this in the home at this time. The home admits people for permanent, respite and intermediate care. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience poor quality outcomes in this area Care plans are not sufficiently detailed to ensure that the correct care is given to meet individual residents needs. Not all care plans and risk assessments have been reviewed on a regular basis. Care plans have not been formed or reviewed in consultation with the resident or their relatives. The standard of medication administration does not safeguard the residents and medication records are not to a satisfactory standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 14 During this inspection eight care plans were examined. These belonged to residents admitted for intermediate and continuing care and those admitted for permanent or respite care. None of the residents or relatives spoken with had been consulted about or where aware of their care plans. Care plans were not comprehensive in identifying the care required by individual residents and were not based on the activities of daily living. They included only brief instructions regarding the delivery of the care by the care assistants. Care plans should initially address all activities of daily living and where further care planning is not required for one of these activities for a specific individual this should be noted in the care plan. This will ensure that every area is covered when care plans are undergoing review. Care home assessments of intermediate care residents in some cases, were taking place the day after the resident was admitted to the home with the initial care planning commenced from the assessment provided by the hospital. Registered nurses in the home must be aware that they are accountable for their own care planning based on their assessment of the resident, from the time that the resident is admitted to the home. Nutritional and continence care plans were not comprehensive even where problems or deviations from normal living where identified. Moving and handling reviews did not contain explicit instructions for care staff, which is especially important when recent orthopaedic surgery has been undertaken. Examples included one resident identified as having a poor nutritional intake but did not have a Malnutrition Universal Screening Tool in place or actions identified to improve the intake. A resident with non insulin dependent diabetes and also a colostomy did not have sufficient dietary guidelines in place or sufficient instructions to care staff on ensuring that the area around the colostomy did not become excoriated and therefore prone to infection. There were no instructions for the disposal of the body fluids or the colostomy bag. Another resident identified as being at a risk of pressure damage gave instructions to apply creams without identifying what cream was to be used, did not identify the mattress used and did not state that this resident refused to be turned regularly. Daily records on one resident identified that the ‘dressing had been changed’ but care plan did not mention a wound and neither was there evidence of a wound care plan. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 15 A resident admitted with a mental health illness did not have anything in the care plan identifying the mental health needs, how this manifested, or ways of dealing with this to ensure needs were met. There were no social care plans or night care plans in place for any resident and care plans were not person centred. Some reviews of care plans had not been undertaken regularly, one care plan evidenced the last review had taken place in July 2008. Personal risk assessments were not always satisfactory, one resident’s risk assessment said the goals were ‘ to prevent falls’ but no mention of how this was to be carried out. One risk assessment for bedrails was seen, this had not been reviewed since 2007. More people had bed rails but risk assessments were not found in the care plans viewed. One manual handling risk assessment had been reviewed in 2006 and then again in March 2008, no evidence of further review was in place. Risk assessments generally need expanding and reviewing on a regular basis to ensure that they are person centred and current to the needs of the resident. Residents were weighed regularly but these weights were not in the care plan and no actions to combat weight loss were apparent in the care plans, although staff said that some actions were being taken. A concern has been raised from a Health care professional that on one occasion the home had two unstable diabetics and one unstable epileptic resident admitted at the same time, this was an unsafe situation as there is only one registered nurse on duty on a shift. All three residents were readmitted to hospital following their return home. Most residents and relatives spoken with said that the staff were always ‘very caring and quite polite’, ‘ the staff are wonderful’, ‘ I think we get very good care here’. However two relatives have stated on different occasions that they were not satisfied with the attitude of some members of staff towards them. One resident said that the chair was too low for him to get into and that he sat on the commode as this was higher. There was evidence of chair raisers on some chairs for people who had had hip replacements but not one in this particular room and he said that staff had not suggested it. Two residents said Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 16 that they found the beds ‘uncomfortable’ but did not find them difficult to get into. A concern relayed to the CSCI stated that in instances where divan beds were being used staff had ‘ to get on their knees to turn residents’. Staff spoken with said that it was ‘difficult at times’. One resident said that there were no wipes specifically for intimate care and the care staff used wet paper towels which ‘ Are very hard and rough’ for this task. It was noted that many residents were sitting on paper incontinence pads on the chairs. Boxes of continence aids were stored in one room in full view of any visitors the resident may have, this could impact on resident’s dignity and confidentiality. Four residents said that generally their call bells were answered promptly, but there were specific times of day that it was ‘ Better not to ring’. ‘ You know when they have their break so there is no point in ringing the bell’. Staff were seen taking their breaks at the same time, this included ancillary staff, the inspector did not see any staff around the home at this time. Residents were seen being assisted to the bathroom in a dignified and empathetic manner and all interactions seen between residents and staff were good. All residents said that generally their call bells were answered promptly, but there were specific times of day that it was: ‘ Better not to ring’. ‘ You know when they have their break so there is no point in ringing the bell’. Staff were seen taking their breaks at the same time, this included ancillary staff, the inspector did not see any staff around the home at this time. It was noted that one resident who is self medicating has tablets sitting on top of bedside table. Although the resident has lockable drawer they said they couldn’t bend far enough to get them in to drawer. This should have been noted in the self-medication risk assessment and alternative arrangements made, as keeping medication unlocked in a communal setting can put other residents at risk. The director of nursing said that people put on blister packs before they go home and the blister packs do not fit into the drawer. The CSCI pharmacist inspector reviewed medicines management at the home and her finding were as follows; The method used to give medicines to residents involves ‘potting up’. I.e. medicines are prepared into named pots well before they are due to be given. Most of the morning medicines were done at 7.00 a.m. and the nurse did not have the medicine administration record charts with him. The charts were Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 17 signed all at once in the medicine storage room at the end of this task. Some Records were found to be incomplete or inaccurate. Some receipts of medicines [antibiotics] received mid-cycle were not recorded and the hand written chart had an error relating to the dose. Risk assessments for residents managing their own medicines do not state which medicines are being selfadministered. The home admits people for continuing care; this includes people who are at the end of their lives. Staff have attended some end of life training at the local hospice but they have not commenced training for the Liverpool Care Pathway and Gold standards Framework, the Director of Nursing said this was discontinued as the managers or registered nurses could not take the necessary time away from the home to attend this as there is generally only one registered nurse on duty, but that they intend to recommence this at some stage. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area There is scope for the range and frequency of leisure activities to be increased. The home provides nutritious well-balanced meals for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently the home does not have an activities programme and no communal activities are offered. However there is an activities co-ordinator who visits the home once a week and undertakes one to one conversation with the residents. The activity co-ordinator stated that the residents admitted for intermediate care do not want activities, although this was not identified in care plans. She said that she used to provide quizzes and bingo at intervals. Two long-term residents spoken with said that they missed the quizzes, which they used to enjoy. Another resident said that they used to play bridge but this was not now possible, however the resident was not specific over whether it was because there were no other residents able to play bridge or because Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 19 there was no opportunity. Residents said that they enjoyed the one to one discussions but one resident said that they missed mixing with other people as they did with communal activities and one resident said. ‘ Staff have no time to stop and talk, the work load has increased by 40 due to the hospital people, this was a down turn for this place’. Care plans did not specify individual residents interests or choice of leisure activities. Whilst residents said that they could make choices regarding activities of daily living “Up to a point’, they said there were specific times for awakening and that breakfast was given ‘ quite early’. These were seen being given out at 7 am. Residents were unsure whether they could ask for their times of being awakened to be changed: ‘ You have to do things at specific times because the staff, well, they have their routines and are very busy’. There is an open visiting policy. The local minister of religion comes in when asked to do so, but there are no arrangements in the home to enable people to routinely participate in religious worship. The home provides a varied and nutritious diet for residents. There is a fourweek rolling menu, which offers one main meal at lunchtime, which includes a starter and offers further choices of omelettes, salads, and other items if required. There is a good supper menu in place with one main option and choice of other options if required. Residents have a choice of cereals, toast etc at breakfast. Meals are provided from a central kitchen and transported to the home, although two concerns have been raised regarding meals not being served at a reasonable temperature, management said this has now been addressed. The majority of residents spoken with said that the meals were good. “ The meals are OK.’ ‘ Excellent food’. ‘ Food is alright’ ‘ Food not too good, they try’. ‘ Very nice food’. Some residents were not sure if a cup of tea could be had at times of day other than those designated ‘ I’m not sure if you can ask for a cup of tea when you want one’. There was no evidence of fresh fruit being available for residents in the lounges or in the kitchen. The majority of staff have the food hygiene course and there was appropriate documentation in the kitchen as required by the Environmental Health Authority. It was not clear whether the temperature of the fridges in individual resident’s rooms are being checked on a regular basis. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 20 Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18. People who use the service experience poor quality outcomes in this area. There is a complaints policy in place but some residents were unaware of to whom to speak to with any concerns they may have. Staff are aware of their responsibilities in the safeguarding of the people in their care. Recruitment processes do not safeguard the residents and lack of security of the home could put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes complaints policy is made accessible to residents by being included in both the Statement of Purpose and Service User Guide. Some residents were unsure of how to make a complaint and two residents said that if they had a concern or complaint they would not feel comfortable making one and would prefer not to do so. One relative informed the CSCI prior to the inspection that they were not satisfied with the manner in which a concern had been dealt with by the home. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 22 There were no records of complaints received available in the home apart from one which was kept as an incident report. Therefore the manner in which complaints are addressed by the home was unable to be determined and the home should keep records of complaints in the home in order to comply with regulation. The CSCI had received some concerns about the home prior to the inspection The Director of Nursing was unclear as to how many complaints or concerns had been received but stated that three level one adult safeguarding issues have taken place. The CSCI had not been informed of these and a requirement has been made detailing the homes responsibility in this respect. The adult safeguarding policy requires updating and clarification with regard to current reporting protocols. All members of staff have regular adult safeguarding training in house, but it is recommended that senior members of staff undertake the relevant training with the local authority, in order to clarify issues and to ensure that they are well aware of current protocols. It was noted that one member of staff had been employed on the staff bank without a Criminal Records Bureau check relating to this service. The Criminal Records Bureau check and Protection of Vulnerable Adults first check relating to this service had not been applied for until several months following employment when they were employed on a permanent basis. It was brought to the attention of the inspector that staff are being brought in for ‘ trial shifts’ prior to being given employment in the home. Staff confirmed that this occurs. This is without Protection of Vulnerable Adults first checks having being received. Although they are working under supervision anyone having contact with residents must have a Protection of Vulnerable Adults first check in place. On the day of the inspection the front door was not locked and the inspectors were able to walk through the home unchallenged in the early morning, an inspector visiting the home for another purpose on another occasion had also been able to do this mid afternoon. Visitors to the home have also informed the CSCI of this.The door must be kept locked on all occasions to safeguard the residents. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 21,22,24,25,26. People who use the service experience adequate quality outcomes in this area. The home is clean and generally well maintained. Staff have training on infection control but are not always putting this into practice and the home has not been proactive in ensuring that latest guidelines regarding infection control are included in the policies, practices around the home and in the supervision of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was generally well maintained and communal facilities included a large lounge and a garden which was accessible to residents. Management Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 24 states that rooms of long-term residents are redecorated when they leave the home and there is a plan for redecoration of other areas in the home. Resident’s accommodation is in single rooms, the majority of which have an ensuite bathroom, which comprise a shower or private bath and wc. All rooms are within easy reach of a shaft lift. Resident’s rooms are pleasant with some of the upper rooms having views over the sea. All have a lockable drawer. Whilst there are some modern variable height beds in the home, not all rooms have beds suitable for nursing use, and it was noted that some of the older hospital type beds and one commode chair were beginning to corrode, this may impede the control of infection. Staff stated that on some occasions they have had difficulty in giving care to residents due to the height of the beds. One resident said that they did not find the bed comfortable and one resident stated that they had difficulty accessing a chair as it was too low and therefore sat on the commode. Whilst chair raisers were available these were not being used for all residents that require them. Several of the window restrictors were broken. Other equipment, including full body hoists and a ‘Standaid’ hoist, are provided in the home, and there was evidence of other moving and handling equipment. Water records showed that the temperatures of hot water to resident’s outlets had been last checked and recorded in September 2007. Bath water temperatures are tested prior to residents using the baths but the provider is reminded that they are responsible for ensuring a safe temperature of water from all outlets that residents use. The majority of rooms provide an ensuite facility. The home also provides assisted bathing facilities. It was noted that block soap had been left in all communal bathrooms. The use of this type of soap for communal use can introduce cross infection. One bathroom had shampoo provided and this could lead to restriction on resident’s choice or put residents at risk. The cleanliness of the home was to a good standard and there were no odours apparent in any area of the home. Infection control policies require amending to include current research and practice. Staff have infection control training three times a year, but are not always putting this into practice. A visiting inspector stated that staff were not seen to wash their hands, whilst some relatives have raised concerns regarding hand washing and the lack of use of alcohol gel. Staff were seen going into the Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 25 kitchen not wearing protective clothing and one member of staff was not wearing an apron when giving care. A health care professional also raised concerns regarding some aspects of infection control. Some commode pans are in need of replacement as the bases are eroded and could hold bacteria, and one commode was found with toilet paper left between the seat and the frame. The ground floor bathroom had some areas of mould around the tiles and was also difficult to keep clean due to the uneven flooring. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience adequate quality outcomes in this area Current staff skill mix and care staff training may not be sufficient to meet the needs of residents currently being admitted to the home. Not all grades of staff are receiving mandatory or induction training, which could put staff and residents at risk. There was evidence that the relevant checks are not always being carried out prior to members of staff undertaking work at the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides registered nurses over the full twenty-four hour period. There is generally one registered nurse on duty supported by four care staff in the mornings, three in the afternoons and two at night. The number of care staff has been increased since admitting residents for intermediate care, however in view of the current health care needs and frequent turnover of residents currently being admitted to the home, concerns were raised with management that one trained nurse on each shift may not be sufficient to undertake both the extra paperwork generated and to provide nursing care in the event of any acute medical situation. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 27 It was evident from the records viewed in the home that registered nurses are finding difficult to maintain the documentation needed. Two residents said that the work of the care staff has “increased by 40 ” and “ staff are busier than they used to be and do not have so much time to come in and spend with us”. Care staff have an induction at commencement of employment, this is a local induction to the home’s way of working and basic mandatory training over four to five hours, which is not sufficient for the work they have to perform. The group of homes has not yet commenced the nationally recognised ‘ Skills for care’ induction training. Other training is available to staff, the ‘in house training’ scheme addresses Protection of Vulnerable Adults, infection control, food hygiene and other mandatory training, and training is made available from the nursing home support team. However care staff are not receiving training in the skills required to care for the residents which are currently being admitted to the home, and a registered nurse said that the length and substance of the induction training was not sufficient to ensure that inexperienced care staff had sufficient expertise or knowledge to enable them to be of use in the home during the first few shifts. One member of housekeeping staff spoken with had received no induction or moving and handling training. Registered nurses have received training on syringe drivers, phlebotomy and other skills. The provider should ensure that registered nurses continue to update their knowledge both in order to bring up to date information and practices into the home and to meet their practice requirements. Five recruitment files were examined; one member of staff did not have a Criminal Records Bureau check relevant to this home when they were working for the home on their nurse bank. The home is not asking staff to provide a CV as is required in the amended regulations; therefore gaps in employment history cannot be identified. It was brought to the inspectors notice that prospective staff are working trial shifts without records and checks in place. This was identified in the section on protection in this report. All other staff files were in order Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 28 Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 35,36,37,38 People who use the service experience poor quality outcomes in this area That management systems in place do not fully protect the service users This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse (level 2) and is currently working towards the Registered Managers Award. She is registered with the CSCI and currently works thirty six to forty eight hours per week over three to four-day periods. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 30 The CSCI did not ask for an Annual Quality Assurance Assessment prior to this inspection. The home has undertaken some quality reviewing of the services it provides and this takes the form of surveys to residents. It is recommended that this be expanded to include health care professionals. The home does not keep any money for residents or act as appointee for residents. The manager and deputy manager have last received formal supervision in July 2008 but there were no records available regarding other staff’s supervision. It is recommended that this is checked and updated by the manager. Records of times of supervision should be kept in the home. There were no records of Regulation 26 available (monthly visits to the home by the provider required by regulation) since February 2008. Not all records required by regulation were up to date or available and some policies and procedures have neither been reviewed on a regular basis nor reflect informed practice. There was no evidence of Portable Appliance testing although the provider states this has taken place, but other records relating to testing of equipment and utilities were in date. The fire risk assessment was in place but should be reviewed, however it was noted that all doors throughout the home were wedged open, including the kitchen and laundry. An immediate requirement was made regarding this practice, which could put residents at risk and an immediate requirement made regarding the broken window restrictors in resident’s rooms. Whilst there are risk assessments for areas around the home these are in need of updating, this also applies to some resident risk assessment. The home has a top floor sluice/ storeroom, which is secured by a bolt, however this was found to be unsecured and staff should be made aware of the risk to residents and the necessity to follow the home’s policies. Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 31 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 1 2 1 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 17 18 3 3 3 2 X 2 2 1 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 1 1 1 1 X 1 Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 32 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 OP1 Regulation Reg 4(1) Requirement The service must produce a statement of purpose that includes a statement as to the services provided by the home in respect of intermediate care. Amendments to the numbers and qualifications of staff employed must be put in place. That all service users are provided with a statement of terms and conditions and contract on their admission to the home. That prospective service users are informed in writing over whether the home can meet their needs and are able to admit the individual That care plans are formed in consultation with the service user, they fully reflect the care which is to be given to the service user to meet their needs and include instructions for staff on how to meet these needs and that all parts of the care plan including risk assessments are reviewed on a regular basis. The home must ensure that the DS0000014071.V370598.R01.S.doc Timescale for action 24/11/08 2 OP2 Reg 5(b) 24/11/08 3 OP3 Reg 14(d) 24/11/08 4 OP7 Reg 15(1)(2) 24/11/08 5 OP9 13(2) 24/11/08 Page 33 Victoria Highgrove Version 5.2 administration of medication follows current good practice and guidance as produced by the Nursing and Midwifery Council, The Royal Pharmaceutical Society of Great Britain guidance ‘The Handling of Medicines in Social Care’ and the Department of Health ‘Building a Safer NHS’. In the interests of safe medication handling all medication must be administered directly from the original labelled container and not placed into any secondary container for later administration. This was a previous requirement of timescale 12/09/08 6 OP9 13(2) Complete and accurate records must be kept of all medicines given to people so that they receive their medicines correctly. This was a previous requirement of timescale 13/08/08 To have Complete and accurate records around medicine use so that an audit is possible. That all service users are consulted regarding the provision of leisure activities and their preferences and efforts are made to ensure that leisure and social needs are met. That records of any complaints made by service users or other stakeholders are kept in the home. That the policy on adult safeguarding is amended to reflect current reporting protocols, that the manager and other senior staff receive adult safeguarding training through a recognised source. DS0000014071.V370598.R01.S.doc 24/11/08 7 OP9 17[1](a) 24/11/08 8 OP12 Reg 16 (m) (N) 24/11/08 9 OP16 Schedule 4 (11) Reg 13(6) 24/11/08 10 OP18 24/11/08 Victoria Highgrove Version 5.2 Page 34 11 OP25 Reg 13(4) 12 13 OP26 OP27 Reg (3) Reg 18(a) 14 OP29 Reg19 Schedule 2 That the provider ensures that service users are protected from the risk of scalding from hot water. That infection control practices conform to the guidelines of the relevant agencies. That sufficient suitably qualified and competent persons are employed to ensure that service users needs are met and that staff receive training appropriate to the work they are to perform. The registered person shall not employ a person to work at the care home unless the employer has obtained in respect of that person a full employment history together with a satisfactory written explanation of any gaps in employment. This was a previous requirement Compliance date 01/06/08. That the home has completed the relevant checks and obtained the relevant information prior to allowing staff or prospective staff to work with the service users. 24/11/08 24/11/08 24/11/08 24/11/08 15 OP36 Reg 26 16 OP38 Reg 23(4) That the provider undertakes 24/11/08 visits on a monthly basis and ensures that records of this are kept in the home. That the provider liaises with the 06/10/08 fire authority regarding the doors to rooms and a method of maintaining service users safety in the event of fire. This was an immediate requirement That window restrictors to upper floors are kept in a good state of repair. This was an immediate requirement That the provider ensures that security of the home is kept under review at all times That any incidents including DS0000014071.V370598.R01.S.doc 17 OP38 Reg 13(4) 06/10/08 18 19 OP18 OP38 OP38 Reg 13(4) Reg 37 24/11/08 24/11/08 Page 35 Victoria Highgrove Version 5.2 adult safeguarding alerts are reported to the CSCI 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 OP9 Good Practice Recommendations It is strongly recommended as good practice that there is be a robust system to check that the medication administration record charts are correct before they is used, such as the member of staff writing the chart signing and dating the chart and a second person checking the entry for accuracy. That suitable equipment including variable height beds are put in place. That the comfort of service users is maintained by the use of specific wipes for personal care. That all staff are formally supervised and records of this is kept in the home. 2 3 2 OP8 OP8 OP36 Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Victoria Highgrove DS0000014071.V370598.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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