Care Home: Nazareth House

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well This inspection visit was carried out to look into specific areas of service provision and did not look at others areas. What the care home could do better: Up to date care plans must be in place and be regularly reviewed and if necessary amended to reflect any changes in needs or support required. Care plans and care plan reviews must accurately reflect the current needs of each individual and take into account the records completed by staff. Each individual at the home should have an up to date night care plan which is also regularly reviewed. There must be clear guidance for staff to follow, regarding responding to challenging behaviour and any steps to take which mightreduce the anxiety of the individual concerned. The manager should read and sign all incident records and clearly detail any action taken in response to each recording. The use of bed rails must be thoroughly risk assessed, with risk management plans in place. Again the daily records and incident recordings should inform the risk assessment. All prescribed medication must be administered as directed. Where medication has been refused or not administered for some other reason, then this must be recorded. Staff should not be signing that medication has been given when it has not. The manager should ensure that there are processes in place, including supervision meetings, where staff can raise concerns and be confident that these concerns would be acted upon. The manager should develop a training matrix for the staff team. This will help to identify any gaps in skills and knowledge and also identify when refresher training is due. Random inspection report Care homes for older people Name: Address: Nazareth House Ashton Road Lancaster Lancashire LA1 5AQ two star good 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: Lesley Plant Date: 3 0 0 9 2 0 0 9 Information about the care home Name of care home: Address: Nazareth House Ashton Road Lancaster Lancashire LA1 5AQ 0152432074 01524841344 nazarethhouse@lancaster320.freeserve.co. 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) : Poor Sisters of Nazareth care home 41 Number of places (if applicable): Under 65 Over 65 41 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home only: Code PC, to people 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 The maximum number of people who can be accommodated is: 41. Date of last inspection Brief description of the care home Nazareth House is registered to accommodate 41 residents of either sex, aged 65 years and above, in need of personal care. The home is within easy reach of Lancaster and on accessible bus routes. Established in 1899 by the Sisters of Nazareth, the home is set in beautifully landscaped gardens, which includes a wildlife pond. There is also a greenhouse for residents who may be interested in gardening. Accommodation is provided in 39 single rooms and 1 double room, all with en-suite Care Homes for Older People Page 2 of 10 Brief description of the care home facilities. The bedrooms are individually decorated and the home is furnished to a high standard. Doorways and corridors are wide to provide wheelchair access. The home has two passenger lifts, one that accommodates a wheelchair and ramps, affording residents freedom of movement throughout the home and to the gardens. A full time member of staff is employed, who is responsible for the activity programme at the home. Nazareth House caters for residents of different denominations and the home has its own chapel, clergy from all denominations visit the home and conduct services. Details of the fees can be provided by contacting the manager of Nazareth House. Care Homes for Older People Page 3 of 10 What we found: The manager of Nazareth House received information, which resulted in a safeguarding referral being made to the local authority. The issues were investigated and although the allegations were unsupported, the investigation team did find some areas of concern, which lead to this inspection by CQC. Concerns related to the night time support of an individual service user who can display challenging behaviour, the use of bed rails, supervision and training of night staff, care planning, assessment of new service users and medication practices at the home.The visit took place unannounced and included discussions with the manager and care staff. Records, including medication records were viewed. The daily records completed by day staff and night staff clearly show that staff are having difficulties when providing personal care to this service user, with the individual becoming aggressive. One such recording referred to staff completing a complaint form due to being scratched. Staff are also completing separate incident forms regarding these difficulties. Twelve such recordings had been made during the current and preceding month, with some detailing injuries to staff. There were also incident reports which recorded when the service user had been found on the floor, with one querying if the individual had climbed over the bed rail. Three complaint forms had also been completed by staff. The incident reports were discussed with the manager. There does not appear to be any system in place for monitoring or responding to the information they contain. The manager explained that the human resources manager, who works part time at the home, reads the reports and passes any of significance to the manager. The forms do not contain any management signature, to confirm that they have been read and the manager was not aware of the recordings relating to this individual. Two members of staff were spoken to regarding the support required by this service user. Both confirmed that the individual can sometimes stand to be attended to, but that this is not always the case and at these times the individual is supported to lie on his bed whilst personal care is given. These staff also confirmed that the individual can be physically aggressive. The care plans for this person were viewed and showed conflicting information and information which did not reflect the recordings of staff in the diary sheets and incident forms. A moving and handling assessment completed 11th September 2009 states that the individual is passive, requiring assistance and can stand. Care plan evaluations do not reflect the experiences recorded by staff. The August reviews state that the service users anxiety has been greatly reduced and that care staff can anticipate his needs and this has helped in reducing any adverse behaviour that he used to display. The September reviews for anxiety and behaviour do give some advice to staff but this is limited. The service users file contained conflicting information regarding the use of bed rails. The night care plan dated March 2009 states that bed rails are not to be used as the individual climbs over them. However there is a risk assessment for the use of this equipment signed by the persons relative, dated March 2009, with reviews in April and May showing that bed rails are in use. The resident details sheet, which gives an Care Homes for Older People Page 4 of 10 overview of the support required states that bed rails are to be used. Information from the incident reports, which state that the individual has been found on the floor, does not appear to be informing the decision to use bed rails or any accompanying, recent risk assessment. The manager explained that there had been a recent meeting with night staff to discuss night time routines and protocols. The manager also stated that she would be working two night duties over the coming weekend. The purpose of this being to observe and support night staff in their duties and therefor get a clear picture of any difficulties and how these were being managed. The past two weeks of medication administration records were viewed in relation to six people living at Nazareth House. These did not show any omissions. However on checking the actual medication held for these people, medication for one person was still in the cassette, but had been signed by staff as being administered. The manager has recently started conducting monthly audits of medication and night staff also do checks. The manager confirmed that any errors are followed up and that a meeting had been held with senior staff who administer medication, when correct procedures were discussed. The pre admission assessment information for two people recently admitted to the home was viewed and showed that appropriate information is obtained before admission to the home. Training certificates were viewed on a selection of staff files. The manager explained that a training matrix is to be developed, which will identify which staff have completed each element of the training programme and make it easier to spot any gaps in the knowledge and skills of staff. The manager confirmed that staff, including night staff have completed moving and handling training and that all staff are undertaking training regarding dementia, with four staff attending this course on the day of the inspection. Although some staff have completed training regarding challenging behaviour, the manager is looking at alternative, more practical training in this area. Supervision records for five night staff were viewed, showing that supervisions and appraisals are taking place. It does not appear that any difficulties with individual service users are being shared during supervision meetings and that night staff are using the incident records and complaint forms as the means by which they inform the manager of these difficulties. What the care home does well: What they could do better: Up to date care plans must be in place and be regularly reviewed and if necessary amended to reflect any changes in needs or support required. Care plans and care plan reviews must accurately reflect the current needs of each individual and take into account the records completed by staff. Each individual at the home should have an up to date night care plan which is also regularly reviewed. There must be clear guidance for staff to follow, regarding responding to challenging behaviour and any steps to take which might Care Homes for Older People Page 5 of 10 reduce the anxiety of the individual concerned. The manager should read and sign all incident records and clearly detail any action taken in response to each recording. The use of bed rails must be thoroughly risk assessed, with risk management plans in place. Again the daily records and incident recordings should inform the risk assessment. All prescribed medication must be administered as directed. Where medication has been refused or not administered for some other reason, then this must be recorded. Staff should not be signing that medication has been given when it has not. The manager should ensure that there are processes in place, including supervision meetings, where staff can raise concerns and be confident that these concerns would be acted upon. The manager should develop a training matrix for the staff team. This will help to identify any gaps in skills and knowledge and also identify when refresher training is due. 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 £ No R 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 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 13 The use of bed rails must be thoroughly risk assessed, with risk management plans in place. This will help to ensure that such equipment is only used when needed and is only used in a safe manner. 30/10/2009 2 7 15 Care plans and care plan reviews must accurately reflect the current needs of the service user and take into account all available information. The records kept by staff provide important information which is vital for robust care planning. 30/10/2009 3 7 15 Care plans must be in place and be regularly reviewed. This will ensure that staff are providing the correct support in a consistent manner. 30/10/2009 4 8 13 All prescribed medication must be administered as 30/10/2009 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 directed. This will promote and protect the health of service users. 5 8 13 There must be give clear guidance for staff to follow, regarding responding to challenging behaviour. This will promote a consistent and safe approach for staff. 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 30/10/2009 1 2 7 8 Each individual at the home should have an up to date night care plan which is also regularly reviewed. The manager should read and sign all incident records and clearly detail any action taken in response to each recording. The manager should develop a training matrix for the staff team. This will help to identify any gaps in skills and knowledge and also identify when refresher training is due. The manager should ensure that there are processes in place, including supervision meetings, where staff can raise concerns and be confident that these concerns would be acted upon. 3 30 4 36 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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!