Inspection on 04/09/07 for Westcroft

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westcroft 11/02/09

Westcroft 12/02/08

Westcroft 29/06/06

Westcroft 24/03/06

Westcroft 02/09/05

Westcroft 21/02/05

Westcroft 27/07/04

Westcroft 10/03/04

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 Westcroft 1 Cleveland Walk Bath Bath & N E Somerset BA2 6JS Lead Inspector Vanessa Carter Unannounced Inspection 4th and 6th September 2007 09:30 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 DS0000020315.V341042.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. DS0000020315.V341042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westcroft Address 1 Cleveland Walk Bath Bath & N E Somerset BA2 6JS 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) 01225 466685 01225 443367 Mrs Jean Uter Post Vacant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places DS0000020315.V341042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate 21 Patients aged 50 years and over requiring nursing care Staffing Notice dated 03/10/1996 Manager must be a RN on parts 1 or 12 of the NMC register May accommodate one named person with Mental Health needs. The registration will revert when this person leaves the Home. 29th June 2006 Date of last inspection Brief Description of the Service: Westcroft Nursing Home is registered as a Care Home with nursing. It is situated in an elevated position in Bathwick, close to the city centre of Bath. The home is an older property with an extension, set out over three floors. There are a mixture of single and double rooms. One double room has an ensuite facility. There is a passenger lift in the old wing and a chair lift in the new wing: however the home is not suitable for independent wheelchair users and does not enable people that require aids and equipment to move around the home independently. The front entrance has one step into the porch and another step into the foyer; level access is through the side entrance. The home has a large garden to the rear with extensive views over the city. Fees for placement at the home currently range from between £494 - £630, and are determined on an individual basis. Hairdressing, newspapers and chiropody costs incur additional charges. Prospective residents can be provided with information about the home by requesting the home’s brochure from the proprietor - this will detail the services and facilities available at the home. DS0000020315.V341042.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was unannounced and took place over two days. A combined total of 12 hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources:• Information provided by the Proprietor/Acting Home Manager (Mrs Uter) in the Pre-Inspection Questionnaire • Talking with Mrs Uter and Mr Andrew Uter during the course of the inspection • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the residents • A tour of the home • Case Tracking the care of a number of residents • Talking with a number of the residents • Talking with a number of visitors to the home • Looking at some of the homes records • Information supplied by residents and relatives in CSCI survey forms • Information supplied by two GP’s on CSCI comment cards Twenty four requirements were made as an outcome of this inspection indicating to the Inspector that there has been a marked deterioration in the running of this home since the last inspection. Two of the requirements made from the last key inspection, which had been repeated from the previous inspection, have still not been complied with, evidencing that the home remains in breach of regulations. Two immediate requirements were issued during the course of the site visit in respect of fire safety and unsafe staff recruitment procedures. On receipt of the second requirement notice the proprietor and her son requested that the inspection be terminated- What the service does well: Residents were complimentary about the staff and the care they receive and felt that they got the support they needed. They are able to choose how they spend their time and are provided with sufficient food. A range of activities occur throughout the year. Residents can participate in these activities if they are able, and are encouraged to maintain contact with family and friends. Relatives and visitors also expressed satisfaction. The premises appear homely, clean and tidy and free from any odours. DS0000020315.V341042.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 DS0000020315.V341042.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. DS0000020315.V341042.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 DS0000020315.V341042.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information made available about the home is inaccurate. Pre-admission assessment processes are inadequate. This may mean that residents may not get the care and support that they need. EVIDENCE: The home’s Statement of Purpose that was provided for the Commission following the last key inspection in 2006, was written in February 2007 and is due for review in February 2008. However, it was written when the home was asking for a variation to the conditions of registration and it does not present a true reflection of the service it provides. It contains information that does not comply with the conditions of registration that have been set by the Commission. The home’s statement of purpose must detail the correct age range of residents who can live at Westcroft. It also states that the home has 25 to 30 care staff employed whereas there are only 15 members of staff that form the care team. During the course of the inspection the Statement of Purpose was not discussed with the proprietor, and the inspection ended before this could be achieved. DS0000020315.V341042.R01.S.doc Version 5.2 Page 10 A service user’s guide, complete with the terms and conditions of residency is supplied to each resident upon admission. Of the six residents who responded on CSCI survey forms, five said that they had received enough information about the home and had received a “contract”. Comments included “my relative dealt with everything for me”. During the inspection one resident confirmed that they had been provided with a copy of the resident’s information. Further confirmation that signed residency agreements were in place for all residents was not achieved during this inspection. The home’s Statement of Purpose states that an assessment of need will be carried out by someone in a senior position from the home. The pre-admission assessment form was looked at for one new person to determine how the home decided that they could meet that person’s needs and offer a placement. For this resident the form was dated five days post-admission. The resident was unable to verify that they had been visited in hospital “I saw so many people whilst I was in there”. The proprietor said that the form was dated in error and that the resident had been visited prior to admission. From the evidence seen during this inspection this standard can only be partially met. One resident wrote on their CSCI survey form “my son visited the place and made some investigations”. One visitor who was with their relative, said that the home had been chosen for them by the hospital social worker, but they were happy with the choice. Where possible, prospective residents are encouraged to visit the home, have a look around and join them for a meal. All placements are organised with an initial assessment period, and this is usually for one month. A review happens at the end of this period. Emergency admissions are not normally arranged however will be considered if the prospective resident and/or relatives, or the agency referring the service user is able to provide sufficient information to determine that the home can meet the care needs. DS0000020315.V341042.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s care planning processes are poor and residents may not get the care that they need. Medication systems need to be improved to ensure they are completely safe. EVIDENCE: A sample of three care plans were looked at during the course of the inspection in order to determine how the home identifies, plans and then meets the specific needs of each resident. For one resident who had been living at the home for over two weeks no care plans had been prepared. An assessment had determined that the resident was at risk of falls, but a plan had not been prepared to prevent or at least reduce the risk of further falls. This shortfall means that the home may not be safeguarding the residents from possible injury. This same resident was also assessed as being at risk from having frail skin and had already developed a broken area of skin. The home is failing to meet this residents needs. For one other resident the care plans were out of date and did not reflect the deterioration in their health and change in daily routine. Most of the third care plan examined was of a satisfactory quality, DS0000020315.V341042.R01.S.doc Version 5.2 Page 12 although some amendments were needed with the plan about how their social needs are met. Alongside these care plans, the home completes risk assessments in respect of pressure sore formation (this form needs to be named), nutritional needs, and manual handling requirements. It is good practice that the home displays a copy of the manual handling assessments in the residents bedrooms but the devised plan of action (the safe system of work) must detail specific information for the staff to follow. For instance, it must state what equipment is to be used, sling sizes and how many staff are needed to carry out the task. Nutritional screening should be undertaken upon admission and then on a periodic basis. The new resident had not had their weight recorded, so the home will not have a baseline on which to measure weight loss or gain. One other resident had not had their weight recorded since January 2007 - records showed that they had a very low body weight and their plan said they should be weighed monthly. Wound care planning documentation was looked at for one person. The plan did not detail what dressing products were to be used or how often the dressings were to be attended to – it referred to the “wound care book” but staff did not know what this meant. Monitoring of the wound is recorded on a wound assessment chart and each time the dressing is done, a judgement is recorded about how the wound is progressing. It was difficult to determine how long the wound had been present. Only two photographs of the wound had been taken, one was dated in February whilst the other was not named or dated. Between the two photographs there had been a significant level of improvement. The home must ensure that accurate measurements are recorded. It was agreed that staff are likely to be guessing the size of the wounds. The use of photography and accurate measurements would be a better method of reviewing progress. These significant shortfalls mean that resident’s health care is not being monitored effectively and that they are being placed at risk of not getting the full health care support that they need. A comment received from one GP practice on a CSCI comment card was “The staff are very well meaning and try hard. However they sometimes do not recognise when a resident is unwell and requiring a doctor to attend. I do not feel confident that I will be contacted if medical attention is needed”. This comment was not discussed with the proprietor as the inspection was prematurely ended. Six residents completed a CSCI survey form, four said that they always got the care and support they needed whilst two said that they usually did. Of the eleven relatives who returned forms, seven said their relative always got the support they needed and had been agreed upon, and four said they usually did. In respect of the comments made by the GP, these will be referred to again in the section regarding staffing. DS0000020315.V341042.R01.S.doc Version 5.2 Page 13 From the information supplied by the proprietor prior to this inspection it is apparent that residents are able to remain with their own local GP if this is possible. A number of different GP practices therefore visit the home. In addition, visits are made by chiropody services, community based nurses and mental health teams. The medication systems were looked at with one of the registered nurses. A number of improvements are necessary to make medication systems safer. Most medicines supplied to the home are provided in blister packs and are issued on a monthly basis – the most recent supply was stored in an unlocked cupboard. Management of controlled drugs is safe. Examination of the medication administration sheets (MAR charts) showed that handwritten charts were not completed properly. When medications are received into the home and registered nurses have to complete a handwritten chart, the records should be signed by two persons. The home must ensure that when medications are to be administered via a gastrostomy tube, the route of administration is detailed on the MAR chart. The home maintains a record of those medications returned to pharmacy for disposal however do not ask for a signature from the person who collects them and takes them out of the home. A number of requirements have been issued in respect of medication systems. During the inspection residents said that they were well looked after and the care staff were very attentive. “I am happy here and I am well cared for”, “the staff are all nice to me”, and “I am quite content with things” were comments received during the inspection. Staff must ensure that they respect each resident’s privacy as on two occasions staff were observed entering rooms without knocking. Staff must conduct themselves appropriately at all times whilst on duty, particularly so when amongst the residents. Their language must be appropriate and not cause offence, and they must not discuss their concerns about their workload, with the residents so that they then worry for them. There was evidence that the home do think ahead and discuss with residents and their relatives, about end of life planning. A record is made in the care notes if there is an agreement that if health deteriorates, hospital admission is not wanted. This means that residents are likely to be cared for in the way that they wish and that their care needs will be met. DS0000020315.V341042.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can participate in a range of activities if they are able, are encouraged to maintain contact with family and friends and are provided with good food. EVIDENCE: Some of the residents are able to participate in a number of activities that occur on a weekly basis and others that are arranged as and when. Dominoes are arranged every Monday evening for some of the residents, a musical entertainer visits the home twice a month, and outings are arranged. A number or residents like to be taken out for a walk in the local area. There have been recent trips out to Longleat and Horseworld. One resident remembered the Longleat trip “it was a lovely day and the weather was great”. The staff raise funds throughout the year to organise these events and residents are involved in deciding where the outings are made. Most recently the home has had a barbeque and over 70 people attended this – many residents referred to this during the course of the inspection. There are plans for later in the year to take the residents out, into Bath, to see the Christmas lights and to go shopping. Some residents confirmed that they do not like to join in the group activities and prefer to spend their time in their own room. DS0000020315.V341042.R01.S.doc Version 5.2 Page 15 A number of residents are bed bound and for these it is more difficult to determine how their social care needs are met. Some of these residents were too frail and too poorly to be able to participate in any activity. The keyworker for one such resident said that they try and pop in for a chat as often as possible, but this is fitted in amongst other duties. One resident said “ I want to stay in bed and I like to watch TV all the time”, whilst another said “I prefer my own company in my own room”. The home has an open visiting policy and visitors are encouraged at any reasonable time of the day. At 9.30am, the start of day two, one visitor was calling at the home. Other visitors spoken to during the course of the inspection said that they enjoyed visiting the home, were welcomed by the staff, offered refreshments and found the staff friendly and caring. The home has a four-week menu plan but the cook did explain that this is subject to change sometimes. The menu plan appeared to be well balanced and nutritious. Each day the cook goes around each resident to inform them what the midday meal is and to organise any alternatives. On day one of the inspection the lunchtime meal was liver with potatoes and vegetables. Those residents observed taking this meal said that it was tasty and they have enough to eat. The kitchen store cupboards appeared to be sufficiently stocked. Comments received on the CSCI survey forms included “the food is very good” and “I am well fed”. DS0000020315.V341042.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The fact that complaints may not be handled properly and staff awareness of safeguarding adult issues is limited, may mean that residents will not be listened to and may not be protected and safe. EVIDENCE: The home’s complaints procedure is displayed in the main foyer and also included in the home’s statement of purpose and service user’s guide. All residents and relatives who completed a CSCI survey form said that they were aware of the complaints procedure. Pre-inspection information supplied by the proprietor said that the home had dealt with one complaint since the last inspection therefore the complaints log was examined. This just stated that “a letter of reply sent” and there was no indication of any action taken or the outcome. CSCI were aware that the relatives of a previous resident and the local authority had raised concerns with the home in May however this complaint was not logged. Further discussion with the proprietor was not possible as the inspection was ended. The inadequacies of the home’s Protection of Vulnerable Adults (POVA) policy have not been addressed despite this being raised with the proprietor in June 2006. In its current form, it conflicts with the local inter-agency protocols, which the home must follow. Staff awareness of what to do if abuse was observed, alleged or suspected, was generally poor with only one member of staff being really clear about what to do. In between day one and day two of the inspection, a flow chart was devised, with instructions for staff. This chart DS0000020315.V341042.R01.S.doc Version 5.2 Page 17 needs additional information – it refers to who to contact but no telephone number is printed and one staff member who is often in charge of the home, did not know this number and could not locate it. The homes Whistleblowing policy just says that staff are to follow the guidelines, but there are no guidelines. These serious shortfalls have the potential to mean that the residents are not protected from harm or being harmed. Some of the staff who are currently employed to work at the home have not been vetted properly. The home have not obtained the appropriate preemployment checks. This means that the home is not safeguarding residents from being cared for by unsuitable staff. This has been referred to again in the section about staffing. DS0000020315.V341042.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely environment. EVIDENCE: Westcroft has been a nursing home for many years and is a small 21 bedded home, providing a ‘homely environment’ for residents who require personal and nursing care. Due to the layout of the building, it is not suitable for independent disabled residents. The main entrance has two steps to negotiate however there is level access to the home via the side fire exit. The home comprises of two parts referred to as the ‘old’ and the ‘new wing’. In the old part the accommodation is spread over three floors and a small passenger lift provides access to the upper floors for disabled residents. The communal areas are located in this main part of the house. The new wing is over two floors and a stairlift is in situ. DS0000020315.V341042.R01.S.doc Version 5.2 Page 19 To the front of the house there is car parking for just a few cars, and well established shrubbery. The rear gardens have been upgraded – the pathway has been extended so that wheelchair uses are able to have greater access to the lower levels of the garden, a patio area has been created and there are plans for scented plants to be growing around this area. Wheelchair users, due to the gradient of the paths, cannot independently access the garden. There is one combined lounge and dining room for communal use, with the large windows looking out over the city of Bath and the rear gardens. Both areas are small and not able to accommodate all 21 residents at the same time. New lounge furniture is to be provided in the near future. There is TV and music in the lounge area. In the dining room there are three tables, able to seat only 12 residents. The communal areas are to be redecorated in the near future. There are sufficient toilet and bathroom facilities located throughout the home to meet the needs of the residents. The first floor bathroom of the old wing has been refurbished and the bath has been fitted with a bath hoist. This room should not be used as a storage area for resident’s wheelchairs. The second floor bathroom in the old wing has been decorated and had a new standard bathroom suite fitted however there are plans to install a walk-in/sitin bath. This will enhanced the facilities available for the residents. In the ground floor of the new wing there is also an assisted bathroom. The home has an adequate supply of equipment to assist the care staff in moving and transferring residents with impaired or no mobility. There are two manually operated hoists. The home stated that this equipment has been regularly serviced. It was difficult to determine how equipment such as hoists could be used to move the residents in the shared rooms because of a lack of space – the home must always ensure that safe moving and handling procedures are followed and staff are not impeded by the lack of space. Other items of disability equipment in the home include raised toilet seats, grab rails and chair blocks. The home currently has seven pressure relieving air mattresses and plan to purchase a further three. There are 17 single bedrooms and two shared rooms. One of the shared bedrooms has en-suite facilities, whilst the other rooms have wash hand basins installed. Some of the bedrooms have been recently redecorated, and new flooring has been laid in a number of rooms. One relative commented on a CSCI survey form “there has been improvements in the decoration and equipment in the last 12 months”. Each room is furnished with the required level of furniture, including lockable drawers where residents can store any valuables. Some bedroom doors are fitted with locks – the statement of purpose makes it clear that locks can be fitted to the other doors upon request, and if appropriate. Not all of the bedrooms were seen during this inspection. DS0000020315.V341042.R01.S.doc Version 5.2 Page 20 The home has central heating installed and is well lit throughout with domestic style light fittings. The heating was on a low heat and some parts of the home were very warm due to the late summer sunshine. The proprietor has stated that all the appropriate maintenance of the heating and electrical systems, and the water supply are up to date. This was not verified during the inspection process. The home employs one domestic and one laundry person. The home appeared to be clean and tidy throughout, and free from any offensive odours. The domestic works for four hours each weekday – this appears to be insufficient, a sentiment that featured in both resident and relative CSCI survey forms. There are still no arrangements for the periodic deep cleaning of the whole property. During the course of the inspection one of the care staff was helping the domestic out, having therefore been removed from caring duties. The laundry has one large industrial washing machine that has sluicing facilities. There is one large tumble dryer. The bed pan washer remains out of action, a situation that the home were asked to address in February 2007. The proprietor must ensure that if this is relocated to the laundry room, hand washing facilities are still available for the staff to use. DS0000020315.V341042.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has poor recruitment procedures and the training provided is very limited. Some staff are not fully competent and this means that residents may be cared for by staff who do not have the necessary skills. EVIDENCE: The home has a small staff team consisting of registered nurses, care staff and ancillary workers. Some of the staff have worked at the home for many years and they are able to provide continuity - those spoken with during the inspection demonstrated an extensive knowledge of each resident. On day one of the inspection there was one registered nurse in charge of the home, three care staff, one domestic and the cook. The home was fully occupied with 21 residents. A significant number of these residents have ‘high dependency’ needs, requiring two carers to attend to personal care tasks, however the home is only staffed to minimum staffing levels. As part of the inspection, there was to have been a conversation about staffing and dependency levels but this did not happen. The proprietor already has the information about how to determine appropriate staffing levels and therefore should be working to these guidelines. Concerns were expressed in both CSCI survey forms, and direct contact with residents during the inspection, about staffing levels. “it is sometimes difficult to locate staff, they need to check on DS0000020315.V341042.R01.S.doc Version 5.2 Page 22 the residents more”, “staffing levels are too low” and “the house is full, some need an awful lot of help, staff are so busy and there are not enough on duty”. The home must ensure that the person in charge, during the absence of the acting home manager, is competent and skilled. One GP commented on a CSCI survey form that the staff sometimes do not recognise when residents are ill. At the start of the inspection, the registered nurse and the person in charge of the home, did not demonstrate their competency or knowledge of the residents’ care needs. The home must always be appropriately staffed and this must apply to both day and night shifts. The home currently has one member of staff who is completing an conversion course, because their nursing qualification is not recognised in the UK. They are employed as a care assistant until their qualification is recognised. Other registered nurses who work at the home, have also been through the conversion programme. The nurse mentor for this process is Mrs Uter, the proprietor. One relative stated on the CSCI survey form that the communication skills of some staff needed to be improved, whilst one resident wrote “I have problems understanding some and some understanding me”. Some of the staff spoken to during the course of the inspection, were more difficult to understand than others and the home must ensure that sttaff check that they are understood. Pre-inspection information supplied by the proprietor indicates that of the seven care staff employed at the time of completion (May 2007) six staff had an NVQ level 2 or equivalent (86 ). Those care staff who have qulaifications that are not recognised in the UK are included in this. Six staff files were looked at to determine the processes the home follows to ensure that unsuitable staff are not employed at the home. None of these six staff had the checks completed that the home are required by law to complete. Criminal Record Bureau checks (CRBs) had not been undertaken and employee’s had started work without the home having checked whether the individuals were barred from working with vulnerable people. An immediate requirement was issued during the inspection in respect of these staff and in respect of any others who have not had the necessary checks. The home must not have staff working in the home who have not been properly vetted. This serious shortfall means that the residents could potentially be placed at risk. The Inspector did not view a training plan but staff have been instructed that they must attend mandatory training on an individually stated regular basis. This list is displayed in the nurses station. One member of care staff demonstrated her own personal commitment to training, and was able to report about training and who has done what. There was no evidence seen that any training other than mandatory training is arranged for the staff team. When the proprietor completed the pre-inspection questionnaire in May, she DS0000020315.V341042.R01.S.doc Version 5.2 Page 23 included a list of ‘gaps in mandatory training’. This was discussed during the inspection, only very minimal progress has been made in addressing this. One member of staff has not had any ‘recent’ training in manual handling, POVA, fire, health & safety, first aid or basic food hygiene. There is no evidence to support that staff receive ‘suitable assistance’ from the home to attend at least three days training per year. One staff member said that their mandatory training was up to date and this was verified. The staff induction process for new recruits is inadequate. One staff member said “one day is not long enough”. New staff are not allocated a mentor and will just work alongside any other worker. Blank induction forms for two members of staff, who had worked at the home for three and six weeks, were found on the shelf in the office. The Inspector noted that a member of staff whilst assisting with additional tasks to help other staff was doing so unwillingly, using inappropriate language and encouraging residents to share thier burden. DS0000020315.V341042.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is not being managed well. There are no effective quality assurance mechanisms in place meaning that residents wishes are not taken into account. EVIDENCE: The home is currently without a registered home manager. The previous manager left in October 2006. An interviewed candidate has just been offered the post but is unlikely to be in post for a further few weeks. Discussion with the proprietor during the course of the inspection evidenced that the home still has no quality assurance mechanisms in place, but they are proposing to use the ‘registered nursing homes association’ process. They do use an independent person to write a report (a reg26 report) and submit this to the Commission intermittently. The Inspector did not see a development DS0000020315.V341042.R01.S.doc Version 5.2 Page 25 plan, although Mrs Uter does have a lot of ideas of how she plans to enhance the living environment. The home will be required to produce an improvement plan as an outcome of this inspection. The home looks after personal monies for a number of residents and a sample of accounts were checked with a registered nurse. The accounts and monies held tallied evidencing that the home has safe systems in place. The nurse in charge is the only person who has a key to the locked cupboard where the money is held. Staff supervision is currently only undertaken by Mrs Uter, the proprietor. The schedule of meetings was displayed in the nurses station but this only showed the period from June 2007 onwards. This consisted of quarter-hourly slots between appointments, with all staff being seen on the same day. Staff confirmed that they have had supervision but the inspection was ended before the records could verify this. One staff member said that they had a recent appraisal whilst another said that theirs was due soon. Improvements are required with a significant number of the homes records, and these have been detailed throughout the report. These include the documents the home produce to provide information about their service, the records that are kept in respect of the residents, and information kept about the staff. Accident and incident forms are not always completed after a fall, and the home does not maintain a falls log, with a view to identifying any trends in the falls. The proprietor does not take all reasonable measures to ensure that the home is a safe place in which to live and work. The reasons have been listed below: • On day one of the inspection, an immediate requirement was issued as the fire exit was completely blocked by various items of equipment. This was immediately cleared during the inspection, but all staff must ensure that this area remains clear at all times. Safe systems of work devised from manual handling risk assessments are not specific enough and do not detail the equipment to be used for each procedure. Shared rooms are not suitable for those residents who require lifting and handling equipment to be used, as the space is very confined. Bed rails are not risk assessed prior to use. Where concerns were highlighted about an incident that had happened previously, there was no follow up to evidence how the home were going to prevent a further incident. Consent forms for their use were in place, however, the wording on this form must state that use is to maintain safety and not for reasons of “constraint”. DS0000020315.V341042.R01.S.doc Version 5.2 Page 26 • • • • • Some staff have not received mandatory training such as fire, manual handling and protection of vulnerable adults. The workplace risk assessment update, requested during the inspection of September 2005, has yet to be completed. DS0000020315.V341042.R01.S.doc Version 5.2 Page 27 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 1 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 1 1 DS0000020315.V341042.R01.S.doc Version 5.2 Page 28 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 4 Requirement The home’s Statement of Purpose must fully reflect the aims and objectives of the service, and the facilities and services it provides. All prospective residents must be assessed prior to being offered a placement to ensure that the home is able to meet the care needs. Forms must be dated correctly. All residents must have a plan of care, that sets out their specific care needs and states how these are to be met. • These must be completed for all new residents as soon as possible after admission. • The plan must be revised as often as is necessary, and kept up to date. Nutritional screening should be undertaken for all residents upon admission and then on a periodic basis. DS0000020315.V341042.R01.S.doc Timescale for action 06/10/07 2. OP3 14(1) 06/10/07 3. OP7 15 20/09/07 4. OP8 12(1) 20/09/07 Version 5.2 Page 29 5. OP8 12(1) Wound care monitoring must include accurate record keeping and meaningful reviews of progress. Medication procedures must be safe : All medications received into the home must be securely stored. Handwritten MAR charts must be signed by 2 members of staff. Instructions regarding the route of administration of medicines must be recorded on the MAR sheet. A signature must be obtained from the company who take drugs away from the home for disposal. All complaints made about the service should be appropriately handled and acted upon. All staff must attend POVA training and must be able to act appropriately if abuse is suspected, witnessed or alleged. The bed pan washer must be repaired and brought back into use so that equipment used for containing body waste can be disinfected. Ensure that at all times suitably skilled and competent staff are working in sufficient numbers to meet the needs of the service users. Staffing levels should be mindful of the dependency levels of the residents in the home. 20/09/07 6. OP9 13(2) 20/09/07 7. OP16 22 20/09/07 8. OP18 13(6) 06/12/07 9. OP26 16(2)k 06/10/07 10. OP27 18(1) 20/09/07 DS0000020315.V341042.R01.S.doc Version 5.2 Page 30 11. OP27 12(5) All staff must conduct themselves appropriately whilst on duty. Those staff already employed to work in the home, who do not have a CRB, or at least a POVAfirst, must not work in the home until a POVAfirst has been received. An Immediate Requirement Notice was issued during the inspection visit. 20/09/07 12. OP29 19 06/09/07 13. OP29 19 Robust recruitment procedures 20/09/07 must be followed at all times and all new staff must be fully vetted before starting work. This must include the following: Written application form/CV Gaps in employment history should be explored Two written references that have been verified as true CRB and POVAfirst checks (the latter must be received prior to employment starting) Staff must receive training 06/03/08 appropriate to the work they are to perform. All staff must receive the training that the home has themselves deemed as mandatory. New staff must receive a structured induction training that meets the ‘Skills for Care’ requirements and this programme is completed within given timescales. Appoint a suitable home manager as soon as possible who will then apply to CSCI for registration. DS0000020315.V341042.R01.S.doc 14. OP30 18(1)c 15. OP30 18(1)c 20/09/07 16. OP31 8(1) 06/11/07 Version 5.2 Page 31 17. OP33 24 Effective quality assurance mechanisms must be put in place and a report be prepared to detail how they propose to raise standards. This should link to the Improvement plan that will be requested by CSCI. Staff must be appropriately supervised regarding their work performance and training and development needs. All the homes records must be maintained as referred to in Schedule 3, be kept up to date and be available for inspection. The management of falls and reporting of any accidents must lead to preventative measures being taken so as to eliminate, as far as is possible, any further incidents occurring. The fire escape(s) must remain free from obstruction at all times. An Immediate Requirement Notice was issued during the inspection visit. 06/12/07 18. OP36 18(2) 20/09/07 19. OP37 17 06/11/07 20. OP38 13(4)c 20/09/07 21. OP38 23(4)b 04/09/07 22. OP38 13(5) Manual handling risk assessments for each resident must result in a safe system of work being devised that show what equipment is to be used and how the task is to be performed. Bed rail risk assessments must ensure that their use is the most appropriate method of maintaining the safety of the residents, and consent for their use must be obtained. 06/10/07 23. OP38 13(7) 06/10/07 DS0000020315.V341042.R01.S.doc Version 5.2 Page 32 24. OP38 13(4)(c) Complete the update of the Workplace Risk Assessment. This is a repeated requirement – the previous timescales of 31/10/06 and 30/03/07 have not been met. 06/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP10 OP18 OP27 OP30 OP36 OP38 Good Practice Recommendations All staff should ensure that knock on doors before entering bedrooms. Staff must be provided with clear guidance about the homes Whistleblowing policy, so that they know what is expected of them. Review the level of domestic support provided on a weekly basis and ensure that periodic deep cleaning is undertaken Provide evidence that staff have had at least 3 days paid training per year. Staff must receive formal supervision at least six times per year. Consider the appropriateness of accommodating residents in shared rooms who require a hoist to move and transfer, to ensure that sufficient space is available for staff to carry out safe manual handling procedures. DS0000020315.V341042.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000020315.V341042.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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