Care Home: Rockley Dene Nursing Home

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What the care home does well The personal care that people received was based on their individual needs and there were comprehensive records to support this. On the whole, people were treated with privacy, dignity and respect. People described how they were able to make choices and decisions about their life style and the social and recreational activities available. They said, "I like sitting in lounge, but I don`t like the TV, I like reading", "we have entertainers come", "there`s bingo and a bloke comes with a trumpet and a band" and "they do all sorts like knitting. Some of them are very good".People were visited by their relatives. They said their relatives could visit `at anytime` and one relative said, "the staff at the nursing home always make me feel welcome. They answer the doorbell promptly when I visit". On the whole, a comfortable, clean and pleasant environment was provided. People said they were happy with their bedrooms, the standard of cleanliness and hygiene, including clean clothes and bathing facilities. Overall, people and their relatives were content with the staff that cared for them. They said, "the staff appear to have the skills required especially the qualified nurses", "they do their best" and "they`re alright". What has improved since the last inspection? The management and administration of the home was based on openness and respect, where systems were in place to protect people from abuse and uphold their rights. It also included people knowing how to express their concerns and being confident to do so. For people moving into the home the manager now carried out a pre admission assessment. This provided the service with information on how to meet the needs of people and confirm with people that they were able to do so. Also, it gave people the opportunity to discuss with the manager any information they needed to know about moving into the home. Records containing information about people were up to date. The recording and monitoring of accidents of people including a 72 hour care plan following an accident and a tracking system for the manager to monitor accidents for any action to be taken to maintain peoples` safety. In addition, these were being reported to CSCI. The faulty heating in a person`s room had been repaired. Regular forums were in place for people and their relatives to voice their opinions of the quality of the service. What the care home could do better: Increase the monitoring of some quality assurance systems such as medication, the environment, fire and moving and handling, so that all areas relating to health and safety are maintained to keep people safe. To improve the recreational opportunities available for people, provide more visits and trips out. Likewise, increase the choice of drinks and snacks available for people between meals.Displaying the complaints procedure separately from the service user guide would be easier for people to see. Also, increasing the size and position of peoples` names on bedroom doors would make it easier for them to see. Increase staffing levels to make sure staff are in sufficient numbers to prevent people having to wait for assistance. Also, develop staff training to increase their knowledge in the different needs people might have. Conduct a rigorous recruitment process so that people are kept safe. CARE HOMES FOR OLDER PEOPLE Rockley Dene Nursing Home Park Road Worsbrough Barnsley South Yorkshire S70 5AD Lead Inspector Mrs Jayne White Key Unannounced Inspection 4th March 2008 09:00 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 Rockley Dene Nursing Home DS0000006489.V360486.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. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rockley Dene Nursing Home Address Park Road Worsbrough Barnsley South Yorkshire S70 5AD 01226 207916 01226 280187 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) Angel Care Plc Post Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons accommodated shall be aged 60 years and above. Of the 34 registered beds, 30 can be used as nursing care (N) or personal care and 4 can be used as personal care (PC) only. Can provide accommodation and care for one named service user aged under 60 years with terminal illness. 21st March 2007 Date of last inspection Brief Description of the Service: Rockley Dene Nursing Home is a purpose built home providing nursing and personal care and accommodation for up to 34 people. Next to Rockley Dene Nursing Home is Rockley Dene Care Home. Rockley Dene Care Home is registered separately and not covered by this inspection report. Rockley Dene Nursing Home is owned by Angel Care Ltd and is situated at Worsborough Bridge, Barnsley. The home is on a main bus route into Barnsley town centre and there are local shops nearby. Accommodation is provided on two floors. A lift and stairs provide access to the upper floor. There are 16 single and 9 double bedrooms. Four of the double and six of the single bedrooms have en-suite facilities. There is one large lounge area and another lounge area in the conservatory, off the dining room. There is also a ‘snug’ between the dining room and conservatory, but part of it. The conservatory opens onto a patio area and there is a pleasant garden. Information of the services and facilities the home offer, including the statement of purpose and the service user guide that holds the most current inspection report and terms and conditions/fees to people, were available in the entrance hall and people’s bedrooms. The weekly fees are £341.50 for people needing personal care and £442.50 for people needing nursing care. The home charges extra for hairdressing, chiropody and toiletries. Rockley Dene Nursing Home DS0000006489.V360486.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 2 stars. This means that the people who use this service experience good quality outcomes. We visited the home on 4 March 2008 between 09:00 and 18:00 without giving them any notice. Before the visit we took into consideration other information the Commission for Social Care Inspection (CSCI) had received. This included: • An Annual Quality Assurance Assessment (AQAA). An AQAA is a document completed by providers. It gives them the opportunity to tell the CSCI how well they think they are meeting the needs of people using their service. Information contained in notifications from the home about any deaths, illnesses and other events, which affected the health and well being of people living there. Surveys that were sent to a range of people, asking them about the home. One came back from a relative of person that lived there, two from health care professionals, one from a care manager and two from staff. During the visit we spoke with people that lived there, staff, the manager, looked round parts of the building and read some records. • • • We would like to thank the people, their relatives and friends, staff and the manager for their time and co-operation throughout the inspection process. What the service does well: The personal care that people received was based on their individual needs and there were comprehensive records to support this. On the whole, people were treated with privacy, dignity and respect. People described how they were able to make choices and decisions about their life style and the social and recreational activities available. They said, “I like sitting in lounge, but I don’t like the TV, I like reading”, “we have entertainers come”, “there’s bingo and a bloke comes with a trumpet and a band” and “they do all sorts like knitting. Some of them are very good”. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 6 People were visited by their relatives. They said their relatives could visit ‘at anytime’ and one relative said, “the staff at the nursing home always make me feel welcome. They answer the doorbell promptly when I visit”. On the whole, a comfortable, clean and pleasant environment was provided. People said they were happy with their bedrooms, the standard of cleanliness and hygiene, including clean clothes and bathing facilities. Overall, people and their relatives were content with the staff that cared for them. They said, “the staff appear to have the skills required especially the qualified nurses”, “they do their best” and “they’re alright”. What has improved since the last inspection? What they could do better: Increase the monitoring of some quality assurance systems such as medication, the environment, fire and moving and handling, so that all areas relating to health and safety are maintained to keep people safe. To improve the recreational opportunities available for people, provide more visits and trips out. Likewise, increase the choice of drinks and snacks available for people between meals. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 7 Displaying the complaints procedure separately from the service user guide would be easier for people to see. Also, increasing the size and position of peoples’ names on bedroom doors would make it easier for them to see. Increase staffing levels to make sure staff are in sufficient numbers to prevent people having to wait for assistance. Also, develop staff training to increase their knowledge in the different needs people might have. Conduct a rigorous recruitment process so that people are kept safe. 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. Rockley Dene Nursing Home DS0000006489.V360486.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 Rockley Dene Nursing Home DS0000006489.V360486.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): The outcome for standard 3 was inspected. The home did not provide an intermediate care service. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who used the service and their representatives had the information they needed to choose a home that would meet their needs. People moving into the home had their needs assessed, to make sure the home was able to meet their health, social and care needs. EVIDENCE: When we spoke to people they described how the manager visited them before they moved in. They said they were given a brochure and talked with the manager about going to live at the home. They said they were offered a visit to the home, but most people left this to their families. This process meant the manager could decide from the assessment that the service could meet the Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 10 needs of the person. It also helped the person and their family to decide if the place was right for them. We looked at records for three people. The information showed that the manager had carried out an assessment of peoples’ needs before they moved into the home. The information established that the service was appropriate for the person and provided staff with information to formulate an individual plan of care. Rockley Dene Nursing Home DS0000006489.V360486.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): The outcomes for standards 7, 8, 9 & 10 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The personal care that people received was based on their individual needs. Improvements were needed with medication to make sure all peoples’ health care needs were met. On the whole, the principles of respect, dignity and privacy were put into practice. EVIDENCE: All people we spoke with were pleased with the care and medical support they received and felt they were well cared for. They said, “I enjoy my bath” and “I’m in pain all the time, but they ask me if I want to go and lie down”. They described how they had access to health care services to promote and maintain their health care needs. This included visits from the GP, chiropodist and nurses. On the visit people that wanted were having an assessment of their hearing. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 12 On the whole, people we spoke with said that most staff treated them with respect. They said they were able to spend time in their room if they wished. Mainly, we saw staff speaking and interacting with people in a friendly and pleasant way, which showed respect for them. We saw staff respecting the individual preferences of people, often knowing their preferences. There were good relationships between people and staff. We saw staff knocking on doors before entering. However, care must be taken that toilet doors are closed when they are in use, so other people do not try to go into the toilet at the same time. On the whole, peoples’ clothing was clean, as was their hair and nails. It is essential, however, that where staff spill on people’s clothes they change their clothing, promoting dignity and respect for them. People were wearing their glasses and teeth, promoting their ability to see clearly and eat without difficulty, which maintained their dignity. We looked at the case files of three people. The files were tidy. Having dividers in the file would make information easier to find. The plans were a good standard and contained good profile information, records of medical treatment and risk assessments of falls, moving and handling and nutrition. The information in the file was reviewed and on the whole, up to date information was provided, which meant the plans supported the care people said they received. When people were given their medication, they were given their medication on a tray, in small pots, with a glass of water. Nurses where necessary explained what they were doing to give reassurance to people. This highlighted good hygiene practices and respect for people. Some people had to wait for their medication despite asking for it a number of times. This was because the nurse was busy with other people. We saw medication still being given to people at 10:45am. People said they were satisfied with the way their medication was managed. However, when we observed this and looked at their medication and medication administration records this was not always the case. Medication received was clearly recorded on the person’s medication administration record and medication administered had been signed for. However, there were a number of discrepancies where the actual medication remaining did not tally with the medication administration record. Also, one person had been without two lots of their medication for 6 days and another had run out of their medication. There was medication that was not stored securely. This was unsafe as the door to the room where the medication was left remained open all day and there was not always someone in the room. This meant medication could be removed. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 13 Staff responsible for administering medication had received medication training, including the procedures to be followed. However, as the above demonstrates, this training was not always put into practice. Rockley Dene Nursing Home DS0000006489.V360486.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): The outcomes for standards 12, 13, 14 & 15 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were able to make choices and decisions about their life style, where this was possible and the social and recreational activities available met people’s expectations. EVIDENCE: There was a comfortable, relaxed atmosphere, where on the whole there were good relationships between people and staff. We saw people able to spend the day as they wished, following their preferred routines, with the majority of people spending their time in the lounges. When we spoke with people they seemed happy spending time in their rooms or sitting in the lounges and entrance to the home. They said, “I like sitting in lounge, but I don’t like the TV, I like reading”, “we have entertainers come”, “there’s bingo and a bloke comes with a trumpet and a band” and “they do all sorts like knitting. Some of them are very good”. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 15 An activities coordinator was employed. A weekly activities programme was displayed in the corridor. When we were there we saw the co-ordinator put on appropriate music and encourage people to sing a long, which a number did. When we spoke to the co-ordinator she said she speaks to people a couple of days after they have arrived to see what they would like to do. She said there were some trips out, but this was not as much as people would like because of transport. She said people went out Xmas shopping at Xmas if they wished. There had been improvements within the case file with the recording of people’s interests. This could be improved further by describing in the plan of care how each individual’s interests were going to be met. This information could then be given to the activity co-ordinator. They could use the information to determine how what they would like to do could be achieved in the activities programme. A separate record was kept by the activity co-ordinator, which included information about what activities people had participated in or enjoyed. We saw people being visited by their relatives. Visitors spent time with their relatives/friends in both communal areas and peoples’ bedrooms. Staff were welcoming and friendly to visitors. When we spoke to people they said, “family visit” and “I can have visitors anytime I like”. One relative said, “the staff at the nursing home always make me feel welcome. They answer the doorbell promptly when I visit. I’m pleased they don’t have the TV on all the time in the lounge as my relative likes music and enjoys the varied music to listen to on CD or tape”. When we looked in peoples’ bedrooms, the bedroom gave the impression it was the person’s private space that they could personalise it how they wished. They had individual colour schemes and held personal items of the person. People could bring their own furniture and possessions with them when they moved in to the home if they wished. A small number of people continued to handle their own financial affairs though the majority depended on family or legal representatives to do this on their behalf. When we spoke to people they said they enjoyed the meals they were served. They said, “food’s good. You get cereal and toast for breakfast, then your dinner and it’s usually sandwiches for tea”, “they always ask what you want for tea, usually sandwiches or soup”, “there’s a choice of fruit or trifle”, “I’m not bothered about fruit”, “there’s four or five choices from trolley” and “if you have a drink (alcoholic) you don’t pay for it”. The dining room was clean and bright. The tables were nicely laid using tablecloths, condiments and matching crockery and cutlery. The lunchtime meal for the day was displayed. This made it a welcoming environment for Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 16 people to eat their meals. We saw the meals being served. Soft diets were provided. There was a relaxed atmosphere and people were given sufficient time to eat. Staff were courteous and respectful to people when they served their meals. We saw carers assisting people who needed help to eat in an appropriate manner. This experience for people would be improved if staff spoke with the people they were helping. In between meals we saw people being offered tea, coffee and biscuits. Introducing further choice, for example, water, juice and fruit that had been cut up could improve this. Rockley Dene Nursing Home DS0000006489.V360486.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): The outcomes for standards 16 & 18 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were able to express their concerns and had access to a complaints procedure. They were protected from abuse and had their rights protected. EVIDENCE: On the whole, when we spoke to people they were satisfied with the service they received and said they had no need to ‘complain’ or ‘grumble’. One person was actually in the process of making a complaint and was quite clear it was ‘the manager’ they would speak with. They said they were happy to do this as she always looked into it. Others said, “I would consult the manager or nurse on duty” and “never had concerns up to now”. The complaints procedure was in the service user guide that was displayed in the hallway. People would have to read this to know what the complaints procedure was. Displaying the procedure separately would make it more accessible to people. Since the last inspection there had been four complaints. There was a record of all the complaints. This demonstrated that complaints had been listened to, documented, investigated and action taken where necessary to make improvements. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 18 The manager had obtained the updated procedures for adult safeguarding that promoted the protection of people from harm or abuse. A programme of adult protection training was in place. There had been no adult safeguarding referrals. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 19 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): The outcomes for standards 19 & 26 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole, the building and its environment were clean, well decorated and well maintained. This meant people found the home comfortable, relaxing and to their satisfaction. EVIDENCE: When we spoke to people they all said they thought their home was comfortable. They said they had a comfortable bedroom, which they had personalised with pieces of their own furniture and possessions. We saw people moving around the home as they wished. They had access to all indoor and outdoor facilities. The lounge areas, conservatory and dining room presented a pleasant and homely environment for people to live. Areas Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 20 were pleasantly decorated and there were homely touches of pictures and flowers. When we looked round the building it was clean and there were no unpleasant smells. We noticed that some peoples’ names were not on their bedroom doors and some were too high up and in too small a print for most people to read. The area of subsidence in part of the hall, which the manager said at the last inspection was being dealt with by the home’s insurers, had still not been addressed. This was a potential tripping hazard for people. During a telephone conversation with the manager subsequent to the inspection this work was being carried out. A member of staff in their survey said, “during the winter months the conservatory lounge is cold. Residents are occasionally left sat in that lounge all day”. We saw that the majority of people in that lounge did stay there all day, only moving to go to the dining room, which was part of the same room and the toilet. I asked people that sat there if they were warm enough and they said they were. The manager does need to monitor this situation, so that people do not get cold. The manager had identified in the AQAA a redecoration and refurbishment programme has commenced and will be on-going over the next 12 months. This was confirmed when a relative said, “they are updating the rooms. The lounge is much improved. I feel work in all areas will create a much better environment”. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 21 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): The outcomes for standards 27, 28, 29 & 30 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff were sufficiently skilled to support people, but further training was needed to improve these skills to meet all the needs of people living at the home. A review of staffing levels was needed to make sure staff were in sufficient numbers to respond to peoples’ needs within a reasonable timescale. EVIDENCE: On the whole, people and their relatives were content with the staff that cared for them. They said, “the staff appear to have the skills required especially the qualified nurses”, “they do their best” and “they’re alright”. We saw good relationships between staff and people. However, on a number of occasions we observed people having to wait for staff to attend to their needs. This included people having to wait for their medication, after they had asked for it because staff were busy. We heard staff repeatedly say to people ‘they would have to wait a minute’ for either help to be transferred or their medication because ‘staff were busy’. When we spoke to people about this, however, they said ‘they didn’t have to wait all the time’ but ‘staff ran round like flies’. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 22 When we spoke to staff they said the dependency of people was high with nearly half of the people needing assistance to move with a hoist, three people that needed regular turning, four people needing assistance with eating and the majority of people needing some assistance with washing and dressing and going to the toilet. Information provided in the AQAA also gave a high number of people who needed assistance and supported the information given by staff. We looked at staff rotas. They were untidy and not always clear who had covered shifts. The rota did not clearly show when the manager worked shifts as a nurse or as a manager. Taking this into account it looked like five staff were on duty in a morning, four on an afternoon and three during the night. There were ancillary staff employed to make sure people received their meals and the home was kept clean. There was a mixed response from staff about whether the training they received fully equipped them for their role, in particular any specialist training they might need. They said, “need training in palliative care and special disease conditions like multiple sclerosis or Parkinson’s disease and even EMI care too, as we have to look after such residents”, “no induction was offered or even given” and “we have had a few cases of palliative care in the past, but to my knowledge, only one member of staff has had any training relating to this”. There was a training programme in place including adult safeguarding, fire, medication, moving and handling, food hygiene, health and safety and emergency aid. Only four staff had received training in the control of infection. This was because the training provider had cancelled the course in November 2007. The AQAA stated 36 of staff hold NVQ Level 2, with the same working towards it. This does not meet the recommended level of 50 . We looked at the recruitment process for two staff. It was not sufficiently robust enough to protect people. This was because the documentation for some staff were photocopies and no confirmation was available to say these had been checked against original documentation. Some references had not been sent for by the service. The service had accepted references from the member of staff addressed for example, ‘to whom it may concern’. There was no documentation to demonstrate the authenticity of the reference had been checked. Staff had commenced work without a CRB in place and without a Protection of Vulnerable Adults (POVA) first check being made. Police checks from another country had not been translated to demonstrate they were satisfactory and satisfactory written confirmation of any gaps in employment had not been documented. Immediately the service were required to stop a member of staff working on shift until a satisfactory POVA first check had been received. Subsequent to the inspection, the provider has challenged this stating ‘because the worker had not been previously resident in the country this was not required’. CSCI sought further clarification and CSCI guidance does state ‘a CRB check is required for overseas staff, therefore includes a Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 23 POVA first check being in place and staff being appropriately supervised until a full CRB is returned and is satisfactory’. Detail of the guidance is available on the internet. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 24 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): The outcomes for standards 31, 33, 35 & 38 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect. On the whole, effective quality assurance systems developed by a qualified, competent manager were in place, although there were some weaknesses in areas relating to health and safety. EVIDENCE: The manager had commenced employment on 14.05.07. The AQAA stated she was a first level nurse, with 5 years experience in management. Information obtained during the inspection identified overall she had improved the service. One health professional survey said, “much improved last 12 months”. She had a good knowledge of the needs of people, was committed to providing a good quality service and communicated a clear sense of leadership to staff. An Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 25 application to be registered had not been received by the CSCI, but the manager said it had been sent. She said she would begin the process again. A quality assurance system was in place and included a process whereby the views of people were taken into consideration, in addition to the manager’s quality assurance audit. A resident survey analysis for the last 12 months was due to be undertaken. There were regular resident/relative forums where people were encouraged to say what their opinions were on the quality of the service provided. The provider visited the home and provided the manager with a report of those visits identifying and taking action to improve the service. People looked after their finances if they wished and had the capacity to do so, but the manager confirmed that relatives dealt with the majority of peoples’ finances. Where the service looked after money on behalf of people, financial systems were in place to safeguard the money. We looked at the financial record for one person. Written records of transactions were maintained, with two signatories to confirm the transaction. The entries in respect of payments for chiropody could be improved so that the date when the money was debited from was clear. There were safe facilities to store money. There were some shortfalls in the identification and action taken in respect of health and safety. When we looked round the building hazardous substances were securely stored. However, doors to the sluices did not have a lock and this could prevent a risk to people because of the machinery in there. The manager was asked to conduct a risk assessment for this. Also, although servicing and maintenance of electrics and equipment was in place, staff said in their surveys, “repair fire doors which are faulty” and “at least two of the fire doors are faulty and have been reported several times over the last year. No repair has been made”. When we looked at this the fire risk assessment available was dated 05.09.06 and checks of automatic door releases identified this was satisfactory. The manager said she was aware of a fire door that staff had reported as being faulty and it was to be replaced. Subsequent to the inspection the manager informed the inspector there was a fire risk assessment in place dated June 2007. In addition, that the fire door was being replaced. The recording of accidents had improved, with a 72 hour care plan implemented following an accident. In addition, a tracking system for the manager to monitor accidents for any action to be taken to maintain peoples’ safety had also been implemented. Accidents were being reported to CSCI. On the whole, people were moved safely, but there were inconsistencies in practice. This included, a number of occasions when staff moved people without footplates being in place or applying brakes to wheelchairs when they were transferring people into chairs. Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 27 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 OP9OP33 Regulation 13 Requirement All medication, including eye drops must be securely stored. Previous timescale of 21/03/07 not met. Systems must be in place; so that people receive the medication they are prescribed in order to maintain their health. To confirm that medication is being given as prescribed there must be no discrepancies between the amount of medication remaining and the medication administration record. Staff must be in sufficient numbers for people to receive assistance without having to wait for staff to attend to their needs. The recruitment process should demonstrate compliance with the regulation, so that people are kept safe. The member of staff working without a POVA first check must not continue to do so, until one is in place, to keep people safe. Timescale for action 04/03/08 2. OP9 OP33 13 (2) 04/03/08 3. OP9 OP33 13 (2) 04/03/08 4. OP27 18 (1) (b) 04/05/08 5. OP29 19 04/03/08 6. OP29 19 (10 (b) 04/03/08 Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 28 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. 2. 3. 4. 5. 6. 7. Refer to Standard OP9 OP33 OP12 OP15 OP16 OP19 OP28 OP30 Good Practice Recommendations That a key is found for the fridge used to store medication or the fridge is replaced, so that medication is appropriately and safely stored. Opportunities for people to participate in trips and visits outside the home should be increased. Introduce more variety to drinks and snacks that are available between meals. Display the complaints procedure separately to make it more accessible to people. Make the bedroom door signs for people in larger print and place them lower down, so that people can read them more easily. A minimum ratio of 50 of all care staff should have NVQ Level 2 or equivalent. Staff should receive training in specialist areas such as palliative care, multiple sclerosis, Parkinson’s Disease and dementia to increase their knowledge in caring for people with those conditions. For the manager to apply to be registered with the CSCI, so that they can make a decision whether she is fit to be registered. For a risk assessment to be conducted in respect of the risk presented to people who may go in to the sluices. Action should be taken to reduce any risks identified in order to maintain peoples’ safety. 8. 9. OP31 OP38 OP33 Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Rockley Dene Nursing Home DS0000006489.V360486.R01.S.doc Version 5.2 Page 30 - 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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