Care Home: Mother Redcaps Nursing Home

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What the care home does well Although the visits made were limited in focus, we were able to make some other observations. We noted that the people who use the service were supported by staff in a professional manner with all staff interacting with individuals in a friendly and positive way. There was evidence that a number of the staff have worked at the service for several years. This promotes continuity within the service for the people living there and for the staff team. A tour of the home showed that the bedrooms seen were clean and well presented with a number having new flooring and having been recently redecorated. Bedrooms seen were personalized by the people living in them. The Deputy Manager and Responsible Individual were able to provide all the documents we asked for including staff rotas, personnel files, care plans and policies and procedures and we were able to talk to staff in private during our visits. The service fully co-operated with us during the visit. What the care home could do better: Although there was nothing to indicate people at risk of developing pressure sores would not get the care and attention they need. The frequency that care is to be given to prevent pressure sores developing needs to be clearer in care plans so that staff are provided with clear written guidance.Risk assessments around falling need to be more detailed so as to ensure staff have the guidance they need to promote the safety and well being of people using the service. An audit of accidents at the home would provide information that would assist with care planning in relation to falls. The daily records need to be more consistently completed so that there is complete information about what people at risk of poor nutrition have had to eat or drink and whether the care plans to prevent the development of pressure sores have been followed at the appropriate frequencies. The daily records varied in the amount of information provided. There should be a consistent approach to these records to show that the person using the service has received appropriate care and attention and to indicate their day to day well being. A procedure should be available for staff on the management of a persons personal possessions following their death. This should be made available to ensure that staff have access to clear guidance. The flooring in the corridors on the lower and top floors of the home should be replaced within the next 3 months in order to provide a homely, well-maintained environment for the people using the service. The rota showed there were times when the planned number of staff were not available for duty. There must at all times be a sufficient number of staff to meet the needs of the people using the service. An overall indication of the dependency levels of the people who use the service must be gathered on a monthly basis so that planning of responses to staff levels can be made to ensure that peoples needs are met. The views of the people using the service and the staff are to be considered when assessing whether current staffing levels are sufficient. In order to fully safeguard the people using the service, staff who are identified as not suitable to work at the service must not continue to be employed there. A full record of employment history needs to be obtained and any gaps in employment scrutinised in order to ensure that applicants are suitable to work at the home. Random inspection report Care homes for older people Name: Address: Mother Redcaps Nursing Home Lincoln Drive Egremont Promenade Wallasey Wirral CH45 7PL three star excellent service 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: Beate Field Date: 1 5 0 2 2 0 1 0 Information about the care home Name of care home: Address: Mother Redcaps Nursing Home Lincoln Drive Egremont Promenade Wallasey Wirral CH45 7PL 01516395886 01516301730 janetnixon56@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mary George Limited care home 51 Number of places (if applicable): Under 65 Over 65 0 39 0 dementia old age, not falling within any other category physical disability Conditions of registration: 12 0 2 The registered person may provide the following category/ies 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 - Code OP, (maximum number of places: 39) Physical disability - Code PD (maximum number of places: 2) Dementia - Code DE (maximum number of places: 12) The maximum number of service users who can be accomodated is: 51 Date of last inspection 1 2 1 1 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home This care home is a three-storey purpose built nursing home, situated on Egremont Promenade overlooking the river Mersey, and offers nursing care for 51 older persons. A lounge/dining room is provided on each floor with televisions, videos, piano, and music centres available. The home is double glazed throughout and ramp access is available at the front entrance. A lift serves all floors. All accommodation offered is in single rooms and the majority have the benefit of en-suite facilities. A selection of bathrooms, showers and toilets are provided on each floor and assisted bathing facilities are available. The small front and side gardens are well maintained and car parking is provided at the front of the building. Further information about the home including the current fees is available from the acting manager. The acting manager can also provide a copy of the most recent inspection report from the Care Quality Commission. Care Homes for Older People Page 3 of 12 What we found: This random visit took place to follow up the requirements made following a random visit to the home in November 2009. This random visit also looked at issues that had been brought to the attention of CQC by some relatives regarding care practices and the cleanliness of the home environment. Health and Personal Care We looked at three care plans and in particular looked at care planning to prevent the development of pressure sores and the management of food and fluids for people who are at risk of poor nutrition. At the time of this visit no person using the service had a pressure sore. Care plans are in place for the prevention of pressure sores and a discussion with a member of staff indicated that appropriate practices take place. The frequency of care given to prevent pressure sores developing needed to be clearer on one care plan seen. The daily records should also indicate that the care plan has been followed at the appropriate frequencies. The daily records varied in the amount of information provided. There should be a consistent approach to these records to show that the person using the service has received appropriate care and attention and to indicate their day to day well being. Records showed that were a person has been identified as at risk of poor nutrition there is a care plan in place to address this. A regular check is made of a persons weight. A record is also made of what food and fluids have been offered and what has been taken, however there were gaps in this recording so that some entries did not fully show what a person had consumed or been offered. Again, this information needs to be recorded consistently to show that people using the service are being provided with the food and drinks they need when their nutritional well being is at risk. A concern had been raised by a member of the public that a relatives possessions had not been kept following their death. We looked at the homes policy for Handling Service Users Personal Property and this does not cover the management of personal effects following a death at the home. This policy needs to include this information so that clear guidance is available for staff. A discussion with staff indicated that there had been a miscommunication that had led to this persons possessions not being kept and that the usual practice is for possessions to be held at the home until collection unless notified otherwise. Records for one person using the service show that they have had numerous falls. The care plan for this person was not as comprehensive as it could be. For example there was no reference as to how their medication may impact on their falls, whether communal areas and bedrooms had been assessed for hazards, whether appropriate footwear is being worn, the level of staff supervision required and key times. There was also no record of what may have led to the falls and what could be put in place to prevent a reoccurrence. This information needs to be made available as it informs the risk assessment and demonstrates that appropriate action has been taken to safeguard a persons well being. Care Homes for Older People Page 4 of 12 We spoke with the Responsible Individual who provided evidence that was not on this persons file. This evidence included details of a multidisciplinary meeting about the persons current accommodation needs. This included discussions about possible increased funding for this person. There was no clear audit of all accidents at the home that would provide details of how and where accidents had occurred. This would assist with care planning and risk assessments in relation to falls. Complaints and Protection We made a requirement at our last random visit that the whistle blowing procedure be reinforced to the staff team so that staff are clear what they should do if there are concerns about people living at the home that are not being acted upon by the management team. At this visit we spoke to five staff and found that all but one knew about this procedure and the procedure to follow to safeguard vulnerable adults. An improvement plan received from the Responsible Individual for the service shows that training around whistle blowing and safeguarding vulnerable adults has been provided to a number of staff. The staff spoken with had either recently received this training or had been given a date to receive this training. The staff member identified during the visit had been given a date to attend safeguarding training but was unable to attend. This member of staff is to be provided with safeguarding training so that the people who use the service can be fully protected by the training received by staff. The Care Quality Commission had received a notification from the manager of the home stating that it had been alleged that a member of night staff had been asleep on duty. A discussion with the Responsible Individual indicated that appropriate steps have been taken in respect of this to safeguard the people living at the home. The records relating to a further member of staff showed that it had been alleged they had been asleep on duty. It is planned that it will be reiterated at the next staff meeting that such behaviour is unacceptable. Environment A tour of the home took place and we had a look at several of the bedrooms. The home was clean with no immediate hazards to the people using the service. A number of the bedrooms have recently had new carpet and have been redecorated. All bedrooms seen were clean and tidily presented. People had personalised their bedrooms with ornaments, photographs and furnishings. The corridor carpet on the lower floor and top floor had a malodour. There was also a smell of cleaning products in this area. The Deputy Manager advised that these areas have been identified for replacement floor coverings. The Responsible Individual confirmed this. The flooring in the corridors on the lower and top floors of the home should be replaced within the next 3 months in order to provide a homely, well-maintained environment for the people using the service. Staffing There were 39 people living at the home at the time of our visit, all with varying needs and dependency levels. A discussion with the Deputy Manager who is responsible for the Care Homes for Older People Page 5 of 12 rota indicated that there should be at least 3 care staff available at night and 6 during the day. The rota shows there have been occasions when this had not been achieved. There must at all times be a sufficient number of staff to meet the needs of the people using the service. We interviewed five staff members about the staffing levels that operated within the service. The staff members are all employed on the middle and top floors of the service which provides care and support to older people who either have social care or nursing needs. In all cases, staff stated that they considered that there were not enough care staff on duty either in the day or at night. As a result, staff told us that they felt they were unable to give the thorough and proper care that individuals needed. Some expressed concerns that any further decrease in the number of people living at Mother Redcaps would mean that there would be further reductions to the levels of staffing in the service. One staff member stated that they intended to approach the Responsible Individual with their concerns about staffing as well as other care practice issues. We spoke to one person who uses the service. This person stated that while they are happy living at the home and had regard for the staff working there, they considered that staffing levels were not sufficient and that this had started to impact on their care. The person gave examples of how staffing levels were impacting on their daily lives. This person needed assistance in being transferred. For such transfers, two people are required. They stated that for tasks such as assistance with toileting, she had to wait for two staff to assist and that this could take some time because of other priorities they had. She did state that on occasions, one staff member had assisted with transfers in order to assist this person which is an unsafe practice. The individual further stated that there had been an impact on health and personal care. They stated that they had to wait for medication to be given when there was one registered nurse covering two floors of the building and that prescribed cream for a skin condition had not been consistently given to her. We spoke to one relative during this visit. They said that they are happy with the service. They said the staff are very good, respectful and that their relative has a good relationship with them. They said the care staff are incredible, sometimes I think they could do with a few more. During our last visit, we made a requirement relating to the service developing a tool to assess the overall dependency of people using the service so that this could be linked to adjusting staffing levels. During this visit, there was evidence that dependency levels are reviewed for each person on a monthly basis. One care plan we looked at noted that there had been a significant increase in the dependency of one person. This was confirmed through accident records as well as the views of care staff who support this person. There did not, however, appear to any tool that had been developed to provide an overall view of dependency levels in Mother Redcaps. An overall indication of the dependency levels of the people who use the service must be gathered on a monthly basis so that planning of responses to staff levels can be made to ensure that peoples needs are met. The views of the people using the service and the staff are to be considered when assessing whether current staffing levels are sufficient. As part of our visit, we looked at the way in which the service recruits bank staff. This is Care Homes for Older People Page 6 of 12 a group of staff who work from time to time in the service in order to address any shortfalls that may occur in the service at carer or nurse level. We looked at recruitment files relating to two people who worked as bank staff and as registered nurses. While there was evidence that appropriate checks had been carried out before the people came to work in the service, we did note there were two issues which we discussed with the Responsible Individual for the service. One file contained an application form which revealed a gap in employment covering three years. Another personnel file contained information suggesting that this person had broken their terms of employment during 2009 and as a result would not be invited back to work in the service. This person, however, was included on the rota to work in February 2010. Management There has been a change to the management arrangements at the home since our last visit to the service. The manager who was in place since May 2009 has now moved to a different role within the home. The Responsible Individual Janet Fitzgerald is currently overseeing the service until a new manager is appointed. There is a deputy manager and a clinical services manager available. Although the post of manager has been recruited to twice since January 2009, a manager has not been registered with the Care Quality Commission since this time. It is important that a new manager is appointed without delay as this will provide stability to the staff team and provide continuity for the people using the service. What the care home does well: What they could do better: Although there was nothing to indicate people at risk of developing pressure sores would not get the care and attention they need. The frequency that care is to be given to prevent pressure sores developing needs to be clearer in care plans so that staff are provided with clear written guidance. Care Homes for Older People Page 7 of 12 Risk assessments around falling need to be more detailed so as to ensure staff have the guidance they need to promote the safety and well being of people using the service. An audit of accidents at the home would provide information that would assist with care planning in relation to falls. The daily records need to be more consistently completed so that there is complete information about what people at risk of poor nutrition have had to eat or drink and whether the care plans to prevent the development of pressure sores have been followed at the appropriate frequencies. The daily records varied in the amount of information provided. There should be a consistent approach to these records to show that the person using the service has received appropriate care and attention and to indicate their day to day well being. A procedure should be available for staff on the management of a persons personal possessions following their death. This should be made available to ensure that staff have access to clear guidance. The flooring in the corridors on the lower and top floors of the home should be replaced within the next 3 months in order to provide a homely, well-maintained environment for the people using the service. The rota showed there were times when the planned number of staff were not available for duty. There must at all times be a sufficient number of staff to meet the needs of the people using the service. An overall indication of the dependency levels of the people who use the service must be gathered on a monthly basis so that planning of responses to staff levels can be made to ensure that peoples needs are met. The views of the people using the service and the staff are to be considered when assessing whether current staffing levels are sufficient. In order to fully safeguard the people using the service, staff who are identified as not suitable to work at the service must not continue to be employed there. A full record of employment history needs to be obtained and any gaps in employment scrutinised in order to ensure that applicants are suitable to work at the home. 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 8 of 12 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 27 18 The service must gain an 30/11/2009 overall indication of the dependency levels of the people who use the service on a monthly basis so that planning of responses to staff levels can be made. To ensure that peoples needs are met. Care Homes for Older People Page 9 of 12 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 13 The risk assessment to 15/03/2010 manage falls for a person identified during this visit, needs to clearly demonstrate that all risks have been identified and appropriate steps taken to address them. To ensure staff have the guidance they need to promote the safety and well being of people using the service. 2 27 18 There must at all times be a 15/03/2010 sufficient number of staff to meet the needs of the people using the service To ensure that peoples needs are met. 3 29 19 Staff who are identified as 15/03/2010 not suitable to work at the service must not continue to be employed there. To safeguard the people using the service. Care Homes for Older People Page 10 of 12 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 1 7 The frequency that care is to be given to prevent pressure sores developing needs to be clearly identified in care plans so that staff are provided with clear written guidance. A detailed audit of accidents at the home would provide information that would assist with care planning in relation to falls. The daily records should contain sufficient information to indicate if the people using the service have received the care and attention they require. A procedure should be available for staff on the management of a persons personal possessions following their death. This should be made available to ensure that staff have access to clear guidance. The staff member identified during the visit is to be provided with safeguarding training so that the people who use the service can be fully protected by the training received by staff. The flooring in the corridors on the lower and top floors of the home should be replaced within the next 3 months in order to provide a homely, well-maintained environment for the people using the service. A full record of employment history needs to be obtained and any gaps in employment scrutinised in order to ensure that applicants are suitable to work at the home. 2 7 3 7 4 11 5 18 6 19 7 29 Care Homes for Older People Page 11 of 12 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - 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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