Latest Inspection
This is the latest available inspection report for this service, carried out on 26th February 2010. CQC found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Scotia Heights.
What the care home does well The service offers person centered care in small units within a modern purpose built environment. What the care home could do better: The management of this critical incident has been poor in so much as the incident itselfand subsequent concerns raised by the relative were not referred by the service as a Safeguarding. The service has been reactive in its approach, in that procedures, including vital staff training, have been put into place retrospectively. On February 14th 2010 there were no nurses on duty in the home who had received appropriate training, and were confident and competent to manage people with tracheotomy tubes. Furthermore, the actions taken to raise the alarm about this critical incident and to avoid another such incident were slow and ineffective. There was a delay of eight days in completion of a critical incident form. There was also a delay of the same period of time in alerting CQC to this event. It is imperative that the service is able to meet the needs of people who live in the home. This includes ensuring that there are sufficient staff on duty who are confident and competent to manage the critical care needs of people. Nurses must not be expected to work outside their professional scope and they must receive appropriate training and support in the management of tracheotomy tubes and ventilators. Care staff offering one to one care must also be suitably trained and confident to offer emergency support. Critical incidents must be reported immediately after the event and brought to the attention of the manager who, in turn, must act on this information and ensure that people who live in the home are kept safe. There was some confusion over the actual events outlined by the relative and the series of events stated by staff. The service had not obtained a written complaint from the relative, which may make the facts clearer and we suggested that they do so as per their complaints procedure. The service can then continue with their internal investigation. The service will need to produce an action plan telling us how they will improve in the above areas in order to keep people safe. Random inspection report
Care homes for adults (18-65 years)
Name: Address: Scotia Heights Scotia Road Burslem Stoke on Trent Staffordshire ST6 4ET 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: Yvonne Allen Date: 2 6 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Scotia Heights Scotia Road Burslem Stoke on Trent Staffordshire ST6 4ET 01782829100 01782829101 Telephone number: Fax number: Email address: Provider web address: Email-scotia@exemplarhc.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Scotia Health Care Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 0 mental disorder, excluding learning disability or dementia physical disability Conditions of registration: 60 60 The maximum number of service users to be accommdated 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: Physical disability (PD) 60 Mental disorder, excluding learning disability or dementia (MD) 60 Date of last inspection Brief description of the care home Scotia Heights is a purpose-built specialist nursing home providing 60 beds for young adults. The new registration was approved on 10th February 2006 and admission of residents commenced shortly afterwards. The home provides holistic care for adult people aged between 18-65 years of age with a neurological diagnosis. The client
Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home group is people with a primary need of physical disability, with or without associated mental health problems. The home has currently applied for a variation to its Registration. The variation is to enable the home to widen the category of the client groups by having ten beds registered for mental disorder. The environmental facilities are excellent. - All bedrooms are for single use, spacious, having en-suite facilities including shower and all bedrooms have TV and telephone points. There is ample room to negotiate moving equipment as required. There are 12 lounges and 6 dining areas providing high-quality accommodation furnished and equipped to the highest standards and allowing small group living areas. Corridors are wide and spacious with recessed seating areas and there are rooms for visitors and meetings. All facilities, including kitchen, laundry and office accommodation are spacious, bright, well equipped and pleasing in presentation. The home is located in a well-populated area in the northern part of Stoke on Trent. It is on a main bus route and easily accessible by car or public transport to the Potteries towns where all communal facilities can be accessed. The home is located next to a modern leisure centre offering excellent facilities. At the date of the Key inspection, the fees charged by the home ranged from 1030.00 to 2537.40 pounds per person per week. These should be discussed with the Registered Manager in the first instance, as fees are very much dependent on individual needs and available funding. Care Homes for Adults (18-65 years) Page 3 of 10 What we found:
We carried out this unannounced Random Inspection of the service as a result of a Safeguarding referral we have received. These concerns from the relative of a person living in the home are that some nurses are not competent with the care of a person nursed on a ventilator. The specific concerns raised are that a nurse attempted to change a ventilator over to a portable ventilator and was unable to do this and the relative had to show her how this is done. Also that a nurse attempted to put nebuliser fluid down the tracheotomy tube of a patient instead of into the nebuliser chamber. The relative also states that other visitors to the home have raised concerns about the same things. Following a strategy meeting with Social Services we carried out this visit to the the service. We commenced at 3pm and completed at 6.45pm. We were accompanied on the inspection by Teresa McGougan who has recently taken a lead role in safeguarding for Stoke Primary Care Trust. We spoke with the Registered Manager Mr David Price. We explained the reason for our visit including the concerns we had received. Mr Price was aware of these concerns as the relative had also raised them with the service. Mr Price informed us that one of the two newly appointed clinical managers had started the investigation into the allegations and was part way through this. We met with the clinical managers and the senior nurse on duty on 14th February. The clinical manager explained to us that she had received a telephone call from the relative on 19th February 2010. The relative had highlighted the concerns as above and had stated that this had taken place on 14th February 2010. Statements had been obtained from various relevant staff members and to date the following information had been obtained That on 14th February the nurse in charge of unit 4 had rang in sick and another nurse had been sent to work on this unit. At about 8.30 am the emergency alarm was sounded as one of the people who lives in the home on unit 4 had pulled out his tracheotomy tube as he does from time to time. The nurse in charge of this unit was unsure how to put in a new tube and said that she would have a go. The senior nurse on duty rang for the paramedics in case this tube could not be successfully inserted. The paramedics arrived by which time the nurse had correctly inserted the tracheotomy tube. The relative of the person arrived and changed the connections and tubing from the permanent ventilator to the portable ventilator. The nurse did not attempt to do this as the relative had already carried this out. The person was taken to hospital as paramedics were concerned that the he had a pain in his chest. There are no staff statements to suggest that at any time did a nurse attempt to put nebuliser liquid down the tracheotomy tube. The person usually has two nebulisers per day, morning and evening. The carer who was supervising the person (one to one) at the time of the visit demonstrated to us how the person is given a nebuliser correctly. We spoke further to this carer and she told us that she is competent and confident with monitoring this person on his ventilator and that she would know what to do to maintain an open airway in an emergency situation. We were informed,however, that not all of the carers who give one to one support are confident or competent and
Care Homes for Adults (18-65 years) Page 4 of 10 that some carers feel uneasy about this. We visited unit 4 and spoke with the nurse on duty. She was in charge of the unit and had five carers to assist. We had raised concerns about the provision of staff on this unit at the last Key Inspection in October 2009. Mr Price told us that he has increased the provision of physiotherapist hours on this unit and that there is always a physiotherapist on call. The nurse told us that she is confident and competent in the care of people using ventilators and tracheotomies. She told us that the nurse who worked opposite shifts to her is also competent in this area. We asked her about what training she had received in the management of people with assisted ventilation and she told us that she had done this over the years as part of her extended role. She told us that when the service receives a person on a ventilator from hospital or another care environment then a respiratory nurse usually comes out to give staff a talk and instructions in its use. When we spoke with the newly appointed clinical managers they confirmed that all nurses are to be given formal training in the care of people with tracheotomies and ventilators. The unit had one person on a ventilator and throughout the home there were five people with tracheotomys in place. We looked at the care plan for the gentlemen nursed on a ventilator. It was identified that, although this person was at risk of removing his tracheotomy tube, there had been no risk assessment/protocol in place for decannulation until 22nd February 2010 when one had been commenced. We looked at a second care plan for a person with a tracheotomy tube and there was a risk assessment and procedure in place for decannulation. When events happen in the home which give rise for serious concern a form is completed entitled a critical incident form. The critical incident form in relation to the event which happened on 14th February was not completed until 22nd February. We, the commission, did not receive a report about the incident as per Regulation 37 until 23rd February 2010. At the end of the inspection we discussed our findings with the registered manager Mr David Price. The service had started to take action to address the above concerns and we, the commission, were satisfied that, at the date of our inspection visit, people who live at the home were safe and that their needs would be met by the staff who work there. What the care home does well: What they could do better:
The management of this critical incident has been poor in so much as the incident itself
Care Homes for Adults (18-65 years) Page 5 of 10 and subsequent concerns raised by the relative were not referred by the service as a Safeguarding. The service has been reactive in its approach, in that procedures, including vital staff training, have been put into place retrospectively. On February 14th 2010 there were no nurses on duty in the home who had received appropriate training, and were confident and competent to manage people with tracheotomy tubes. Furthermore, the actions taken to raise the alarm about this critical incident and to avoid another such incident were slow and ineffective. There was a delay of eight days in completion of a critical incident form. There was also a delay of the same period of time in alerting CQC to this event. It is imperative that the service is able to meet the needs of people who live in the home. This includes ensuring that there are sufficient staff on duty who are confident and competent to manage the critical care needs of people. Nurses must not be expected to work outside their professional scope and they must receive appropriate training and support in the management of tracheotomy tubes and ventilators. Care staff offering one to one care must also be suitably trained and confident to offer emergency support. Critical incidents must be reported immediately after the event and brought to the attention of the manager who, in turn, must act on this information and ensure that people who live in the home are kept safe. There was some confusion over the actual events outlined by the relative and the series of events stated by staff. The service had not obtained a written complaint from the relative, which may make the facts clearer and we suggested that they do so as per their complaints procedure. The service can then continue with their internal investigation. The service will need to produce an action plan telling us how they will improve in the above areas in order to keep people safe. 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 Adults (18-65 years) 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 Adults (18-65 years) 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 8 13 The registered person shall 03/03/2010 ensure that.......(c) unnecessary risks to the health or safety of people are identified and so far as possible, eliminated. Critical incidents must be highlighted and action taken to avoid repetition. The local Safeguarding procedures must be adhered to in order to keep people safe. 2 30 13 13 (6) The registered person 03/03/2010 shall make arrangements, by training staff to prevent people who live in the home being harmed or suffering abuse or being placed at risk of harm or abuse. All staff delivering care including carers giving one to one care and nurses delivering nursing care must not be expected to work outside their professional scope of practice unless they have been trained in that specific role and are Care Homes for Adults (18-65 years) 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 confident and competent to do so. 3 30 18 18(1) The registered person 03/03/2010 shall.....(a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the people who live there. There must always be nurses on duty at the home who are competent and confident to meet the needs of people who live in the home. This includes the management of people with critical care needs and the care of people with trachyostomys and those on ventialtors. 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 16 It is recommended that the service obtain the complaint in writing from the complainant prior to commencing a formal investigation so the facts can be ascertained. This will also ensure that the service adheres to its own complaint procedure. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 Adults (18-65 years) 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!
