Care Home: Eversleigh Nursing Home

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What the care home does well Prospective residents receive a full and detailed assessment of their needs prior to staying at the home to ensure these can be met. Staff have a good understanding of the needs of the residents and seek specialist support where required to ensure their health care needs are met.Staff are supported and supervised which improves their ability to carry their job out appropriately. Staff spoken to were friendly and approachable and were caring in their approach towards residents. There is a clear management structure within the home and senior staff are always on duty to allow for the effective running of the home. A resident stated "I speak to ... the manager who is excellent". There is a training consortium within the home to support staff in their training needs to allow them to effectively and safely care for the residents. The home has achieved the "Gold Standard Framework" with commendation. This is a programme of care which helps staff to effectively support people who require specilist care at the end of life. Residents spoken to during the inspection were positive about the staff support they receive. One stated they were "very very comfortable and happy". Another stated "they are very nice to you" and another said "I am happy here". The home has recently purchased new equipment including several hoists and new nursing beds to improve the way their meet health and personal care needs of the residents. What has improved since the last inspection? This is not applicable as this is the first inspection with the new registered provider. What the care home could do better: Staffing hours must be consistently assessed and actions put into place to ensure that these are sufficient at all times to meet the needs of people who live there. Action needs to be taken to identify any hot pipes and appropriate action taken to manage any burn risks for residents. The storage of food needs to be regularly checked to ensure food remains fresh and is appropriately wrapped. Meals provided to residents need to be regularly reviewed to ensure they continue to receive appropriate choices and meals they enjoy.Areas of the home where maintenance and decoration needs attention need to be addressed through an appropriate maintenance programme with appropriate timescales. Some attention is needed to address infection control and hygiene practices in the laundry to prevent any risk of the spread of infection within the home. The number of carers with a National Vocational Qualification II should be increased to help ensure residents receive a safe and effective level of care and support. CARE HOMES FOR OLDER PEOPLE Eversleigh Nursing Home 2/4 Clarendon Place Leamington Spa Warwickshire CV32 5QN Lead Inspector Sandra Wade Key Unannounced Inspection 25th September 2008 08:45 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 Eversleigh Nursing Home DS0000071762.V372275.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. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eversleigh Nursing Home Address 2/4 Clarendon Place Leamington Spa Warwickshire CV32 5QN 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) 01926 424 431 01926 424 696 Central England Healthcare Ltd Vanessa Josephine Fisher Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (42) of places Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: Old age not falling within any other category (OP) 42 Physical Disability (PD) 42 The maximum number of service users to be accommodated is 42. 2. Date of last inspection Not applicable first inspection with new provider. Brief Description of the Service: Eversleigh is a large, regency building in the centre of Leamington Spa and is close to public transport routes and local amenities. The home has been converted from two Victorian houses into attractive and spacious nursing home accommodation. It provides nursing care for forty-two older people with physical frailty. The accommodation is based over three floors which can be accessed by a shaft lift. Wheelchair access to the home is via an external lift from the car park. Gardens are situated to the side and back of the home and car parking is available to the front. There are 32 bedrooms which consist on 30 single rooms and two twin rooms. All have washbasins and 15 have an ensuite facility. At the time of this inspection the fees were not published in the Service User Guide. These can be obtained by contacting the home. Extra charges over and above the fees are made for hairdressing, dry cleaning, chiropody, physiotherapy, dentist, opticians, newspapers, specialist nursing equipment/materials including incontinence aids and the purchase of clothing or personal effects. In addition to this extra charges are made for an escort to hospital or paramedical visits. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was the first unannounced inspection to this home and it took place between 8.45am and 8.45pm. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection and information contained within this has been included within this report where appropriate. Quality satisfaction surveys were sent out to ten residents to obtain their views on the service and seven were returned. Discussions were held with staff, residents and visitors during the period of the inspection. Three people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, social activity records, accident records, financial records, complaint records and medication records. Residents were observing in the dining room during lunchtime to ascertain what the mealtime experience was like. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: Prospective residents receive a full and detailed assessment of their needs prior to staying at the home to ensure these can be met. Staff have a good understanding of the needs of the residents and seek specialist support where required to ensure their health care needs are met. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 6 Staff are supported and supervised which improves their ability to carry their job out appropriately. Staff spoken to were friendly and approachable and were caring in their approach towards residents. There is a clear management structure within the home and senior staff are always on duty to allow for the effective running of the home. A resident stated “I speak to … the manager who is excellent”. There is a training consortium within the home to support staff in their training needs to allow them to effectively and safely care for the residents. The home has achieved the “Gold Standard Framework” with commendation. This is a programme of care which helps staff to effectively support people who require specilist care at the end of life. Residents spoken to during the inspection were positive about the staff support they receive. One stated they were “very very comfortable and happy”. Another stated “they are very nice to you” and another said “I am happy here”. The home has recently purchased new equipment including several hoists and new nursing beds to improve the way their meet health and personal care needs of the residents. What has improved since the last inspection? What they could do better: Staffing hours must be consistently assessed and actions put into place to ensure that these are sufficient at all times to meet the needs of people who live there. Action needs to be taken to identify any hot pipes and appropriate action taken to manage any burn risks for residents. The storage of food needs to be regularly checked to ensure food remains fresh and is appropriately wrapped. Meals provided to residents need to be regularly reviewed to ensure they continue to receive appropriate choices and meals they enjoy. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 7 Areas of the home where maintenance and decoration needs attention need to be addressed through an appropriate maintenance programme with appropriate timescales. Some attention is needed to address infection control and hygiene practices in the laundry to prevent any risk of the spread of infection within the home. The number of carers with a National Vocational Qualification II should be increased to help ensure residents receive a safe and effective level of care and support. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eversleigh Nursing Home DS0000071762.V372275.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 Eversleigh Nursing Home DS0000071762.V372275.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): Standards 1 and 3 were assessed. Quality in this outcome area is good. There is good, detailed information about the home available to prospective residents so they can make informed choices on whether to stay. Prospective residents are assessed prior to their stay to ensure their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A combined Statement of Purpose and Service User Guide detailing information about the care and services provided by the home has been developed. The Annual Quality Assurance Assessment completed by the home confirms a copy of this is provided to each resident when they are admitted. In addition to this, there is a brochure with photographs of the home and details about the care, management and financial arrangements which is provided to any visitors as required. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 10 All of the residents who completed our questionnaires felt that they had received enough information about the home before they moved in to help them make a decision on whether to stay. One person did not feel that all that was promised had materialised. Three residents files were viewed to confirm the assessment process prior to them staying at the home. It was evident from records in place that all three of the residents had received an assessment of their needs prior their admission. Assessment records showed key areas of need had been considered including personal care, diet and weight, sight, hearing, communication, specific medical needs and mobility. This allows staff to prepare plans of care showing the staff support needed to meet the resident’s needs. Eversleigh Nursing Home DS0000071762.V372275.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. The health and social care needs of residents are set out in plans of care to help staff ensure they are met. Residents are treated with respect and their choices are considered when providing their daily care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three residents were read in detail during the inspection. It was evident that generally records were clear and easy to follow with specific instructions to staff on actions that needed to be taken to ensure the needs of residents were met. Care plans viewed for all residents contained risk assessments in relation to poor nutrition, mobility and the use of bedrails where appropriate. These identified any risks to the resident and how these should be managed. There were also risk assessments in place in regard to moving and handling residents showing how many staff should support the resident as well as any equipment needed such as a hoist. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 12 It was not evident that residents or relatives were being asked to sign a disclaimer indicating their agreement to use the bedrails. These are considered to be a form of restraint and it is therefore important that either the resident or their representative gives their consent to their use. One person was diagnosed with diabetes and records showed that this was tablet controlled. There were clear records to show that the blood sugar levels of the resident should only be taken if they were unwell and not routinely as this was not considered necessary. Staff were also able to confirm this. Care plans detailed any tasks which residents could undertake independently such as their personal care. One care plan stated for example that the resident could wash their own hands and face from a bowl of water in front of them but needed help with their dentures, dressing and bathing. One resident was observed to be thin and frail and their records were viewed. A daily living needs assessment and care plan document showed that this resident was of a low weight – 34.6kg (5.4 stone). It was evident that this person was being weighed monthly and their weight had dropped to 33kg (5 .1 stone) and had risen again to 33.2kg (5.2 stone) in September 08. The home had sought the specialist advice of a Dietician in March 08 but there were no clear records on file of what the advice of the Dietician was. There was a care plan in place to manage this persons weight which suggested that milk power should be added to porridge, mash and puddings to help increase the residents calorie intake. It was not clear who was responsible for doing this. The chef advised that this would be the nurses as she had not been told to do this. The care plan also said that the resident should be weighed weekly. Records in place showed that this was not happening and there were varying gaps between the actual times the resident was being weighed. Weight records in place showed that the resident was maintaining weight around the 33kg. Staff advised that the doctors were aware of the residents weight and had prescribed fortisips – a meal supplement, should the resident miss a meal. It was explained however that due to the resident eating three meals a day these were not being given as they were not considered necessary. Staff said they were monitoring the amount of food the resident was taking but this was not evident from records in place. This is important to demonstrate the resident is taking sufficient calories to support their health. One resident’s records indicated NFR (not for resuscitation). There were no records demonstrating how this decision had been reached, by whom or to indicate that this was being regularly reviewed with all parties as required. In addition to the support of medical professional such as the GP and Dietician, it was evident that residents also receive support from a Chiropodist, hearing services and an Optician when required. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 13 Questionnaires sent to residents by us asked the question “Do you receive the care and support you need? One person answered “always”, four people answered “usually” one commented “sometimes have to wait” and another commented “most nursing and care staff are excellent but change of ownership and major changes to working practices caused a large number of older and trusted staff to resign”, one person responded “sometimes” and wrote “since change of ownership there has been less individualised care”. Residents spoken to during the inspection were positive about the staff support they receive. One stated they were “very, very comfortable and happy”. Another stated “they are very nice to you” and another said “I am happy here”. A review of medication was undertaken and on the whole this was managed well. Some medications were stored in a cabinet in the clinic room. Staff explained that they had increased the number of trolleys due to the amount of medication needed and there was not room for all of the trolleys to be stored in the clinic room. The nurse did explain that there were plans being considered for additional space for medication storage and management. A controlled drugs cabinet was available to store these safely. It was evident on viewing this that this was too small for the amount being used as medication as medications were tightly packed in. The manager said that they had been in discussions with the Pharmacist to get a larger cabinet and those supplied so far had not been suitable and they were awaiting another delivery. The home was using a multi dose system (MDS) for their medication which means medication is stored in blister packs so medication can be easily identified for each day. Only registered nurses are responsible for medication and administer this. It was evident that copies of prescriptions are kept to show all medications ordered for residents. On viewing the medication received, given and remaining it was evident that for one person there was one more tablet left over than there should have been. This suggests the resident had not been given the correct medication on one of the days. The medication record for another person indicated “self medicates” but there was no risk assessment showing the resident was able to do this safely themselves. In discussion with the nurse it was identified that the person was not self-medicating but was being given this by a relative also residing at the home. Staff said that a risk assessment had been completed for a relative to administer these but this was not on the residents file. It was also not clear what audit tools were in place to ensure the medication is being given as directed by the GP. Records need to clearly reflect how medication is being administered and risk assessments should be kept within the residents file in regard to any self-administration as required. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 14 Movicol had been written on the Medication Administration Record (MAR) for one resident but it was not evident that this had been prescribed for them by the GP. There was also none available in the trolley in the name of this resident suggesting that the medication belonging to somebody else had been used. The nurse agreed to follow up this matter. There were no concerns identified during the inspection in regard to privacy and dignity. The Annual Quality Assurance Assessment (AQAA) forwarded to us by the home showed that they have a door knocking policy so that staff do not enter residents rooms unless invited. There is a portable phone to enable residents to make private calls and the ‘preferred’ names of residents are established to ensure they are always addressed in an appropriate manner. The AQAA also states that all staff are inducted and trained to respect the residents privacy and treat them with respect. Eversleigh Nursing Home DS0000071762.V372275.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. Quality in this outcome area overall is good. Residents have access to a range of social activities and are able to make choices about how their care is delivered. The meals provided are wholesome and nutritious although ongoing changes in food provision have impacted on the enjoyment of meals by residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an Activity Organiser employed by the home for five days per week from 9am – 2.30pm. She is also a trained nurse and covers some of the caring shifts. Each month an activity programme is devised for the residents. The one for September was viewed and showed that activities provided included keep fit, quizzes, coffee in town, pat dog visits, residents’ birthday celebrations, music with Dora, bingo, giant snakes and ladders and manicures. Each resident has a social activities care plan which indicates any preferred social activities so that staff can take this into consideration when providing Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 16 activities. One plan stated that the person was a practicing Roman Catholic. It was evident that communion had been arranged for them in their room. There was evidence that each resident had been asked for ideas in regards to activities. They had suggested shopping trips, drives in the country, trips to cafes and going to the pub. Participation records showed that a mystery tour had been arranged in the mini bus but it was not fully clear other ideas had been followed up. Records of those residents who had participated in activities were available and these confirmed that quizzes, church visits and one to one chats had been carried out. There were also records to confirm an exercise class had taken place with between four and nine people. In some cases residents had chosen not to participate in any of the activities despite efforts by staff to encourage them. On the day of inspection the Activity Organiser was not working so no social activities were seen to take place. One resident was found in their room with the television on loud in the background. This was found to be the case each time the inspector went to see them. The resident was not facing the television so they could only hear it. On one occasion there was a children’s programme on the television. Staff were asked about this and said they had been requested to leave the television on so that the resident was not left in total silence in their room. Whilst this is accepted, it was not evident that full consideration had been given to the programmes most suited and appropriate to the resident. Comment cards received by us from residents showed that two people out of seven felt there were “always” activities arranged by the home that they could take part in. One person commented “the social co-ordinator … is excellent as was her predecessor”. Two people felt there were “usually” activities they could take part in. One person stated “could do with more armchair keep fit to involve all residents in the lounge”. One person responded “sometimes” and two people responded “never”. One of these stated they were “not able” to join in and the other stated they “cannot take part”. Care plans did state residents likes and dislikes and the importance of ensuring choices are offered in regards to daily living activities such as when attending to personal care and serving meals. One care plan relating to food stated that the resident liked to eat in the lounge or dining room and this was observed to happen. Another care plan stated that the resident liked to eat in their room, this was also observed to happen. This resident also told the inspector they always had their meals in their room. The chef keeps records of the likes and dislikes of residents and also keeps details of the choices that each resident has made each day. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 17 The chef also had details of those residents needing soft diets and special plates or cutlery to help them eat independently. The chef explained that she provided sugar free jellies, juices and tinned fruit when required for those needing a diabetic diet. She also explained that one resident was vegetarian and they bought in a selection of suitable foods including vegetarian sausage, vegetable pies, nut cutlets, quiches and vegetarian grills. Meals are served from a serving hatch from the kitchen to the dining room. A flower arrangement decorates each dining table. All the crockery and cutlery is matching and there are tablecloths with matching folded napkins. Salt and pepper mills are provided at each table so that residents can independently help themselves. At lunchtime it was evident that many of the residents have meals within their bedrooms. Some were seated in the dining room and some were seated in the lounge. Each meal had a plate cover for transportation to the rooms. The meal was beef stew with dumplings mashed potato, gravy and broccoli or a second choice of chicken escalope. The meals looked appetising and suitable portions were seen. The lunchtime was observed in the dining room and lounge and this was found to be a mostly positive experience with staff being on hand to assist where necessary. One resident was afraid the gravy was going to run over their plate and a carer came to their assistance. This same carer pushed one resident’s chair under the table a bit more so they were more comfortable to eat. One resident who was not able to mobilise was seated in the lounge to have their meal. This resident kept trying to get out of their chair because they wanted to go to the toilet. The resident told a carer but was asked to wait as the staff were busy serving lunches. When the carer left, the resident became unsettled and continued to try and get out of the chair, they could easily have fallen. Eventually a senior carer came into the lounge and when the resident said they needed the toilet, the carer immediately organised for the resident to be assisted. This was not a positive lunchtime experience for this resident. There were sufficient stocks of fresh meat and vegetables and the chef confirmed that orders are made two or three times a week so the home are always using fresh produce. A menu was available in the dining room but the meals served were not exactly as advertised. For example the pudding on the menu was mandarin cheesecake but the pudding served was a fruit crumble and the vegetables served were different. The chef said that she was new to her post and work was being undertaken to review the menus. She advised that she was trying Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 18 to do more comfort foods and adjust the menus for the new season including more suet puddings and rice puddings. The Annual Quality Assurance Assessment (AQAA) forwarded by the home states that a specific menu is designed for special occasions such as Christmas, Easter, New Years Day or on request for special birthdays. Surveys received from residents showed that four out of the seven felt they “usually” liked the meals. Three said they “sometimes” did. One person commented “the meals tend to be flavourless”. Another stated “chef has left now after excellent long term service”. “Many changes in staffing generally. Several chefs some agency – not good”. Another stated “there are some shop bought cakes arriving for desert…..which are difficult to manage for a disabled person”. Another commented “ huge turnover of kitchen staff has resulted in an uneven quality of service and food content …. lunchtime meals are often tepid”. During the inspection one resident spoken to said that they were “always happy” with the meals. Another who was less able to communicate had eaten all of their main meal suggesting they had liked it. Another said “I didn’t get what I asked for today” and stated the food portions were smaller. Staff spoken to confirmed there have been changes to the staffing arrangements in the home. The manager confirmed that the new chef was involved in implementing changes to the menus to ensure residents have a choice and can enjoy their meals. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. Complaints and concerns are taken seriously and systems are in place to ensure any allegation of abuse is managed appropriately to safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A formal complaints procedure is displayed in the home which details the process for residents and relatives to follow should they have any serious concerns. A copy of the complaints procedure is also included in the Statement of Purpose/Service User Guide given to residents on admission. There is also a “Comments and Concerns” book which showed that there had been concerns raised by resident’s families about catering, bathing, laundry not coming back and the insufficient cleaning of rooms. It was evident that the manager had taken action to address these. It was recorded that she had explained about new systems being implemented and the recruitment of new staff in order to address these matters. In one room the sink had been blocked and although actions had been taken to unblock this, it was not clear how quickly this had been done because there was no date of completion recorded. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 20 The comment cards received by us from residents showed that four out of seven “always” know who to speak to if they are not happy. Two people stated they “usually” did and one person stated they “never” did and wrote “I just try and catch hold of someone who is around”. Policies and procedures for safeguarding residents are in place and the manager has stated in the Annual Quality Assurance Assessment forwarded to us that staff complete training in relation to this during their induction to the home. Staff spoken to were aware of their responsibilities for reporting any abuse and for ensuring the safety of the resident should this occur. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. The home is pleasant and comfortable and is subject to ongoing improvement to make this more pleasant for the residents. Some attention is required to hygiene and infection control management in the laundry. This is to ensure residents live is a safe and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Resident’s accommodation is provided on three floors with all floors accessible by using a lift or stairs. Access to the home for wheelchair users is accommodated by an external lift. The home is spacious and has an attractive lounge and dining area. Some of the bedrooms have ensuite toilets and there are also communal toilets which residents can access. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 22 Several bedrooms were viewed and it was evident that the residents had been able to personalise them with their own possessions and furniture to make them comfortable and homely. Call bells were available for them to alert staff if needed. Specialist equipment is available to help meet the needs of the residents, this includes three electric hoists, one standing hoist, electric baths, shower chairs for use in the shower rooms, grab rails and raised toilet seats. Rooms are centrally heated and can be controlled in the residents bedrooms. The manager reported in the Annual Quality Assurance Assessment (AQAA) forwarded to us that 2 new boilers have been fitted to make the heating system more effective. It was observed that pipe work and radiators do not have guaranteed low temperature surfaces. In one of the communal toilets there was hot pipes going down the wall just inside the doorway which could present a burn risk to any service users who may use this. The AQAA states that there are plans to install a new heating system with low surface temperature radiators. During the tour of the home it was noted that the general décor is looking tired and worn. This includes for example worn stair carpets and paint chipped areas in the communal toilets. The provider has acknowledged this and has stated in the Statement of Purpose for the home that there are plans for the accommodation to be fully reconfigured and refurbished. One of the twin rooms viewed only had a small portable screen providing limited privacy. It was noted that people in this room had commodes and it was therefore likely the small screen would not have provided sufficient privacy and dignity for the people using these. The bathroom downstairs had a large blind at the window which was closed down reducing the lighting in the bathroom. On checking why this was the case it was found that the glass behind it was clear glass and the window was close to a walkway. This prevents the bathroom from being used in natural daylight. There are specific staff allocated to do laundry and cleaning and a member of staff who provides a cleaning service to the home said that every room is cleaned every day. The laundry is collected each day and the process for managing this was discussed. It was evident that the laundry person was emptying the dirty laundry onto the floor to sort it into relevant washing piles. This is not good Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 23 hygiene practice or effective infection control management. Systems should be in place, which prevent laundry being sorted on the floor. Soiled linen is washed at sluice programmes to ensure items are fully clean. Staff also have access to a sluice room on each floor. It was observed that dirty washing once sorted was being stored in open weave baskets in the laundry, which are difficult to clean to maintain good hygiene. It was also not evident that the laundry person wears a disposable apron for the dirty tasks, which again helps to promote good hygiene. One of the comments received by us suggests that there have been problems with laundry being returned. The homes comments book also contained a comment that there were problems with laundry being returned. The provider has acknowledged this in the Annual Quality Assurance Assessment document forwarded to us. This states that they have increased the laundry staffing hours to ensure the prompt return of clean laundry and all residents have been allocated a designated laundry staff member to liaise with on laundry issues and who has responsibility for keeping wardrobes and cupboards tidy on a monthly basis. The laundry person spoken to said they were new and they currently did not return laundry to the rooms as other staff were doing this although they would be doing this eventually. The Statement of Purpose for the home states that all items of clothing need to be labelled so that it can be returned safely. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. Staff training is provided to ensure staff are suitably trained to care for residents. It is not clear that staffing arrangements have always been effective in supporting the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to be friendly and approachable and some staff were new to the home so were still getting familiar with residents and working arrangements. It was not evident staffing for the home has always been effective in meeting the needs of the residents. The manager confirmed that they aim to provide seven care assistants and two nurses on the morning shift, five care assistants and two nurses on the afternoon shift and three care assistants and one nurse on the night shift. Duty rotas seen showed that numbers quoted for the morning shift are being achieved with the deputy managers working shifts with the nurses. There are sometimes shortfalls in the numbers for the afternoon/evening shift with sometimes there being four carers and not five available. On 23 September 2008 there were only three night staff indicated on the rota and not four as planned. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 25 There are also specific staff who are allocated to complete ancillary duties which include laundry, cleaning and catering duties. Duty rotas show there are five staff who work in the kitchen. This includes one Head Chef, one Head Cook and one Assistant Cook. They are supported by two Kitchen Assistants. Catering staff work seven days a week from 7am to 6.30pm. There are four domestic staff who work from 8.30am to 2.30pm each day. In addition to this there is a laundry person who works in 9am – 4pm each day. Eversleigh was operating as a care home before the new provider took over and many of the staff transferred over to work for the new provider. Since the new registration of the home, a number of staff have left. The Annual Quality Assurance Assessment (AQAA) that the manager has completed shows that 16 staff including carers/nurses have left the home in last 12 months. This has led to a recruitment drive by the home to employ new staff and has resulted in new staff being recruited to every department. There has also been a restructuring of each department with each now having a designated Head. It was evident through the inspection process that staff leaving has had an impact on residents and their families and some were disappointed that familiar faces were no longer around. Out of the seven comment cards received from residents one felt that they “always” received the care and support they needed, three felt they “usually” did and three felt they “sometimes” did. One resident commented “agency and temporary staff are a regular occurrence” and “huge turnover of kitchen staff has resulted in an uneven quality of service”. Another stated “since change of ownership there has been less individual care”. Another stated “you cant always find someone around to talk to”. Out of the seven comment cards received, four residents felt that staff were “usually” available when they needed them and three said they “sometimes” were available. One resident stated “they are understaffed so are not available in the lounge”, another states “since the change of ownership there seems to be fewer staff to help”. Another states “much depends on the time of day”. During the inspection staff were seen to be busy with residents throughout the day and any conversation with residents was limited to questions linked to their care as opposed to social interaction. Staff spoken to acknowledged that they did not have much time to interact with the residents although they would like to. It was established that this was partly due to having agency carers who needed regular staff support as they did not know the residents well and being less familiar with working regimes. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 26 Management staff confirmed that it had been a very difficult start due to staff leaving but it was felt that staffing of the home was getting easier as new staff were being recruited. Staff training is provided on an ongoing basis. The Annual Quality Assurance Assessment (AQAA) states that there 33 permanent care workers at the home and out of these there are ten who have achieved a National Vocational Qualification (NVQ) II in Care to help them more effectively care for residents. This is below our standard for 50 of care staff to achieve this. The manager has confirmed in the Annual Quality Assurance Assessment that staff employed from the agency all have a NVQ II qualification to ensure they are suitably qualified to care for the residents. The AQAA for the home also states that the home runs its own training organisation and employs a full-time training manager and a part-time training officer. It states that the training organisation is accredited with EDEXCEL to deliver NVQs in Health and Social Care and also runs a four monthly lecture programme in mandatory courses and clinical updates. The home also has achieved the “Gold Standard Framework” with commendation. This is a plan of care which helps staff to effectively support people who are at end of life. The training schedule for the home was viewed. This shows that the majority of staff have completed health and safety, moving and handling, fire, cross infection and abuse training. It was not clear that all staff have completed food hygiene training as required. In addition to the above statutory training, some staff have also completed training on dementia and syringe drivers. A review of records of new staff were viewed to confirm that appropriate recruitment practices were being carried out. It was evident that a criminal records bureau (CRB) check had been obtained for two out of the three staff files seen. Employment records showed that both had been received prior the start dates but it was evident that one member of staff was on the duty rota the day before the employment date stated. It was however evident a Protection of Vulnerable Adult (POVA) check had been obtained to allow them to work before the CRB check was received. The third file contained a POVA check and the manager reported that this member of staff would not have access to residents unsupervised until the CRB check has been returned. The AQQA stated that all new staff undertake induction training and have to complete a probationary period of three months. A new member of staff spoken to said they had received some training on their first day and it was planned for them to do further training. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 27 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): Standards 31,33,35 and 38 were assessed. Quality in this outcome area is good. The home is run by an experienced manager who is of good character. Actions are being taken to ensure the home is run in the best interests of the residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is an Registered General Nurse and has recently attained the Registered Managers Award, NVQ Level 4 in Health & Social Care and Manual Handling Trainers Certificate. The manager worked at the home for many years prior to the new provider taking over. Staff were positive in their comments about management and stated they felt well supported in their roles. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 28 A service user comment card stated “I speak to … the manager who is excellent”. A review of quality monitoring was undertaken. A resident consultation form had been completed for each resident with information such as preferred times to go to bed and get up and preferred drinks etc to help staff in providing care and services in accordance with the wishes of the resident. Resident and relative satisfaction questionnaires had been prepared to be sent out in October 2008. The home had a book of thank you cards in place and some of the comments were viewed. One person had written “just wanted to thank you for all the excellent care and support you gave my mother whist she was a resident with you. “ Another stated “many thanks for all the care attention and affection you give my mother”. One resident spoken to during the inspection said they were “very, very comfortable and happy”. Another resident spoken to said when talking about staff “they are very nice to you”. Another resident said “I am happy here” and commented they joined in any social events taking place. Systems are in place to manage small amounts of money for residents if this is requested. The Service User Guide confirms that written records will be kept for each resident in relation to any transactions made on their behalf. The manager stated that at the time of inspection they were not managing any money as residents were invoiced for any expenditure. A review of health and safety was undertaken and it was evident checks had been recently undertaken. Hoists had been serviced on a six monthly basis. The lift was last seen for maintenance checks in Sept 2008 and service agreements were in place for lift to be checked regularly. Electrical Portable appliances had been tested in June 2008 to ensure they were safe for residents to use. A gas inspection had been done in August 2008 and wheelchair servicing was being undertaken to ensure they are safe for residents to use. The AQAA states that a member of staff has lead responsibility for health and safety within the home and undertakes updates and assessments as required. This person also monitors accidents for any patterns, weekly fire alarm tests and monthly fire drills. The AQAA also states that risk assessments are undertaken in the use of chemicals, manual handling of residents, bed rails, kitchen equipment and laundry equipment. Staff receive training in health and safety in line with Skills for Care standards. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 29 One issue requiring attention relating to health and safety was the storage of some foods. This included a lemon which had been cut in half and left uncovered alongside meat in the fridge. There was also cheese that was not properly covered. Some peppers were found to be very soft and decaying. Some juice stored in the fridge had no date of opening so it was not clear it was still safe for staff to use. Risks associated with hot piping in the toilet identified as well as any other hot pipes that may be around the home will need to be assessed to ensure the home is safe for residents. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 30 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13 Requirement Prescribed medication must only be used for the person it has been prescribed for. This will ensure that they are safe at all times. Action needs to be taken to address hot piping in the home to ensure there are no burn risks to residents. Food needs to be appropriately stored to ensure it is kept fresh and is suitable to eat. Fresh foods need to be regularly checked to ensure they have not deteriorated and remain suitable for use. Timescale for action 31/10/08 2. OP38 13 30/11/08 3. OP38 13 15/11/08 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 OP7 Good Practice Recommendations Care plan records must show that instructions relating to DS0000071762.V372275.R01.S.doc Version 5.2 Page 32 Eversleigh Nursing Home 2. 3. 4. OP9 OP9 OP11 5. 6. OP15 OP19 7. OP26 8. OP28 the delivery of care are being carried out consistently. This includes weighing residents within the stated timescales and keeping adequate records in regards to food and fluid intake for any residents who may be at risk of poor nutrition. This is to prevent any oversight in meeting the care needs of the resident. It is advised that a review of the storage of medication is completed to ensure this is suitable and sufficient to manage medications effectively. Records relating to medication management need to be clear in regards to self medication to ensure this can be managed safely. Appropriate guidelines must be followed in regard to residents who opt for non-resuscitation. Records must clearly state any agreements and with whom and any decisions must be regularly reviewed. It is advised that a review of menus and the food provided is undertaken to ensure this is being provided to the satisfaction of the residents. A maintenance plan for the home should be devised showing all planned areas of maintenance and improvement. This is to demonstrate that those areas of the home needing refurbishment will be completed within a reasonable timescale so that the residents live in a safe, pleasant and comfortable environment. A review of management of laundry should be undertaken to ensure good hygiene and infection control practices are undertaken. This is to prevent any spread of infection or illness to the residents. Action should be taken to increase the number of caring staff with a National Vocation Qualification II to help them provide more effective care to the residents. Eversleigh Nursing Home DS0000071762.V372275.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Eversleigh Nursing Home DS0000071762.V372275.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. 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