Care Home: Forest Court Nursing Home

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What the care home does well We specifically observed staff move the service user in question, safely with a hoist and in line with the service user`s written assessment and care plan. This was carried out after we pointed out that the service user had clearly been incontinent. At the time of this inspection the service user was accepting of this care. We read the service user`s care file in detail and this told us that the required care was being delivered under difficult and challenging circumstances. There were some areas of shortfall and these are discussed later in this report. It was also apparent from the service user`s records that external health care agencies have been appropriately contacted and involved when needed. This has included the local County Council`s safeguarding adults team. An appropriate referral had also been made by the service under the Deprivation of Liberty Safeguards (DOL`s) and an assessment completed by an appropriate assessor. These actions help to protect very vulnerable people. Prior to this inspection we asked the service to review the number of staff on duty and confirm to us that there were enough on duty each shift to meet peoples needs. The service did this and told us that they considered there to be enough staff on duty to meet peoples needs. Since this inspection a further review has been carried out and an increase in staffing has taken place between the hours of 4pm and 10pm and during the night hours. As part of this inspection it was explained to us that the service have a number of staff that it knows it requires to have on duty at any given time to be able to confidently meet peoples needs. The manager has previously confirmed that she will not go below this. The manager has always had the freedom to arrange the use of agency staff if a permanent member of staff goes off sick at the last minute or if annual leave cannot be covered by the home`s own staff. This arrangement remains in place. We looked at the planned duty rosters for some future dates and for dates prior to this inspection. The duty rosters, as well as an additional record which is kept on a daily basis of people whoturn up for work, confirmed that the service was more than usually staffed above the minimum number by at least one or two members of staff each day. We looked at the numbers of staff on one particular day where a concern had been expressed that there had only been two care staff and one registered nurse on duty in the evening hours. Records confirmed that there had actually been six care staff and two registered nurses on duty. On the day of this inspection there were five care staff on duty and two registered nurses. The home had covered absent staff with two agency carers and one agency nurse who knows the home well. It has also been confirmed that the home will automatically plan to have agency cover at a weekend if the permanent staff numbers are at the minimum. This is because there has been a history of staff sickness at weekends and the home does not want to risk being short of staff. What the care home could do better: There were some shortfalls identified during this inspection. The first was how staff monitored certain service users who require their whereabouts to be checked at regular intervals. This maybe because they are prone to frequent falls, may present with challenging behaviour, may be prone to exploring/walking around the building or because they are generally anxious and require frequent reassurance. At the time of this inspection there were several service users who should have been frequently monitored. It was apparent after looking at the records kept in relation to this task, for the afternoon of 22nd August 2010, that only a few records were being maintained. On looking at past records, they also demonstrated that service users were not being monitored as frequently as they should have been. An example was seen in one service user`s care plan that their location should be monitored and recorded every fifteeen minuites. This was not being consistently done. Staff had clearly not considered the fact that some records were not being completed, despite the names of those who required monitoring being known to all staff, and arrangements for delegating staff to these tasks had not been properly instigated at the beginning of the afternoon shift. This was immediately fed back to the staff on duty and a review of the situation took place the next day. After the review the manager confirmed that some of the service users who were originally under this arrangement did not currently require this level of monitoring now. This was because they were either not currently presenting with challenging behaviour, they were walking around less, etc. The service will now generally review this arrangement each week, but also assess service users on a daily basis as to whether they require this level of observation. The service has also looked at how senior staff are delegating specific responsibilities at the beginning of each shift. The second shortfall was in relation to the safe administration of medicines. A concern had been expressed that a visitor had been handed medicines to administer to a relative and had carried this out without a nurse witnessing the administration. We spoke to the nurse involved in this incident who explained that this had taken place but because the service user would often refuse prescribed medicines from the nursing staff. The medicine on this occasion had been pain relief. The visitor had offered to give this to their relative and the nurse had considered this the most likely way that the service user would accept the pain relief that they needed, so agreed. We recognise that the situation was difficult and the priority was to ensure the service user accepted and took the medicine they required. However, this is not good practice and on reading the service user`s care planfor medication, although it had been identified that the service user often refused medicines, there was no written guidance/protocol in the care plan for staff to follow. It is important that clear protocols are followed in situations like this, particularly when the service user lacks mental capacity in order to safeguard the service user and staff from bad practice decisions. The service must make sure that any guidance in service user medication care plans takes in to consideration the Mental Capacity Act 2005 and best interest agreements if in place. Random inspection report Care homes for older people Name: Address: Forest Court Nursing Home Bradley Court Road Mitcheldean Glos GL17 0DR two star good service 23/02/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janice Patrick1 Date: 2 2 0 8 2 0 1 0 Information about the care home Name of care home: Address: Forest Court Nursing Home Bradley Court Road Mitcheldean Glos GL17 0DR 01989750775 01989750348 Telephone number: Fax number: Email address: Provider web address: www.bupa.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Zoe Rees Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFC Homes) Ltd care home 49 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 49 49 The maximum number of service users who can be accommodated is 49 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental Disorder, excluding learning disability or dementia (Code MD) Date of last inspection 2 3 0 2 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home Forest Court is a large building situated on high ground outside the town of Mitcheldean in the Forest Of Dean. There are extensive gardens with an enclosed area that provides a safe and sheltered garden for people to enjoy. There is plenty of parking with level access into the home. This care home specialises in the care of the older person who has dementia and who requires nursing care. There are qualified nurses on duty at all times and all staff have experience or have appropriate training in this specialist area of care. The home provides single bedrooms. There are large communal areas and wide corridors for people to walk freely in. Daily activities are available and family and visitors are welcome to visit at any time. Public transport goes as far as the town of Mitcheldean. Fees range from eight hundred pounds to nine hundred pounds per week, these vary depending on the size of bedroom. The majority of people receive funding of some sort due to their very specialised needs. Fees exclude, Chiropody (foot care), toiletries, hairdressing and papers/magazines. Information on the home can be found in the front hall or can be supplied on request. Care Homes for Older People Page 3 of 10 What we found: We carried out this inspection after receiving information about the care of one particular service user. Including concerns relating to the general supervision of other service users and about the numbers of staff on duty. One inspector visited the service on a Sunday evening between the hours of 7pm and 10pm. We met the service user in question and read their care records including their medication records. We also spoke to the staff on duty and inspected staff duty rosters, accident records and records relating to the specific supervision and monitoring of some service users. The service were not however able to demonstrate that they were supervising and monitoring some service users, including the one in question, as had been agreed in their care plans. There had been a shortfall in correct medication practice in one incident and there was a lack of direction for staff in the service users medication care plan in relation to their refusal of prescribed medicines. What the care home does well: We specifically observed staff move the service user in question, safely with a hoist and in line with the service users written assessment and care plan. This was carried out after we pointed out that the service user had clearly been incontinent. At the time of this inspection the service user was accepting of this care. We read the service users care file in detail and this told us that the required care was being delivered under difficult and challenging circumstances. There were some areas of shortfall and these are discussed later in this report. It was also apparent from the service users records that external health care agencies have been appropriately contacted and involved when needed. This has included the local County Councils safeguarding adults team. An appropriate referral had also been made by the service under the Deprivation of Liberty Safeguards (DOLs) and an assessment completed by an appropriate assessor. These actions help to protect very vulnerable people. Prior to this inspection we asked the service to review the number of staff on duty and confirm to us that there were enough on duty each shift to meet peoples needs. The service did this and told us that they considered there to be enough staff on duty to meet peoples needs. Since this inspection a further review has been carried out and an increase in staffing has taken place between the hours of 4pm and 10pm and during the night hours. As part of this inspection it was explained to us that the service have a number of staff that it knows it requires to have on duty at any given time to be able to confidently meet peoples needs. The manager has previously confirmed that she will not go below this. The manager has always had the freedom to arrange the use of agency staff if a permanent member of staff goes off sick at the last minute or if annual leave cannot be covered by the homes own staff. This arrangement remains in place. We looked at the planned duty rosters for some future dates and for dates prior to this inspection. The duty rosters, as well as an additional record which is kept on a daily basis of people who Care Homes for Older People Page 4 of 10 turn up for work, confirmed that the service was more than usually staffed above the minimum number by at least one or two members of staff each day. We looked at the numbers of staff on one particular day where a concern had been expressed that there had only been two care staff and one registered nurse on duty in the evening hours. Records confirmed that there had actually been six care staff and two registered nurses on duty. On the day of this inspection there were five care staff on duty and two registered nurses. The home had covered absent staff with two agency carers and one agency nurse who knows the home well. It has also been confirmed that the home will automatically plan to have agency cover at a weekend if the permanent staff numbers are at the minimum. This is because there has been a history of staff sickness at weekends and the home does not want to risk being short of staff. What they could do better: There were some shortfalls identified during this inspection. The first was how staff monitored certain service users who require their whereabouts to be checked at regular intervals. This maybe because they are prone to frequent falls, may present with challenging behaviour, may be prone to exploring/walking around the building or because they are generally anxious and require frequent reassurance. At the time of this inspection there were several service users who should have been frequently monitored. It was apparent after looking at the records kept in relation to this task, for the afternoon of 22nd August 2010, that only a few records were being maintained. On looking at past records, they also demonstrated that service users were not being monitored as frequently as they should have been. An example was seen in one service users care plan that their location should be monitored and recorded every fifteeen minuites. This was not being consistently done. Staff had clearly not considered the fact that some records were not being completed, despite the names of those who required monitoring being known to all staff, and arrangements for delegating staff to these tasks had not been properly instigated at the beginning of the afternoon shift. This was immediately fed back to the staff on duty and a review of the situation took place the next day. After the review the manager confirmed that some of the service users who were originally under this arrangement did not currently require this level of monitoring now. This was because they were either not currently presenting with challenging behaviour, they were walking around less, etc. The service will now generally review this arrangement each week, but also assess service users on a daily basis as to whether they require this level of observation. The service has also looked at how senior staff are delegating specific responsibilities at the beginning of each shift. The second shortfall was in relation to the safe administration of medicines. A concern had been expressed that a visitor had been handed medicines to administer to a relative and had carried this out without a nurse witnessing the administration. We spoke to the nurse involved in this incident who explained that this had taken place but because the service user would often refuse prescribed medicines from the nursing staff. The medicine on this occasion had been pain relief. The visitor had offered to give this to their relative and the nurse had considered this the most likely way that the service user would accept the pain relief that they needed, so agreed. We recognise that the situation was difficult and the priority was to ensure the service user accepted and took the medicine they required. However, this is not good practice and on reading the service users care plan Care Homes for Older People Page 5 of 10 for medication, although it had been identified that the service user often refused medicines, there was no written guidance/protocol in the care plan for staff to follow. It is important that clear protocols are followed in situations like this, particularly when the service user lacks mental capacity in order to safeguard the service user and staff from bad practice decisions. The service must make sure that any guidance in service user medication care plans takes in to consideration the Mental Capacity Act 2005 and best interest agreements if in place. 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 set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 17 You must maintain an 31/05/2009 accurate record of any care given in relation to nursing care i.e. wound care, pressure relief care and any other care required as stipulated within a care plan. There is a legal requirement for concise records to be maintained. Concise and well documented records also help provide an audit trail of the care delivered. They also help staff to know what care has already been given and what care has to be given in the future. Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered person must 27/09/2010 ensure that service users are properly supervised and where this is stated specifically in the service users care plan, the care plan must be adhered to by the staff on duty. This is so that people receive the correct level of care to meet their needs and to maintain their safety. 2 9 13 The registered person must 27/09/2010 ensure that proper arrangements are in place for the safe administration of medication. This must include clear and relevant guidance for staff and where appropriate consider the Mental Capacity Act 2005 and best interest agreements. This is so that service users are protected from poor practice decisions and actions during the administration of their Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action medication. It is also so that when service users lack mental capacity with regard to decisions relating to their medication that hey are afforded further protection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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