Care Home: Carrick House Nursing Home

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What the care home does well The home provides a homely and maintained environment for residents to enjoy. Residents are encouraged to bring personal items in the home to personalise their bedrooms. The home has acquired a certain expertise in caring and supporting people who are terminally ill and who have end of life care needs. The manager and her staff are familiar with the needs of people who are terminally ill, particularly with regards to symptoms control. They are familiar with systems such as the Gold Standard Framework and Liverpool Care Pathway. They are well supported by the GP in meeting the needs of people who are terminally ill and of all residents that live in the home. The manager has been in post for a number of years and is familiar with the issues that arise when managing a care home. She keeps an active presence on the floors and maintains a good contact with residents, their relatives and friends and visitors to the home.Carrick House Nursing HomeDS0000022921.V376915.R01.S.docVersion 5.2There is a core group of permanent members of staff that ensures continuity of care. They receive training to ensure that they are skilled and competent to care for residents. What has improved since the last inspection? During the last inspection there were a number if health and safety issues that had not been addressed appropriately. On this occasion all health and safety checks were being carried out and there were certificates to show that items of equipment were being maintained and serviced as required to ensure the safety of all people who use the premises. The care plans were not that individualised in the past, as the home was using a form of care pathway/pre-printed care plan, where the particular action that needed to be taken to meet the needs of residents were highlighted. These have been updated and during this inspection we found that care plans were more individualised than previously. The management of medicines in the home has improved and systems and procedures that are in place are followed to ensure the safety of residents. The management of accidents/incidents in the home has also improved. Records are now more comprehensive to look at causes of the accidents/incidents and at control measures to prevent the likelihood of similar accidents occurring again. The home has addressed the issue of restraint. Previously there were residents who stayed in their wheelchairs with a lap strap. This practice has stopped and residents are not restrained in wheelchairs. The manager is aware that restraint must only be used as a last measure and that incidences of restraint must be appropriately documented and that appropriate risk assessments and control measures must be in place whenever restraint is used. What the care home could do better: Whilst care plans were generally good and addressed the needs of residents, we noted that the approach to care plans and risk assessments needed to be more dynamic and flexible to ensure that these are updated as and when the needs of residents change. End of life care is on the whole covered appropriately in care records. We noted that the resuscitation status of residents was agreed between the home and the residents and/or their relatives without the input of the GP. It would be desirable to have a medical input in deciding the resuscitation status of residents. Although the home says that it provides adequate social and recreational activities for residents, this is the area of the service with which residents areCarrick House Nursing HomeDS0000022921.V376915.R01.S.doc Version 5.2 least satisfied. The majority of residents said in our questionnaires that they do not always receive stimulating activities to keep them occupied. The home has made progress in many areas. However there is one area where it has not made much progress. The home has area where the sluice and the laundry are located. This is far from ideal because of the risk of cross infection. The building work to build separate premises for each facility must be carried out as soon as possible. Key inspection report CARE HOMES FOR OLDER PEOPLE Carrick House Nursing Home 61 Northwick Avenue Kenton Middx HA3 0AU Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 28th July 2009 11:00 DS0000022921.V376915.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carrick House Nursing Home Address 61 Northwick Avenue Kenton Middx HA3 0AU 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) 020 8907 0399 020 8907 0051 chnh@mdhomes.co.uk MD Homes Ms Zherabanu Nazerali Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 24 15th August 2008 Date of last inspection Brief Description of the Service: Carrick House Nursing Home is part of MD Homes, a small private company providing care homes services mainly for the elderly. The home is registered for 24 residents of mixed gender requiring nursing care. In the past couple of years it has specialised in the provision of end of life care. It is a large detached building, with some extensions, which is situated in a residential area of Kenton. Accommodation is provided on the ground and first floors. Residents occupy a mixture of single (eighteen) and double rooms (three). The home has a communal dining room, a lounge, a separate kitchen, toilets and bathrooms, and a conservatory. The home is about five minutes walk from the Kenton Road where buses are available. It is also within five minutes walk from Northwick Park underground station. The home has off street parking for about six cars, but there is also parking on the roads near the home. The home is managed by Zhera Nazerali and her deputy and they are closely supported by the operations director, Zena Chan. Fees charged by the home range from £735 to £900 depending on the needs of residents. The statement of terms and conditions of the home, available to all residents, has details of what is covered by the fees. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 5 There were 17 residents in the home at the time of the inspection. Carrick House Nursing Home DS0000022921.V376915.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 2 star. This means the people who use this service experience good quality outcomes. This report contains the findings of an unannounced key inspection that took place on the 28th July from 11:00-17:00. The last inspection took place on the 15th and 18th August, when the service was rated as providing an adequate service to people who lived in the home. For this inspection we looked at a sample of records, talked to four residents, five members of staff, the manager and the operation manager. We toured some of the premises and we inspected the management of medicines by randomly checking the records and medicines of a few residents. The manager also completed an Annual Quality Assurance Assessment (AQAA) of the service. This was generally appropriately completed and was used in writing this report. Satisfaction questionnaires were received from two social and healthcare professionals, two members of staff and five residents. We have used these, where possible to inform our report. We would like to thank all residents that spoke to us during the inspection to tell us about their life in the home and the manager and all her staff for their cooperation and support during the inspection. What the service does well: The home provides a homely and maintained environment for residents to enjoy. Residents are encouraged to bring personal items in the home to personalise their bedrooms. The home has acquired a certain expertise in caring and supporting people who are terminally ill and who have end of life care needs. The manager and her staff are familiar with the needs of people who are terminally ill, particularly with regards to symptoms control. They are familiar with systems such as the Gold Standard Framework and Liverpool Care Pathway. They are well supported by the GP in meeting the needs of people who are terminally ill and of all residents that live in the home. The manager has been in post for a number of years and is familiar with the issues that arise when managing a care home. She keeps an active presence on the floors and maintains a good contact with residents, their relatives and friends and visitors to the home. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 7 There is a core group of permanent members of staff that ensures continuity of care. They receive training to ensure that they are skilled and competent to care for residents. What has improved since the last inspection? What they could do better: Whilst care plans were generally good and addressed the needs of residents, we noted that the approach to care plans and risk assessments needed to be more dynamic and flexible to ensure that these are updated as and when the needs of residents change. End of life care is on the whole covered appropriately in care records. We noted that the resuscitation status of residents was agreed between the home and the residents and/or their relatives without the input of the GP. It would be desirable to have a medical input in deciding the resuscitation status of residents. Although the home says that it provides adequate social and recreational activities for residents, this is the area of the service with which residents are Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 8 least satisfied. The majority of residents said in our questionnaires that they do not always receive stimulating activities to keep them occupied. The home has made progress in many areas. However there is one area where it has not made much progress. The home has area where the sluice and the laundry are located. This is far from ideal because of the risk of cross infection. The building work to build separate premises for each facility must be carried out as soon as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Carrick House Nursing Home DS0000022921.V376915.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 Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents or their representatives are offered information about the service that the home provides for them to decide if they would like to receive a service from the home. The needs of all residents that are referred are appropriately assessed by the manager and her staff to make sure that the home would be suitable for the prospective residents. EVIDENCE: The manager and the operations manager stated that the service users’ guide (SUG) and the statement of purpose (SoP) are kept updated and reviewed as and when required. They say that a brochure is given to all prospective residents and/or their relatives to inform then about the service that the home provides. The brochure contains the service users’ guide and the terms and conditions for staying in the home. Four of the five residents that responded to Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 11 our survey stated that they received information about the service prior to moving into the home. We looked at whether two new residents had contracts/statement of terms and conditions. We noted that these were in place and had been signed by the residents/representatives. Four of the five residents that responded to the satisfaction survey stated that they had received the home’s contract The care records of each of the three residents that we looked at contained preadmission assessments that had been completed by the manager when she visited the residents to assess their needs, prior to admission. These were well completed and provided clear information about the needs of residents. The needs assessments of the funding authorities and in some cases hospital discharge reports were also available in the care records to provide information about the needs of the residents that had been referred to the home. The home is clear about the residents that are accepted for admission. They must have either palliative care needs or older people care needs. These are the areas where the home has gained expertise and does well. As a result the home is well able to meet the needs of the residents that are admitted. The home’s staff group reflects the local community and most staff are familiar with the cultural and spiritual needs of residents. All the needs of residents, including the cultural and spiritual needs are discussed at the point of the assessment of their needs and care records are put in place to address the identified needs. The two members of staff who responded to the survey said that they received information about the needs of residents that they care and support, to enable them do their job appropriately. To demonstrate that their needs were being met, one resident said that they were very happy in the home and another said that the home does nearly everything very well. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans appropriately reflects the needs of residents, but are not always updated when the needs of residents change. Residents receive a good standard of personal hygiene and the healthcare needs of residents are met in the home. Medicines management is appropriately addressed to ensure a safe system for residents. End of life care is addressed in an open and sensitive manner to make sure that the needs of residents in relation to this aspect of care would be met when residents develop these needs. EVIDENCE: We looked at the care records of three residents that had been admitted after out last inspection. We noted that the needs of the residents were appropriately assessed at the point of admission and that care plans were drawn to address these needs. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 13 The manager explained that there is a format on the computer for each need that residents are likely to have with a number of actions to meet each need. Care plans are then chosen according to the needs of the resident and each plan of care is tailored to the specific need of a resident. We noted that care plans and risk assessments were reviewed at least monthly and that these were drawn up with the involvement of residents and their relatives. There was also evidence throughout the care records of discussions with the relatives of residents about the care of residents. This is good practice. We however noted that care plans and risk assessments were not always changed as and when the needs of residents change. For example the condition of a resident had started to deteriorate and the mobility of the resident had decreased, but the manual handling risk assessment and the care plan had not been updated to reflect the changes in the needs of the resident. Residents presented as appropriately dressed and with a good standard of personal hygiene. All residents are registered with a GP and there were records to show that they were seen by various healthcare professionals including the dentist, optician, chiropodist and palliative care nurse when that was required. All residents who responded to our survey stated that they are satisfied with the care and support that they receive for them to meet their needs. Four out of the five said that they always receive the medical care that they require and one said usually. The two healthcare professionals, who sent responses to the survey, said that people healthcare needs are appropriately monitored and met by the service. None of the residents had a pressure ulcer at the time of the inspection. There were residents with leg ulcers and there was evidence that they were being cared for as required. During the last inspection we looked at the management of restraint particularly with regards to residents who sat in wheelchair with seat belts on. At the time, comprehensive risk assessments and guidelines were not in place for the use of restraint on residents. The home has since looked into this matter. There were no residents in wheelchairs with a lap belt on at the time of this unannounced inspection. We noted that only one resident used a wheelchair because they wanted to and to increase their independence with regards to mobility. The manager stated that the practice of using lap belt has stopped and that all residents are seated in armchairs or are provided with appropriate chairs depending on their assessments. We noted the use of some tilt-in-space/Kirton chairs and suggested that residents who use these chairs also have risk Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 14 assessments in place. As those chairs have a degree of tilt towards the back, these could be seen as a form of restraint to someone trying to get up. The management of medicines was of a good standard. The amount of all medicines were recorded and signed for when received in the home. The amount of medicines that was carried forward to a new medicines cycle was also recorded. The medicines charts were signed when medicines were administered or a code was used if a medicine had not been administered. Instructions for the administration of medicines were generally clear and in cases of a variable dose, the amount of medicines that was administered was generally recorded. We checked the management of controlled medicines and noted that all records were kept as required by legislation. Medicines that required to be disposed of were disposed through a waste contractor. The home is accredited to the Gold Standard Framework for end of life care. It therefore uses the framework to assess people who are admitted to the home with regards to end of life care. The information that care records contain (advanced care planning) about end of life care is on the whole well completed and includes the cultural and spiritual aspects of the end of life care needs of residents. Residents who are close to death are cared for according to the Liverpool Care Pathway. This is decided by the home’s nursing staff with the support of the community palliative care service after an assessment of the needs of the residents. Generally the home is proactive and identifies residents that are deteriorating at an early stage to make sure that the necessary medicines can be prescribed and stocked in the home, ready to be used if required. Medicines may be required for people who are terminally ill to manage symptoms such as pain, nausea and vomiting, breathlessness, constipation and anxiety. There is a section in the care records that addresses the resuscitation status of residents. This is generally completed with the home and the relatives of residents. It would be good to involve the multidisciplinary team in this decision including the GP (Resuscitation and your right to refuse it. www.direct.gov.uk) as normally it is for the most senior clinician to be involved in these decisions (Decisions relating to cardio-pulmonary resuscitation, www.resus.org.uk ). Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides social and recreational activities for residents but residents are not fully satisfied with the activities that they receive. The majority of residents are satisfied with the meals that the home provides. These are nutritious and are provided to residents according to their choices. EVIDENCE: The organisation employs an activities coordinator that visits the home once a week to do some activities with residents and to help in the preparation of a programme of activities for the home. The care records of residents contained some information about the life history and the social and recreational needs of residents. A care plan addressing these needs was generally in place for each resident. On the day of the inspection, residents spent the time talking to staff and listening to music. A few stayed in the room either because they were not well Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 16 or because they wanted to. A resident clearly asked that they wanted to go to their room and that they did not want to be in the communal area. The home has a little library for residents to use and can also avail itself of ‘talking books’ and ‘talking news’ from the Brent Library service. Other activities included visiting entertainers, exercise sessions, board games and art sessions. We were informed that the home organised a garden party on the Sunday before the inspection. There have been outings to a local theatre that a few residents have enjoyed. The manager stated that staff continue to encourage residents to go on outings and make suggestions about places to go out. She added that generally there are few people that want to go out. The organisation has an adapted minibus for wheelchairs that is used for outings. The survey that we conducted showed that the provision of social and recreational activities is the area of the service with which residents were least satisfied. Only one resident was fully satisfied with this aspect of the service, one usually, two sometimes and one never. As a result the home must review the provision of social and recreational activities to make sure that these meet the expectations of residents. Lunch consisted of roast chicken, potatoes, broccoli and carrots. Desert was home made cream caramel. Supper on the day consisted of home made soup, sandwiches, quiche, and jelly and ice cream for desert. Residents are generally told about the menu for the day and asked about their choices in the morning. The chef then prepares the meals according to the choices that residents have made. We noted that the menu was generally complied with, but there were some alterations now and again, mostly about preparing meals that were planned for another day on the said day or cooking different vegetables that were on the menu. The kitchen was very clean and tidy. It was given a 5 star rating during an assessment by the Environmental Health Officer of the Local Borough. Records about the meals that were cooked in the home were recorded. Meals for the evening were prepared by the chef and the assistant cook. On the whole the meals that were provided were varied and nutritious. The choices and tastes of individual resident were also taken into account, as there was some flexibility in providing meals to suit the choices and tastes of residents. Three of the five residents who filled our questionnaires said that they are always happy about the meals that are provided by the home and two said usually. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints seriously and responds to complaints in an appropriate manner. The manager and her staff are aware of the action to take to safeguard people who use the service that the home provides. EVIDENCE: We looked at the complaints register and noted that there have not been any complaints since the last inspection. The complaints procedure is available in the foyer of the home in the form of complaints leaflets. It is also included in the home’s brochure. All five residents who responded to our survey stated that they could speak to someone informally if they were not entirely happy about the service that they receive in the home. However three out of the five residents stated that they knew how to make a complaint. There have not been any referrals to the safeguarding adults team of the local authority. All staff have had some form of training on protection of vulnerable adults and on understanding abuse. The whistle blowing procedure is available on a notice board. Staff that we spoke to knew that they had to report all allegations of abuse to the person in charge. The two members of staff who returned our survey stated that they knew what to do if they had concerns about the home. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 18 In the past the management of the home has dealt appropriately with allegations of abuse when these were reported to the safeguarding adults team of the local borough. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a maintained, clean and homely environment for residents. EVIDENCE: The grounds in front of the home were on the whole tidy. The back of the home consists of a patio area with some lawns and flower beds. There were also potted plants and shaded areas for residents to sit. The door to the back garden was left open and residents were encouraged to sit outside if they wanted to. The home is located in a residential area and the building is in keeping with other buildings on the nearby roads. The exterior of the building is on the whole in a good condition. One resident said that the fact that the home is not purpose built makes it more homely and gives it more character. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 20 The lounge and dining areas were appropriately decorated and furnished. Furniture and fixtures and fittings were generally in good condition, but we noted that some of the specialist chairs were slightly torn in some areas exposing the foam. The chairs with the exposed foam could be a source for cross contamination and should be replaced as soon as possible. The manager stated that she has ordered some more of the chairs to replace those ones that were torn. The bedrooms of residents continue to be in a good state of décor and appropriately personalised. Residents have brought their pictures, photographs and items of decorations to personalise their bedrooms. A few are below 12 square metres but are arranged to provide as much functional space as possible. We noted that the decorator was in the home at the time of the inspection carrying out some redecorations tasks. Residents that we spoke to said that they like their rooms and they had everything that they need in their rooms. The home employs ancillary staff to make sure that it is kept clean. On the day of the inspection it was clean and there were no odours. All residents who responded to the survey said that the home is always clean and fresh. The home has yet to provide a separate sluice and a separate laundry room. At the moment these two facilities are in the same area. This is far from ideal as clean clothes, after washing, are still being handled in a sluice. The manager stated that the work to build a new sluice with a sluicing disinfector was being tendered and that once a builder has been appointed the work will start. Carrick House Nursing Home DS0000022921.V376915.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides appropriately trained staff in adequate numbers to meet the needs of residents. The recruitment procedure is adhered to, to make sure that only the right and suitable applicants are employed by the home. EVIDENCE: At the time of the inspection there were seventeen residents in the home. In the morning there was a trained nurse and three carers. In the afternoon there was also the same number of staff. The manager generally works from 08:0017:00. She is part of the nursing and care team in the morning in addition to what is usually in place, and spends the rest of the day doing management duties. At night there was one trained nurse and one carer on duty. Our survey shows that four in five residents are always satisfied with the availability of staff and one is usually satisfied. Three out of the five said that staff always listen and act on what they say and two said that staff usually do that. One of the four residents that we talked to during the inspection said that staff rush them at times when giving personal care. We looked at the personnel files of two members of staff. We noted that all the records that should be in place to comply with the recruitment procedure Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 22 and legislation were in place, including references, CRB checks and proof of identity and eligibility to work in the UK. New members of staff receive an induction to the home that includes the common induction standards as per skills for care. The two members of staff who returned our questionnaires said that they received a comprehensive induction when they started work in the home. There were also records to show that staff receive regular supervision, although the items that are discussed are not always recorded. All the staff that we spoke to during the inspection said that they receive regular supervision and that they are appropriately supported by management to do their job. The training records of the two members of staff showed that they have had some mandatory training and training in clinical areas. The manager stated that more training was planned for staff for them to be fully up to date with training. For example fire training and manual handling have been arranged for them. According to the AQAA the home has more than 50 of its care workers trained to NVQ level 2 in care or above. The AQAA states what the home has improved during the past year in the area of recruitment and training. It says that the home has “increased the amount of training in non-mandatory disciplines e.g. diabetes, strokes etc. This has improved the knowledge of the staff as a whole and helped them better meet the needs of service users”. The home proposes in the AQAA to review the shift pattern of staff in the future, as a way of improving the service, to ensure that staff numbers reflects the needs of residents and the ‘busy times’ of the day. During the last inspection we recommended that training in customer care and communication be provided to staff, following a complaint investigation. This has not yet been provided. One of the two respondents to the home’s staff survey said that communication between other carers and the home manager could be improved. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in an open and inclusive manner. The home has a quality assurance system to monitor the quality of the service that is provided. Safeguards are in place to ensure that the personal money of residents is appropriately managed. Health and safety issues are appropriately addressed to ensure the safety of all people who use the premises. EVIDENCE: The manager has now been in post for seven years. Her deputy has recently resigned and the home was in the process of recruiting for a deputy manager. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 24 The home is well supported by Zena Chan the operations director, who was present for part of the inspection. The manager is a nurse and has the registered manager’s award. There was also evidence that she has attended mandatory training and other training to keep herself up to date. She mostly works from 08:00-17:00 and provides hands on care generally in the mornings and is supernumerary for the rest of her time. Minutes of residents/relatives meetings were available. This shows that residents and/or their relatives were given the opportunity to express their views and to contribute to the running of the home. Minutes of staff meetings were also available for inspection. A summary of the results of the home’s latest satisfaction survey was available for inspection. We were informed that the survey is generally carried out yearly. The home continues to use the Blue Cross Quality Management System that was drawn up by the Registered Care Homes Association. This consists of a system of audits that look at processes, records and policies and procedures that are required when running a care home. We were able to see the home’s development action plan in its Annual Quality Assurance Report to address areas that needed improving. The home only manages the personal money of one resident. The account of the resident is managed by the head office and money is requested from the head office whenever the home needs to buy something for the resident or when an expense is made on behalf of the resident. All the records are kept at head office and are audited. A summary of the expenses of the resident is also requested by the funding authority from time to time, as an additional safeguard of the financial affairs of the resident. There were a fire risk assessment, a health and safety risk assessment and a fire emergency plan available for inspection. These were all kept up to date. There was evidence of weekly fire detector tests, emergency lights tests and monthly water temperature tests. A few rooms that did not have thermostatic valves during the last inspection, have been fitted with these to reduce the risks that residents face from scalding. The home had an up to date electrical wiring test certificate and the work that had been recommended at the time, had been completed to ensure that the wiring system was safe. A portable appliances test certificate and a gas safety certificate were also available for inspection. Safety certificates were available for the hoists and the lift, and to show that the water system in the home has been treated for legionella. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 25 We looked at the accidents/incidents records. We noted that records were clear about the accidents/incidents that were sustained by residents. Most of the accidents/incidents seemed to have occurred as a result of falls such as when residents tried to move on their own when they were in their rooms. The causes of the accidents/incidents were generally identified and there was evidence of action that the home took, to reduce the likelihood of similar accidents/incidents occurring again. Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1,2) Requirement Timescale for action 31/10/09 2 OP12 16(2) (m,n) Care plans and risk assessments must be updated as and when the needs of residents change to make sure that these appropriately reflect the needs of residents. There must be a review of the 31/10/09 provision of social and recreational activities in the home to make sure that residents are stimulated as much as possible. This must include outings and involvement of the residents in the local community whenever possible (Repeated requirement-timescale 30/09/08 not met). The home must have separate premises for the sluice and laundry to ensure good infection control systems. It must also have a sluicing disinfector. (Previous requirementtimescales of 30/04/08 and 31/01/09 not met) 31/01/10 3 OP26 13(3) Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations It is recommended that all people sitting in specialised chairs have a risk assessment in place to address the reason for using these chairs and to rule out their use as a form of restraint. That the resuscitation status of residents be discussed with the involvement of the residents and /or their relatives, the home and the GP. That all chairs that have damaged fabric be replaced as these could be a source of cross contamination since they cannot be easily wiped clean. It is strongly recommended that training in customer service and communication be provided to all staff. This would raise awareness of issues with regards to communication and address any shortfalls if there are any. 2 3 4 OP11 OP26 OP30 Carrick House Nursing Home DS0000022921.V376915.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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