Care Home: Homefield Nursing Home

What the care home does well Providing a supportive care environment for people to live in, and making sure that staff interactions contribute to people having a positive state of being. Ensuring its residents receive care and support, and have access to the health and social care services they need. Taking seriously concerns or complaints raised by residents or their representatives and dealing with them appropriately. Making sure its staff receive training about safeguarding residents and that they know how to carry out their responsibilities in this respect. Carrying out recruitment procedures that support and protect residents. Maintaining good contact with residents` families and supporting its residents to keep in touch with their families and friends. Offering residents a balanced and nutritious diet, and placing priority on the serving of meals and support for residents during mealtimes.Providing information and visiting opportunities to help residents or their representatives decide whether Homefield is the right place for them. Making sure new residents feel welcome when they arrive at the home. What has improved since the last inspection? The home now has a skilled and experienced manager who has been registered with the commission, following a process of assessment to determine her fitness to run the home. The home has addressed two of the three requirements made at our last visit, so that improvements were evident to the use of risk assessment tools and to ensuring residents` comfort and dignity is maintained by wearing appropriate clothing. All staff members have been provided with training focused on maintaining dignity. The manager has strengthened the home`s internal audit systems, which has improved the monitoring and evaluation of care practices. A full-time activities coordinator has been appointed to plan and lead activities and events that residents may take part in. The complaints procedure has been modified so each complaint results in lessons learned, and a complaints book has been introduced in which staff members are encouraged to record any complaints made to them. The garden has been redesigned and gazebos erected to give shade to residents and their visitors during the summer months. Staff training has improved, for example, over 80% of care staff have completed NVQ Level 2 or above. Senior staff are undertaking leadership training. What the care home could do better: Comply with our previous requirement to make sure there is enough storage space for equipment, such as wheelchairs and hoists. Equipment was still being stored in communal areas of the home, which is potentially hazardous for residents and impacts adversely on their quality of life. The manager has already told us how they plan to improve this and we will judge if their measures are effective at a future visit. Make sure it is evident that any use of physical restraint methods to prevent falls, such as lap belts, chairs and tables, is always subject to risk assessment and a recording of the decisions to use them. Also, make sure it is always evident that any planned restraints are monitored and regularly reviewed to make sure they are still appropriate to meet the particular resident`s identified need.Ensure all staff members are aware that oral intake for some residents may be affected by breakfast sometimes finishing late and lunch being offered quite early in the day. CARE HOMES FOR OLDER PEOPLE Homefield Nursing Home 1 Lime Close Bickley Kent BR1 2WP Lead Inspector David Lacey Unannounced Inspection 10th June 2008 10:00 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 Homefield Nursing Home DS0000010136.V365561.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. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homefield Nursing Home Address 1 Lime Close Bickley Kent BR1 2WP 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 8289 7932 020 8289 7928 homefield@missioncare.org.uk www.missioncare.org.uk Mission Care Ani Grace Manayin Care Home 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places Homefield Nursing Home DS0000010136.V365561.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 (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. 3. 4. Dementia Code DE(E) (of the following age range: over 65 years) The maximum number of service users who can be accommodated is: 44 Staffing levels for the home are as follows: On the basis that the manager of the home holds a RMN qualification: AM: 2 RMN`s or RGN`s with 6 Care Assistants RGN`s working in the home do so on the basis: That they have substantial experience or relevant training specific to dementia. Date of last inspection Brief Description of the Service: Homefield is registered to accommodate up to 44 older people with dementia who need nursing care. The home has 12 bedrooms on the ground floor, 22 bedrooms on the first floor and 10 bedrooms on the top floor. Some bedrooms have en-suite facilities. There is a dining room and main lounge situated on the ground floor, and a smaller lounge on the upper floor. There is a small garden at the side of the building and limited off-street car parking to the front. The home is situated on a local bus route and near Bickley train station. Fees for this care home (as at June 2008) range from £576 - £940 per week. Homefield Nursing Home DS0000010136.V365561.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 two stars, which means that people using the service receive a good service. This key inspection included an unannounced visit to the care home, which was undertaken over two days. On the first day, two hours were spent observing the care being given to a small group of people living in the home. To gain the views of people living in the home, I spoke with residents and relatives. I met with the registered manager and some members of the home’s staff. I sampled documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures. At the end of the visit, I gave feedback to the registered manager, one of the company’s directors and other senior staff members. This included feedback about the findings from the period of observation carried out on the first day of the inspection. Since the last key inspection, we carried out a random inspection of the home and we have used findings from that visit in planning this present key inspection. We have also surveyed a sample of the home’s residents and their relatives, and have taken into account the responses we have received. What the service does well: Providing a supportive care environment for people to live in, and making sure that staff interactions contribute to people having a positive state of being. Ensuring its residents receive care and support, and have access to the health and social care services they need. Taking seriously concerns or complaints raised by residents or their representatives and dealing with them appropriately. Making sure its staff receive training about safeguarding residents and that they know how to carry out their responsibilities in this respect. Carrying out recruitment procedures that support and protect residents. Maintaining good contact with residents’ families and supporting its residents to keep in touch with their families and friends. Offering residents a balanced and nutritious diet, and placing priority on the serving of meals and support for residents during mealtimes. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 6 Providing information and visiting opportunities to help residents or their representatives decide whether Homefield is the right place for them. Making sure new residents feel welcome when they arrive at the home. What has improved since the last inspection? What they could do better: Comply with our previous requirement to make sure there is enough storage space for equipment, such as wheelchairs and hoists. Equipment was still being stored in communal areas of the home, which is potentially hazardous for residents and impacts adversely on their quality of life. The manager has already told us how they plan to improve this and we will judge if their measures are effective at a future visit. Make sure it is evident that any use of physical restraint methods to prevent falls, such as lap belts, chairs and tables, is always subject to risk assessment and a recording of the decisions to use them. Also, make sure it is always evident that any planned restraints are monitored and regularly reviewed to make sure they are still appropriate to meet the particular resident’s identified need. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 7 Ensure all staff members are aware that oral intake for some residents may be affected by breakfast sometimes finishing late and lunch being offered quite early in the day. 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. Homefield Nursing Home DS0000010136.V365561.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 Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information to help residents and/or their representatives decide whether Homefield is the right place for them. Visits to the home are encouraged. Prospective residents are assessed to ensure the home can meet their needs, and the home makes it clear to prospective residents and/or their representatives that it can meet their assessed needs. Residents have written contracts/statements of terms and conditions with the home. EVIDENCE: The home has a statement of purpose and a service user’s guide, which gives information to residents and to people thinking of moving into the home. A visitor said the local social services department had helped to find a place for his relative, that he had been given enough information about the home and that he had visited to look around before his relative moved in. Following an Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 10 issue raised at this inspection, the provider is considering adding information to the service user guide about the home’s internal communication strategies, for example, that staff handovers take place between each shift so all staff know about residents and their changing needs. Care documentation sampled during the inspection visit included five residents’ records relating to the pre-admission process. This information showed that residents’ needs had been assessed to make sure the home is suitable for them. There was evidence of care management assessments and completion of the home’s assessment for residents. The home’s assessments were generally completed in full, though there were some gaps in some of those seen. After the assessment has been completed the home confirms in writing that they are able to meet the individuals’ needs. The files seen included records of the possessions brought in by each individual. When a new resident has been offered a place at the home, the system of internal communication is followed whereby all relevant departments are informed. As many staff as possible sign a welcome card for the resident and flowers are placed in their bedroom. Prospective residents and their representatives are able to request to visit the home before making a decision to move in. A relative said she and her family had looked at “a lot of homes” for their mother before choosing this one. They had been given information to help make a choice, as well as a look around the home. Five residents’ files were sampled to assess the provision of contracts/statements of terms and conditions with the home. Four residents’ files contained copies of the relevant documentation. It was understood the contract for the remaining resident was with their representative. Homefield does not offer intermediate care, thus standard 6 does not apply to this home. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have a plan of care that sets out their individual needs. The home ensures its residents receive care and support, and have ready access to health and social care services. Medicine administration is carried out safely. Residents are treated with respect and their right to privacy and dignity maintained. At the time of death, staff treat people and their families with sensitivity and respect. EVIDENCE: Two hours were spent observing five residents’ experiences while in communal areas of the home. The two hours’ observation time was divided into 24 fiveminute timeframes. Analysis of the data obtained indicated that the care setting was supportive, with residents showing mainly positive or passive mood states. The findings from these observations were shared with the manager and some of her senior colleagues, to assist in evaluation and development of practice. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 12 I sat in on a staff handover between the morning and afternoon shifts. Each resident was discussed, with staff who had been caring for a resident in the morning making sure staff coming on duty were briefed about that person and any particular needs they may have. Carers were encouraged to contribute to the discussion by sharing their observations from their work in the morning. The manager sat in on the handover so she was aware of current issues for particular residents and could take the opportunity while staff were together to share information she wanted them to hear. The handover continued between nursing staff in charge of each shift for sharing of information about specific clinical and managerial issues. I sampled five residents’ care plans. The care plans seen were based on assessed needs and had supporting risk assessments in place for falls, pressure care, and moving and handling. A previous requirement about risk assessments had been met. Following training, staff are now using the universal malnutrition screening tool (MUST), and starting food fortification and supplements when needed. The training for this is commented on under standard 30. Two residents with pressure ulcers had records of the monitoring of the progress of these ulcers, and evidence that appropriate pressure relieving equipment was in use. There was some evidence of people’s involvement in the development of care plans, for example, some relatives had provided information about residents’ backgrounds, social needs and lifestyle preferences. A relative had provided information to staff about the behavioural cues that showed her relative needed to go to the toilet. The manager reported that this information had enabled staff to improve how they meet the resident’s continence needs. Another relative commented, “In general, I am quite happy with the care my mother receives.” Reports from care management reviews were on file, and two reviews were taking place during the inspection visit. I discussed the monthly reviewing and updating of care plans by the home’s staff with the manager and her colleagues while giving feedback at the end of the inspection. These reviews are taking place each month but records are often very brief, sometimes just consisting of the date and the initial of the person carrying out the review. More detail could help to make sure it is clear that any changing needs have been identified and actioned (recommendation 1). The home makes sure that residents have access to specialist health care services as they need. There was evidence of GP, optician and chiropody visits to individuals, and records of residents’ attendance at various outpatient clinics. One relative said it would be helpful for the home to make relatives aware of appointments with outside agencies like the dentist or optician. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 13 One of the improvements introduced by the manager is monthly auditing of medication administration. This had last been completed in May 2008 and the audit reports were available. I saw medicines being given to some of the residents. This was done safely and according to the home’s medicine procedures. None of the residents has responsibility for their medication. Storage of medication was satisfactory, though staff will need to monitor the temperature of the clinical room during the warmer weather to make sure it remains within the recommended limits for safe storage of drugs. There were no controlled drugs in use at the time of this inspection. I sampled medication administration records (MAR) as part of case tracking and found them to be satisfactory. One resident’s MAR showed he was on digoxin. When questioned, a nurse confirmed there is safe practice by telling me this drug would be omitted if the resident’s pulse rate fell below a certain level and if necessary the prescribing doctor would be contacted for advice. The pulse rates had been recorded on the MAR along with administration of the digoxin. Care staff administer creams more often than nurses, although the nurses always sign to say it has been administered. It was understood that nurses ask carers to confirm they have done this and carers often report this information at staff handovers. Residents I observed and those I met with during the inspection visit were well groomed, with hair tidy and nails clean and trimmed. They were dressed appropriately for the time of year. I was able to judge the home had met our previous requirement to maintain residents’ comfort and dignity by making sure they can wear appropriate clothing. Comments from the local authority included the view that respect for individuals’ privacy and dignity is an area that has improved at Homefield. It had been observed recently that staff have seemed more attentive to the dignity of residents, “by taking the time to interact as opposed to task led interaction”. The home is taking part in the Royal College of Nursing dignity campaign. A study day focused on dignity was being held at the time of this inspection for all staff at the home. The notifications we receive from the home showed there had been a relatively high number of deaths at the home in the earlier part of this year. I raised this with the manager and the responsible individual who said they had also identified this, had looked at the relevant circumstances but had not identified any issues needing specific attention. From testimonials, staff members treat dying residents and their families with care, sensitivity and respect. The manager and staff team are sensitive to any particular religious or cultural needs of the individual resident and their family. The organisation’s practice development nurse has a professional background in palliative care and told me she is leading the further development of care for people in the last days of life. This will include the use of a ‘care pathway’ for the last days of life, which involves the family and members of the multi-professional team, including the palliative care team. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s activities provision has been improved, so that most residents are offered choices of activities that meet their needs and preferences. The home helps its residents to maintain contact with their families and friends. Residents are offered a balanced and nutritious diet and the home places priority on the serving of meals and support for residents during mealtimes. EVIDENCE: On the first day of the inspection, two hours were spent observing five residents’ experiences while in communal areas of the home. One resident was provided with an individual activity, the others were either sleeping or were able to listen to the recorded music being played. The television was also on but none of the five residents watched it. The two hours’ observation time was divided into 24 five-minute timeframes. Residents experienced engagement with staff in 35 of these timeframes, and engagement with a ‘task’ or activity in 29 of the timeframes. Whenever there was some interaction by the activities coordinator this had a positive outcome for the resident(s). Similarly, Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 15 interactions by other staff assisting with activities generally had positive outcomes, though in one instance staff ‘took over’ and completed an activity for a resident who needed some help with it. Staff members’ desire to help is understandable but they need also to try to encourage residents to maintain independence whenever possible. The findings from these observations were shared with the manager and some of her senior colleagues, to assist in evaluation and development of practice. The home’s provision of activities has improved, meaning greater stimulation for residents and more choice of activities both inside and outside the home. During the inspection visit, there were planned activities being provided for some residents, either in a group setting or delivered to the individual. Other residents in the lounge and conservatory were played recorded music at the same time as having the television on. The local authority had asked that activities hours at the home be increased. There was a newly appointed activities coordinator who was formerly a carer at the home, so knows the residents well. I saw her working with residents and spoke with her during the inspection. She was enthusiastic about her work, and told me about the activities programme and about planned trips out from the home. She records people’s participation in activities and was well aware that activities need to be tailored to meet the needs and preferences of individuals. I saw residents enjoying various activities during my visit. A relative commented, “Having daily activities is very good”. A care professional stated the activities coordinator “works hard to include all residents”. It was evident from discussions and comments received that different needs of individuals are catered for, including different faith needs and the needs of people who do not follow any religion. I saw staff interacting well with relatives and other visitors. It was evident the home supports residents to maintain contact with their families and friends, providing this is their choice. People can visit the home at any reasonable time. A relative said, “As visitors, we have always been made very welcome”. The manager has introduced a system of ‘protected mealtimes’, which means all staff make themselves available and if visitors arrive they are welcome to sit with their relatives in the dining room but not interrupt their meal by taking them elsewhere in the home. I spent time with residents at lunch on the first day of the inspection visit. The dining room had five round tables, which were attractively laid with tablecloths, flowers and napkins. Carers were available to assist residents where necessary, encourage them to take their drinks and provide general supervision. There were several relatives in the dining room, also helping their relatives to eat their lunch. The provision of plate guards and spoons was helpful for several residents as it meant they could feed themselves without further assistance. The food served matched what was shown on the menu, the content of which had been reviewed since the previous inspection. The home’s pre-assessment document had described the system in use of placing pureed food into moulds, which are then rapid frozen so they resemble the original shape of the food. This makes pureed meals Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 16 more attractive in terms of presentation and therefore more appetising for those residents who need their food prepared in this way. As many residents need assistance with feeding, breakfast sometimes finishes late. As lunch is offered quite early, this may affect some residents’ oral intake and staff should monitor this (recommendation 2). Also, as we have previously suggested, the home should consider offering ‘finger food’, which has been found to benefit people with dementia. Homefield Nursing Home DS0000010136.V365561.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that any concerns or complaints they raise will be taken seriously and dealt with appropriately. The home has policies and procedures for complaints and for safeguarding adults. Staff receive training and know about protecting residents from abuse. The home needs to improve how it shows that any use of physical restraint is in the best interests of the person. EVIDENCE: The home has an appropriate complaints procedure, which is made readily available to residents and their families. The procedure has been modified so each complaint results in lessons learned. Information provided to us by the home before the inspection showed that five complaints had been received within the past twelve months, each of which had been resolved within the timescales set out in the home’s procedure. This information was followed up during the inspection visit by examination of the home’s complaints records. Since the previous inspection, a complaints book has been introduced in which staff members are encouraged to record any complaints made to them. People I spoke with and those who responded to our survey said they knew how to make a complaint and who to speak to if they were not happy about Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 18 something. A relative commented, “I can speak to the senior nurse in charge or send in a written complaint”. Another relative stated that when she has raised a concern, “normally the response has been immediate”. A visiting professional stated, “The manager has always answered or addressed any queries or concerns I have had”. During my visit, there were signs of wellbeing amongst residents, who appeared comfortable and relaxed when interacting with members of the staff team. Staff receive training in protecting vulnerable adults from abuse and those I spoke with knew about different forms of abuse. They understood their reporting responsibilities if they witness or suspect abuse of residents, and were aware of the protection available to whistleblowers. The manager stated Mission Care has ensured all its staff members are aware of the organisation’s zero tolerance policy towards abuse in any form. The home has its company policy about protecting vulnerable adults on display and local multi-agency safeguarding guidance was readily available in the home. Between AprilAugust of last year we were made aware of three safeguarding concerns involving residents at the home, which the local social services department investigated under their procedures. I spoke with the manager about maintaining the balance between keeping people safe and at the same time always respecting their rights. It was evident during my visit that measures of physical restraint, such as bedrails, lap belts, chairs or tables, were being used with some residents to prevent falls. The use of physical restraint methods must be subject to risk assessment and a recording of the decisions to use them, but it was not always evident this was being undertaken. For example, the care plan for one resident recorded the use of a lap belt and referred to “restraint consent”, whereas the only entry on the file was the next of kin’s agreement for the use of bedrails. Another resident’s file included the next of kin’s signed agreement to the use of bedrails, with evidence that person had been advised of the advantages and disadvantages. However, there were no entries about the use of a lap belt even though the resident had one in place while she was sitting in her chair throughout both days of the inspection. The same type of restraint was being used for particular residents but the lack of consistent recordings made it difficult to determine if these restraints had become habitual or whether they were successful methods arising from good planning and regular evaluation. The home needs to improve how it shows that any use of physical restraint is in the best interests of the person (requirement 2). Any restraint should always follow agreed policies and procedures that focus on best practice and improved outcomes for the individual resident. The organisation’s practice development nurse said that policies and procedures, including those for restraint, were being reviewed and updated. The updating is taking account of the need for compliance with legislation about mental capacity. She had a clear timescale for this work and confirmed the revised Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 19 policies and procedures would be available for our inspection once the updating is complete. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean and generally well maintained, though there are signs of wear and tear in some areas. Residents’ living environment should be improved once the much needed upgrade to the home’s only passenger lift is completed. Storage arrangements still need improvement. The home has infection control procedures for its staff to follow to ensure effective hygiene. EVIDENCE: The organisation’s maintenance team carries out the home’s redecoration and refurbishment programme. The lounge and dining room have been redecorated and other areas of the home are on the schedule. It was evident that some areas, such as corridors, are showing signs of wear and tear but I was assured the future redecoration programme will include these areas. Bedrooms I saw Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 21 during the visit met the relevant standards but varied in the degree to which they had been personalised. The manager said this had been raised at a recent relatives’ meeting so that families and staff members may work together to make each resident’s room as homely as possible. Gazebos had been erected in the redesigned garden to give shade to residents and their visitors during the summer months, and people were using these while I was visiting the home. Both days were warm and the temperature felt high on the upper floor of the home, where some residents spend the whole day either in the small lounge on that floor or in their rooms. If staff decide it will be beneficial for residents to use portable electric fans in the warm weather, the appropriate tests and risk assessments will need to be carried out. The home has one passenger lift, which has been prone to break down with consequent impact on the care of residents. The lift breakdowns have also made it harder for staff to carry out their duties and for families to visit residents living on the upper floors. The manager told me, and confirmed by written notification, that major refurbishment of the passenger lift was starting the week following the inspection. The work was going to take two weeks and contingency plans had been put in place to minimise disruption to service provision. Relatives had been able to find out about these arrangements at a meeting held the weekend before the inspection visit, which was attended by the manager and by Mission Care’s responsible individual. Our previous requirement to make sure there is enough storage space for equipment, such as wheelchairs and hoists, had not been met (requirement 1). Equipment was still being stored in communal areas of the home, which is potentially hazardous for residents and impacts adversely on their quality of life. For example, wheelchairs were being stored on the patio. It started to rain at one point during the inspection, whereupon they were brought inside and stored in the residents’ lounge next to the television. One resident had to be moved to another part of the lounge to make room for the wheelchairs. Another example was a communal bathroom on the middle floor that had a mobile hoist, an empty linen skip, and a trolley with various items on it. It would not have been possible to use this bathroom without clearing it first. As we had already repeated this requirement at our random inspection, we sent a warning letter to the provider and asked for an improvement plan. We have received a prompt response, well within the timescale we had set, that has told us how they are going to meet the requirement. We will assess compliance at a future visit. The home was clean and there were no unpleasant odours evident in communal areas. It was understood from the home’s self-assessment document and from discussion with the manager that the organisation is to purchase an ozone steriliser unit, to remove any persistent odour and improve infection control. The home’s self-assessment confirmed it has an infection Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 22 control policy and staff have received training to enable them to use good infection control practices. Laundry for residents living at Homefield is done at another of the organisation’s care homes, which is nearby. The CSCI also inspects this home (Elmwood) and I did not visit it at this inspection. The home had resolved a complaint about the laundry received in August 2007 and had not had any further complaints since. A relative said the laundry was done well. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and competent staff are employed to meet residents’ needs. The home is recruiting to fill vacancies and thus limit its use of temporary staff to cover shifts. There are robust recruitment procedures, which are carried out to ensure they support and protect residents. Staff are supported to undertake training that is relevant to their work and benefits residents. EVIDENCE: Two hours were spent observing five residents’ experiences while in communal areas of the home. The observations included staff interaction with residents. The two hours’ observation time was divided into 24 five-minute timeframes. Staff interactions with residents occurred during 36 of these timeframes, with no interactions observed during the remaining timeframes. Forty-four per cent of staff interactions with residents were positive and 54 neutral, such as simply exchanging information. One negative interaction was observed. Staff members interacted more with some residents than with others. Residents who appeared better able to communicate tended to receive more interaction from staff. One resident was asleep during most of the observation time. Staff waking this resident to take fluids or food engaged only in neutral interactions. Overall, staff interactions contributed to people having a positive state of Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 24 being. Staff were prompt in responding to this group of residents and appeared to have enough time to meet their needs. The findings from these observations were shared with the manager and some of her senior colleagues, to assist in evaluation and development of practice. We received a number of comments about the continuing use of temporary staff, all of which showed this was not an arrangement they supported. Comments from relatives included, “The permanent staff are very good but agency staff are not always as good”, “The home will function better with fewer bank staff and temporary staff”, and “I believe that the majority of the regular staff are a big asset. They are very kind and caring and treat the residents as individuals”. Comments from staff were similar, in that although agency staff are provided when needed to cover vacant shifts they do not know the residents so the quality of care can suffer. A staff member said it was the usual practice to use bank staff who know the residents and only use agency staff if no bank staff members were available. There were some related concerns about the level of staffing. A relative stated, “I feel that Homefield is understaffed. They can do much better with at least two more additional staff”. A visiting care professional commented that having more staff members in the home would “ease some pressure on existing staff and extra staff could also interact with residents instead of using the TV or radio for distraction”. The manager told me about the provider’s current efforts to recruit staff. There were five carer vacancies at the time of the inspection. Two new staff members had already been appointed and were awaiting completion of recruitment checks before they take up their posts. The manager gave assurance that recruitment would continue so the remaining vacancies could be filled. The home’s recruitment procedures are robust and designed to support and protect residents. Staff members I spoke with outlined the recruitment and selection process they had undergone before taking up their posts. They said this had included an interview, references and Criminal Records Bureau (CRB) checks. I examined a sample of three staff files, all of which contained the necessary recruitment information. Confirmation of current Nursing and Midwifery Council (NMC) registration is obtained for nurses employed at the home. The quality and range of staff training had improved since the last inspection. As well as induction programmes and mandatory health and safety training, more staff members were undertaking training to help them meet the specific needs of people with dementia. The manager confirmed the need for more dementia training was recognised, to enhance all staff members’ understanding of and ability to deliver a person-centred approach to care. Staff members I spoke with were positive about the training made available to them and its benefit to them in their work with residents. As mentioned under NMS Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 25 10, study days led by the Royal College of Nursing (RCN) and focusing on dignity were of value to staff at the home. I have commented about the use of restraint under standard 18, and the manager was aware training and support to care staff must raise awareness of restraint and ensure best practice. The home’s self-assessment information provided to us before the inspection showed that over 80 of care staff had completed NVQ Level 2 or above, which is a good proportion. Nurses are supported to undertake continuing professional development, in line with NMC requirements for maintaining their nursing registration. A programme of leadership training, facilitated by the RCN, is now running at Mission Care and senior staff members from Homefield are undertaking this training. The community dietician has provided staff with training to use the universal malnutrition screening tool (MUST) and it was evident from care plans that they are now completing these for residents. The training is continuing as needed and the dietician is reviewing the outcomes every six months. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home has improved and the home’s manager is now registered with the commission following an assessment of her fitness to manage this care home. The home seeks the views of its residents and their representatives about the running of the home. Residents’ financial interests are safeguarded. Staff members receive regular supervision. The home promotes the health and safety of residents, staff and visitors, and the manager is aware of improvements that are needed. EVIDENCE: Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 27 The home’s manager, Ani Manayin, is a qualified nurse and an experienced manager, with previous experience of managing a care home before taking up her post at Homefield. Since our last key inspection, she has become registered with the commission, following a process of assessment of her fitness. She undertakes continuing professional development, promotes equal opportunities and understands the importance of person-centred care and ensuring good outcomes for residents. From my observations and discussions, Miss Manayin has an open, inclusive approach, and manages by walking around, talking with people and observing what is going on in the home. There are open sessions with the manager for relatives each week. This is a flexible arrangement and relatives can see the manager at other times. Relatives’ meetings are held regularly, the last one taking place the weekend before this inspection visit. Positive comments were made about the management of the home and how it has led to improvements in service. For example, a care professional commented, “Overall there has been a significant improvement at Homefield compared with 18 months ago. Having a permanent manager has improved staff morale and there is now a better atmosphere throughout”. The professional stated they had observed that as staff morale has improved, staff seem happier to assist residents and now have a good rapport with residents. Staff members commented positively about improvements to the management of the home over the past year. A senior member of staff told me that communication between staff in the home had improved as a result of having a permanent manager in post, and that this was to the benefit of residents’ care. I saw minutes of the monthly staff meetings, which are kept on file. The provider has notified us of a temporary change to Homefield’s management, which had begun by the time of this inspection. Following the resignation of the manager at another of Mission Care’s homes, it was decided to appoint Miss Manayin as the interim manager for four days each week until a new manager can be recruited for that home. Homefield’s deputy manager and acting deputy are undertaking the day-to-day management of the home and receive weekly supervision from Miss Manayin. The organisation’s practice development nurse is basing herself at Homefield for one day each week. We have made it clear to the provider that we do not support the decision to split the manager’s responsibilities in this way. The longer this temporary arrangement continues, the more it increases the potential risk for residents and the more difficult it may become to maintain the recent improvements to services at Homefield that the manager has led. Miss Manayin was able to be present for both days of the inspection visit at Homefield and it was apparent she had been spending more time in the home than the original notification to us had suggested. The provider has undertaken to keep us informed of progress in relation to the temporary management arrangements. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 28 There has been improvement in how the provider makes sure the home is being run in the best interests of its residents. The self-assessment (AQAA) provided to us by the home’s manager was clear and contained relevant information. The AQAA told us about developments and also where the home still needs to make improvements. The data section of the AQAA was fully completed. There are various strategies to assure the quality of the home’s services. The provider carries out monthly visits in compliance with regulation 26 and reports were available in the home for inspection. The manager carries out monthly audits to assure the quality of care being provided, and her reports of these audits were available for inspection. The audits include care plans, medication administration, complaints, notifications, residents’ weights, and accidents. In May 2008, Mission Care carried out a survey of residents in all its care homes. Staff from another home carried out the survey of residents at Homefield, visiting them at the home to gain their views. Twenty of the 44 people in residence responded to the survey and the findings have been compiled into a report and made available for inspection. The main areas people were asked about were: their living environment, the food and meals provided, the quality of care received, and the programme of social activities. It is planned to re-run the survey in autumn 2008 and also to survey relatives. Staff members at Homefield do not assist residents with their finances. I was given confirmation by relevant administrative staff from Mission Care that the provider sends regular accounts to residents or their relatives or other representatives for any extra costs incurred, for example hairdressing, newspapers or toiletries. Supervision and appraisal arrangements have been strengthened since the last inspection. From discussions with the manager and staff, and from examination of records, it was evident that staff members are receiving regular one-to-one supervision. Staff receive feedback on their work and their development needs are identified. The home is following policies and practices that generally meet health and safety requirements and legislation. The manager is aware of areas where they need to make improvements, for example removing equipment from communal areas, and has an action plan for achieving these. A sample of maintenance records was examined during the inspection visit. Those seen indicated that maintenance and safety checks are undertaken regularly. Those examined included gas and electrical safety, electrical installation testing, fire safety inspection, water safety, and lift servicing. Earlier this year, the local authority (Bromley) gave Homefield a four-star rating for food hygiene. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 29 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 3 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X X X 3 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 3 3 X 3 3 X 2 Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 30 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 OP22 Regulation 23 Requirement The registered person must ensure that suitable provision is made for storage for the purposes of the care home. Previous requirement – see comment under standard 22. The registered person must ensure it is evident that any use of physical restraint methods is always subject to risk assessment and a recording of the decisions to use them, and that it is evident any planned restraints are monitored and regularly reviewed to make sure they are still appropriate to meet the identified need. Timescale for action 11/07/08 2 OP18 13(7); 13(8); 17(1)(a) Sch 3(3)(p) 31/07/08 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 The registered person should ensure there is sufficient DS0000010136.V365561.R01.S.doc Version 5.2 Page 31 Homefield Nursing Home 2 OP15 detail in records of monthly reviews to make sure it is clear that any changing needs have been identified and actioned. The registered person should ensure residents’ oral intake is monitored. This is because intake for some residents may be affected by breakfast sometimes finishing late and lunch being offered quite early in the day. Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Homefield Nursing Home DS0000010136.V365561.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!