Care Home: Piper Court

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What the care home does well Provide people with a homely and clean environment. Interaction between people living at the home and staff was good. People appeared settled and cared for. What the care home could do better: There are a number of areas in need of improvement, particularly the training of staff. Staff need to be updated with a range of mandatory training, such as moving and handling, health and safety, first aid and infection control among others. The training programme for updating staff about safeguarding needs to continue so that all staff have completed this training. Formal staff supervision also needs to take place at least six times per year. Staffing levels should be reviewed to ensure there are sufficient staff on duty to fully meet the needs of the people living at Piper Court. Qualified nursing cover should also remain under review to ensure continuity of care to people living within the nursing unit. The needs to be two references in place for all new employees, one of which must be from the person most recent employer. New staff need to also complete their induction. Where staff are in primary employment elsewhere but cover shifts at Piper Court there needs to be systems in place to monitor this. Support for the manager needs to continue and management arrangement need to remain under review. The noise associated with the flushing of toilets needs to be addressed. The ground floor sluice needs to be repaired as does the out of order toilet. Random inspection report Care homes for older people Name: Address: Piper Court Sycamore Way Stockton-on-Tees TS19 8FR one star adequate service 12/01/2010 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: Jacqueline Herring Date: 2 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Piper Court Sycamore Way Stockton-on-Tees TS19 8FR 01642606512 01642605503 Telephone number: Fax number: Email address: Provider web address: www.southerncrosshealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Sheila Fraser Legg Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross BC OpCo Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 60 mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 10 0 The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 60 Mental Disorder excluding learning disability or dementia, Code MD, maximum number of places 10 Date of last inspection 1 2 0 1 2 0 1 0 Care Homes for Older People Page 2 of 12 Brief description of the care home Piper Court is a modern, purpose built facility that is registered to provide personal and nursing care to sixty older people. The home is divided into three units. On the ground floor of the home there is a twenty-eight bedded unit that accommodates people requiring personal care. On the first floor of the home there is a twenty-two bedded unit that accommodates people requiring nursing and personal care and also a ten bedded mental health unit. Each unit has separate lounge areas, a dining room, toilets and bathing facilities. Bedrooms are single in nature and meet the required amount of space, all have ensuite facilities, which comprise of a toilet and hand wash facilities. The home is situated close to North Tees Hospital and other local amenities. Care Homes for Older People Page 3 of 12 What we found: This inspection at Piper Court was unannounced and was conducted on 28 June 2010. It was completed in one day by by one compliance inspector. The purpose of this inspection was to check for compliance in respect of a warning letter that had been sent to the provider. The warning letter detailed breaches of one of the regulations that protects people from harm. Other areas that effect people safety and welfare were also looked at during this inspection. We looked at staff training records, staff supervison records, staff recruitment records, along with the duty rota and quality assurance reports. We also had a look around the home, observed interactions between staff and people living at Piper Court and also spoke to staff, the manager and Service Quality Adviser. The area of safeguarding and protection of vulnerable adults was identified as a concern through the Local Authority Safeguarding. The concerns related to potential delays in action being taken about allegation of potential abuse and the understanding of the correct procedures to be followed. As such, a warning letter was sent to the provider in relation to the breach of Regulation 13 (6), in which the provider needs to ensure that staff are trained to prevent people being placed at risk of harm or harmed. An action plan was received in respect of the warning letter and on the day of the inspection, a more specific action plan was made available that covered all areas of concern. There was evidence that recent protection of vulnerable adults training had been carried out and certificates were evidence on staff files. Further training is due to take place the day after the inspection and a further session was also being planned. Some staff said that this training had been planned for them but they were unable to attend due to being on duty. Three staff spoken to said they were due to complete the training the following day but now had to be on duty. This was discussed with the manager and Service Quality Adviser who agreed to look at this to ensure that as many staff as possible would receive this training as soon as possible. Staff supervison records detailed that a group supervision was held following safeguarding training. Action plans had been developed to be completed by the next supervions. The action plans were to, Ensure a comprehensive understanding of safeguarding vulnerable adults, reflect upon this learning within their own and other practice and provide examples of good practice. CQC was satisfied that this along with other areas identified within the warning letter regarding actions by managers were being appropriately actioned. The manager confirmed that some new bedroom furniture had been purchased. New chests of drawers were observed in bedrooms while we were having a look around. The manager also said that new furniture was being purchased every month. Care Homes for Older People Page 4 of 12 During the inspection there was a intrusive noise approximately every twenty minutes or so. When we asked both the manager and staff about this they said that it was when the toilets were they were flushed and that it had been happening for a long time. This was discussed with both the manager and the Service Quality Adviser with a view to having this matter addressed as soon as possible. The ground floor sluice is out of order and staff said had been for some time as was a ground floor toilet. This toilet is sited within a shower room and there was an extremely stale, stagnant odour. The toilet, showers and bathroom continue to need to be refurbished as recommended at the last Key Inspection. The files of two recently appointed staff were looked at as at the last inspection it was identified that gaps in employment were not being explored and references were not being dated. The employment history for both members of staff did have gaps, but these had been explored and a comments made about this. In one of the file there was only one reference in place, this reference was not from the person direct manager but from a qualified nurse. In the second file both references were in place an appropriate, however one of these had not been dated. At last inspection there was discussion with the manager about keeping copies of the reference request letters on file so that there was a clear audit trial in place. We also discussed that it may be useful to date stamp reference on receipt as this again strengthened the audit trial in the event that the referee does not date the reference. Neither of the two people had a completed induction. The manager did say they had been given their induction and had worked the first few shifts in a supernumerary capacity. The manager also said that one of the staff members had definitely completed their induction but the form was not available. The second person works night duty and a mentor had been allocated to them. A third file of a qualified nurse who works on the bank was looked at for the purposes of checking the monitoring and competency arrangements in place, as this persons primary employment is elsewhere. This person had previously been employed permanently at Piper Court. There was no information on this persons file to detail who their primary employer was and the number of hours they worked for their primary employer. This person can work between twelve and thirty-six hours at Piper Court. This was discussed with both the manager and Service Quality Adviser who agreed that this was an area that needed to be strengthened. A further area looked at during this inspection was the continuity of qualified nurses, as one of the permanent day duty RGNs if off work, the deputy who would be working on day duty is now the acting manager and there are no other regular qualified nurses for day duty. Night duty has permanent qualified staff, and they are covering some of the day duties. The other day duties are being covered by agency nurses. The service is only using one agency and they are requested the same nurses. This was evidenced on the duty rota and it was clear that continuity was being provided by the agency. Agency staff induction were also in place and these matched up with the names on the duty rota. Other areas looked at during this inspection included staff training. A copy of the training Care Homes for Older People Page 5 of 12 statistics dated June 2010 was made available. It identified the need for more staff training as currently only 27 of staff are up to date with moving and handling, 19 with nutrition, 20 for health and safety and 23 for infection control among others. The manager has completed supervison with a number of staff to cover the essential steps for infection control. It is not clear about the number of staff trained in First Aid, however some recent training has been arranged for this. Staff on both the nursing unit and residential unit both said there were insufficient staff on duty to fully meet the needs of people living there. In respect of the nursing unit, there is one qualified nurse and three carers. Currently all of the people living on the nursing unit need two staff members to meet their needs and a number are also nursed in bed. Staff are not aware of any tool or analysis that takes place to determine appropriate staffing to meet the dependency needs of people living there. They have been told that the ratio is in line with the numbers. On the residential unit staff also expressed concern about staff levels due to wide range of needs of people living on the unit. There is currently one senior care assistant and two care assistants, however they said that the senior care assistant is involved with medication and other task so it regularly leaves two staff to care for the people living on that particular unit and again a number of them need two members of staff to support and care for them. The deputy manager is currently acting up in the capacity of home manager and is in the process of registering with CQC in the interim until Southern Cross successfully recruits a new manager. We looked at the system in place for formal staff supervisions. It was clear that staff supervison had not been taking place at the frequencies needed. The manager has recently conducted some supervision with a number of staff, these have tended to be group supervisions as she wanted to cover topics with the staff that have either caused some concern such as safeguarding or that needs to be covered to increase knowledge of care practice in the absence of time for training. She is aware of the need for individual staff supervison. Staff spoken to said that they were not receiving regular formal supervision. One member of staff said, I cant remember when I last had it, over a year ago, another member of staff could not recall having ever had supervision. Regulation 26 reports and other quality assurance records were looked at. The most recent regulation 26 report contains a good level of detail of the review of the existing care plan and outlines some further agreed action as a result of the visit. It does identified the need to accelerate the training with in the home. The health and safety audit also identifies a number of areas that need to be addressed as does the monthly medication audit. There is some concern that in the main, the manager is responsible for addressing all of these areas, however in view of the fact that she is new to the role and needs to increase her knowledge in a number of areas, has no backfill for her own deputy position and is using agency staff to cover many of the day shifts, this is quite a task to achieve. It is acknowledged that support is being provided by the Service Quality Adviser, however this needs to continue and management arrangements need to remain under review. Care Homes for Older People Page 6 of 12 What the care home does well: What they could do better: 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 7 of 12 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 8 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 19 23 The intrusive noise associated with plumbing must be attended to. This will make the environment more pleasant for people living at the home. 09/08/2010 2 21 23 The ground floor toilet sited within the shower room that is out of order must be attended to, as does the malour in the room. This will ensure that people are able to use this facility. 23/07/2010 3 26 23 The ground floor sluice that is out of order must be attended to. This will ensure that appropriate infection control measure are in place for dealing with bed pans/commode pots. 23/07/2010 4 36 18 All staff must receive formal 09/08/2010 supervision at least six times per year. Care Homes for Older People Page 9 of 12 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 This will ensure that staff are provided with the support they need to fulfill their job role. 5 38 18 All staff must receive 09/08/2010 training that is appropriate to the work they are to perform. There must be sufficient staff employed at the home that are trained in first aid. This will ensure that peoples needs are being met by staff who have the appropriate knowledge, skill and experience. 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 18 The remainder of staff who have not completed up to date Protection of Vulnerable Adults training should now complete this. Redecoration should take place in the bathrooms/shower rooms and toilets and some of the flooring should be replaced. Staffing levels should be reviewed to ensure there are sufficient staff on duty to meet the needs of people living at Piper Court. There should be sufficient skill mix available within the home and staff who can provide continuity of care to people living there. 2 21 3 27 4 29 When new staff are appointed two references should be obtained and available within their recruitment file. 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 5 30 Staff should receive appropriate induction training on commencement of employment, which needs to be completed. The acting manager should have the support needed to enable them to fulfill their role, which should then ensure that effective management systems are in place for the benefit of people living at the home and staff working there. 6 31 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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