Care Home: Southcrest Nursing Home

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What the care home does well As the focus of this inspection was to check upon the previous requirements we did not look at all aspects of the service and may not, therefore, have identified some of the positive areas regarding the home. During our previous inspection we saw that information is available to people who are considering moving into Southcrest. Although we did not look over this information during this visit is was nevertheless available within people`s bedrooms.People who were sat in the lounges appeared well attired and most comments about the home from people were favorable. There is open visiting and people were welcomed, so that people living at the home are able to maintain important friendships and relationships. Relatives who spoke to us were complimentary about the service offered. We saw some activities taking place in the lounge on the top floor. The home has managed to appoint a new activities coordinator following the resignation of the previous post holder. People are able to bring personal belongings into the home to make their bedroom more familiar to them and more homely. What the care home could do better: Care plans and risk assessments must be in place, be accessible and up to date. This is to ensure that clear guidance about how identified care needs are to be met in a consistent way is available. A review of the systems in place to ensure that wound care is managed has taken place however it remains unclear as to whether wound care is taking place in line with instructions given. There remains some concerns about the home`s ability to manage people`s nutritional needs. There remains significant concerns regarding the home`s ability to manage people`s medication. The shortfalls identified have the potential of placing people`s health and welfare at risk. Some aspects of infection control need to be improved to ensure that people are safeguarded against the risk of infection. Although some improvements have taken place to reduce the use of agency nurses further improvement is needed to ensure that competent staff are on duty at all times. We found some aspects of health and safety that do not sufficiently protect people. The use of bed rails needs to be constantly well managed. We also highlighted health and safety concerns in relation to the passenger lift and the hot water supply to a bath. Random inspection report Care homes for older people Name: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG one star adequate service 25/06/2010 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: Andrew Spearing-Brown Date: 0 9 0 9 2 0 1 0 Information about the care home Name of care home: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG 01527550720 01527550738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Sunila Samuel Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Kalpana Ananthram,Dr Sabarathnam Ananthram care home 40 Number of places (if applicable): Under 65 Over 65 40 0 old age, not falling within any other category physical disability Conditions of registration: 0 40 Age: Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 40 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 (OP) 40 Physical disability (PD) 40 Date of last inspection Care Homes for Older People 2 5 0 6 2 0 1 0 Page 2 of 16 Brief description of the care home Southcrest Nursing home is a forty-bedded care home providing general nursing care for older people. Accommodation is provided over three floors in both single and shared occupancy bedrooms. Some bedrooms have ensuite toilets and a wash hand basin. The home has a passenger lift so that people using the service can access all parts of the home. There is a variety of aids and equipment available to help people to move about more independently and ramped access to the rear of the building. There are a number of toilets and bathrooms available placed close to peoples bedrooms and the lounges on each floor. There is a small car park available for visitors and staff . The home is near to the town of Redditch and local shops are within walking distance. The home is on a bus route and also in walking distance of Redditch railway station. Copies of the most recent inspection reports are availble in the home for people to read if they wish. For up to date information regarding fees the reader should contact the service directly. Care Homes for Older People Page 3 of 16 What we found: This inspection was unannounced and took place over a period of two separate days. As the visit was unannounced nobody within the home knew we were going to visit. The purpose of this inspection was so that we, the commission could monitor the homes compliance regarding the requirements issued at the time of the last key inspection which took place during June 2010. The requirements within the previous report were in relation to the safety and well being of people living at the home. The manager designate, who was appointed during May 2010, was present during the majority of our visit. On the first day of this inspection we were informed that there were thirty two people living at the home plus one person who was in hospital at that time. While at the home we looked at a range of records such as care records, medication records and staffing records. Other records seen were in relation to the servicing of equipment and health and safety. We spoke to the manager designate, nurses on duty, care staff, some residents and some visitors. Choice of Home. We have previously seen information regarding the service entitled Statement of Purpose and Service Users Guide. We previously commented that the guide sets out what people can expect from the service. Having such information available may assist people in their decision making process regarding moving into the home. The manager designate is aware that some information is in need of amending to reflect the recent changes to the managerial arrangements within the home. We previously reported that the manager designate is aware of the importance of having sufficient details regarding peoples care needs prior to their admission. Recently the home has had a number of emergency admissions which are therefore less planned. The manager designate has informed us that she is keen to see a reduction in the number of such admission preferring people to enter the home on a planned basis. The home has recently admitted a person from the south of England. We were informed that due to the distance involved nobody from the home saw this individual prior to admission. We did nevertheless see information supplied by the local authority and the previous nursing home. This information was sufficient for the home to draw up an initial care plan. Despite having information available no care plan was written and no risk assessments were in place. The person concerned was seen to have a bed rail in place. We have previously had concerns about the insufficient risk assessments regarding the use of bed rails at Southcrest. The manager designate confirmed that these documents were not in place within the individuals file and none were in place upon the homes computer. Another resident, who already knew of the service, told us that the manager designate had spoken to her before she moved in to the home. During our inspection we were informed that the manager designate was planning to carry out further pre admission assessments on people who may potentially become a resident at Southcrest in the Care Homes for Older People Page 4 of 16 foreseeable future. Health and Personal Care. During our previous inspection we became concerned regarding some aspects of the care provided in relation to wound care, meeting nutritional needs and the use of bed rails and the risks involved. As a result we asked to view care plans in relation to some people concentrating in these areas. A care plan is a document designed to give staff guidance in order that they are able to carry out the required care in a consistent way meeting identified needs. The care plans are written on a computer. However, on the day of our second visit electronic versions were not available due to a software problem. As a result we were reliant on the home having paper versions available. As indicated earlier one person recently admitted into the home had no care plans and no risk assessments. We looked at the file of another person and found it to be empty other than an initial assessment. As the computer was not available we were unable to establish what, if any, care plans and risk assessments were in place. Since our previous inspection the manager designate has reviewed the documentation used regarding wound care. In addition we have also received assurance that dressings are no longer changed routinely during the night. We saw that more photographs of wounds were in place then previously although at times staff had recorded that the camera was not available. Furthermore we saw some photographs with no indication as to when they were taken or who they were of. However despite the improved available documentation it was not evident that nurses are changing the dressings or reviewing and assessing wounds as frequently as they are recording they need doing as there were gaps in the records and times when the assessment was not completed. We saw a record saying that a swab could not be taken to the surgery as no forms were available. No other record existed to demonstrate whether the swab was every taken. The care plans regarding pressure care did not contain up to date information regarding locations of wounds, the grade of the wound, the treatment required and the frequency of changing dressings. Risk assessments regarding pressure care and records regarding weight were not up to date. These findings have the potential of placing people at risk as it was not always evident that staff are taking due regard for peoples health and welfare. The documentation regarding another person was conflicting. We saw a letter to the GP requesting a supply of dressings stating that the wound was to be re dressed every two days. The treatment plan also indicated that the dressing needed changing at this frequecy however there were times when there were periods of up to eight days beween recorded changes. The care plan printer off the computer on the first day of this inspection because no paper version was held on file stated that the dressing needs to be changed twice a week. Another person had two care plans in place regarding pressure care. One said the person had a wound while the other said she did not. The nurse on duty assured us that no wounds existed at that time. We looked at another file and had concerns. The care plan did not cover areas such as the management of agitation. The initial assessment showed that the person concerned Care Homes for Older People Page 5 of 16 was receiving a certain type of food supplement. However, the care plan made reference to a different one. We asked staff whether the person was having these. We were told that he had run out and that it was reported to the nurse. Nobody seemed to know whether it had been decided to stop the use of supplements or whether he had simply not got any left. The care records showed that a urine test was needed, however no further record was in place to show whether this was done or what the outcome was. Many of the people residing at Southcrest have bed rails fitted to their bed. The vast majority had bumpers fitted correctly to prevent the risk of entrapment. We did however notice a couple of exceptions whereby this was not the case. We brought these to the attention of the manager designate. Within our previous report we highlighted some concerns in relation to the administration, storage and management of medication. As a result we issued requirements including one immediate requirement. We viewed the current months medication and had a number of concerns. Medication is stored in medication trolleys on each floor. We previously reported that medication needs to be maintained at or below 25 degrees Centigrade. We saw a thermometer close to one trolley showing the temperature to be at its maximum. No records are maintained to show this information or how the problems can be resolved. The vast majority of the MAR (Medication Administration Record) sheets were completed to show that staff had administered medication as prescribed. The MAR sheet of one person showed that the home had run out of a night sedative. We observed that staff had recorded to order new stock and awaiting new stock. The daily records stated on one occasion extremely restless and agitated throughout the night. Please follow up script for monthly med. The same person had also run out of a medication patch used for pain relief. The MAR sheet stated awaiting new stock still. It was of further concern to see that staff had not applied the patches in line with the instructions on the sheet. On other occasions the MAR sheet was signed to demonstrate that a patch was applied when the home did not have any in stock to apply. We saw another sheet whereby a nurse had signed for medication in the morning but each evening a nurse stated that they were out of stock. We audited the medication recorded on the previous months sheet. There was a gap of one day between the two sheets when staff had failed to sign for all medication. Staff are not signing or recoding elsewhere when they have applied creams. The MAR sheets did on occasions show some ticks but these can not be traced back to anybody in particular. The manager designate informed us that she has plans to introduce a new system for carers to sign once they had applied a treatment. On one persons MAR sheet it clearly stated that they were not to take another form of painkiller at the same time as another as they both contained the same drug. Despite this we saw that on two occasions this had happened. When people are on a variable dose nurses are generally not recording the actual dose given. We were unable to balance some boxed laxatives which indicated that nurses were not always taking the item from the correct box. Care Homes for Older People Page 6 of 16 On one persons MAR sheet nurses were continually signing on the wrong date for the medication given. On another sheet medication prescribed for every eight hours for one week was given twice a day for almost two weeks. The MAR sheet had some crossing outs upon it with no explanation. The majority of our concerns regarding medication were seen on the first day of this inspection. As the service was aware of our concern regarding the lack of compliance with the requirements and the risk of poor outcomes for people using the service it was of concern it see further examples on the second part of the visit. We found a MAR sheet where a nurse had failed to sign for some of that mornings medication. On another MAR sheet we saw gaps covering the time between the two visits. We saw an example when a nurse had signed the MAR sheet to say eye drops where administered but later over signed to say that the person had refused. This would indicate that the sheet was signed prior to the treatment. We copied documents under Code B of the Police and Criminal Evidence Act and informed the manager designate that the commission may consider enforcement action. Daily Life and Social Activities. Since the last inspection the service has appointed a new activities coordinator. During our visit we saw a small number of people in the top floor lounge engaged in some activities. Some paintings done by people living at the home were going to be displayed around the home. We did not see anybody actively involved in any day to day tasks within the home such as dusting or folding laundry. The home has open visiting and we saw a number of relatives and friends coming and going during our visit. People we spoke to were complementary about the service provided. Prior to this inspection we were informed that the manager designate was going to commence a surgery whereby people could make an appointment to see her and discuss any matters regarding the service provided. This has commenced however, nobody had taken up the offer of an appointment. We previously reported upon some concerns regarding the homes ability to ensure that peoples nutritional needs are met. We saw some improvement in the practices within the home during this visit. We did not see any meals left unattended in peoples bedrooms although not everything was kept within a heated trolley before serving. Some staff were seen to be sitting by or with people while assisting them to have their meal however other staff were not. Complaints and Protection. We have previously seen the homes complaints procedure. This was not seen on this occasion as the one on display had been taken down by the manager designate in order that she could amend it in line with the comment within our last report regarding our address. We have not received any complaints about the service provided at Southcrest. The Care Homes for Older People Page 7 of 16 complaints file did not contain any further complaints made directly to the home from when we last saw it. The manager designate is currently investigating a matter under safeguarding and is due to let the multi agency attendees at a recent strategy meeting know the outcome. The manager designate has previously reported back on her progress in relation to other matters primarily shortfalls reported upon within our previous report. Environment. There is a communal lounge on each of the three floors. In addition the ground floor has another room known as the quiet lounge. A corner of the quiet lounge is curtained off and used as an area for the storage of wheelchairs. Part of the lounge on the first floor is now used as a hairdressing facility and has some touches to it to make this a positive experience. We have commented within previous reports that there is not sufficient dining space for everybody to sit at a table if they so wish. During this visit we did not see anybody having their meal with a dining area. People ate meals either within their own bedroom or within one of the lounges using a small individual table. The vast majority of people living at Southcrest are frail and many reside within their own bedroom. There remains an absence of aids to assist people with a dementia type illness in their orientation around the home and therefore maintain their independence. We saw an amply supply throughout the home of personal protective equipment such as disposable gloves and aprons. Some staff were seen walking around the home wearing gloves. On a couple of occasions we saw the manager designate stop people and bring to their attention that they were risking a potential spread of any infection by doing this. Some areas of the home were not clean and tidy especially when we arrived early on a Monday morning. We saw that bins in communal areas as well as bedrooms were full and the dining room on the middle floor had food on the table cloth and on the floor. A non slip mat in a walk in shower was dirty and stained as was the shower tray. The manager designate removed the mat immediately and asked for the shower to be cleaned. Some carpets along the corridors are stained. The floor boards on the first floor near to the dining room are squeaky. Some paint work is in need of renewing as it appears damaged by equipment such as wheelchairs and portable hoists. Throughout this inspection cleaning materials were suitably locked away to prevent any unauthorised access. People residing at Southcrest are able to personalize their own bedrooms with items such as ornaments, photographs, furniture and television. We mentioned within our last report that wardrobes were not secured to the wall to prevent them from accidentally toppling over on to people. During this inspection we noticed that wardrobes were not secured and therefore the risk remained. At the end of this inspection we were told that a programme to secure wardrobes would commence. A passenger lift is provided therefore affording people access to all areas of the home. The rubber flooring on the lift was slightly raised presenting a potential trip hazard. The Care Homes for Older People Page 8 of 16 lift door does not have a full beam to prevent them closing onto people. It was evident that the signal beam in place was not functioning as the door did not stop and reopen when we tried to break the beam. Within our last report we mentioned the fact that bed linen was not ironed. During this inspection we made the same observation. Due to the linen that was not ironed some people appeared unkempt in their beds. One persons head was resting on mis shaped pillows, a quilt and a pressure relieving cushion. The person concerned appeared to be uncomfortable. A stained bed rail cover was removed once we brought it to the attention of the manager designate. Staffing. Within our previous report we stated that people were positive about the staff. During this inspection one person in particular was very positive. We also received positive comments from the family and the GP of somebody who had recently died. During our visit the home had seven care staff on duty during the morning shift and six in the afternoon. During the morning two carers work on the ground and top floor with three on the middle floor. In addition to care staff were other people such as cleaning staff, laundry staff, catering staff, an activities organiser and an administrator. It was evident that the home did not have any domestic staff working on the weekend before our visit on the Monday morning. A newly appointed clinical lead at the time of our inspection in June is no longer working at the home. The service has recently appointed a new clinical lead. This person was on duty during our first visit however this was still in her capacity of an agency nurse. We were informed that a new deputy manager was due to start the week after our visit. The service is currently relying heavily on agency nurses. We previously stated that we were told that the emergency call bell is sometimes switched off and therefore not answered. We had brought this to the attention of the service and work was due to take place in order that this overriding can not happen. During this inspection one person told us that he had to wait to be toileted. We informed the manager designate of this allegation who undertook to investigate. We did not look at training in any great depth as part of this inspection. We were however informed that the catering staff were undertaking a three day external training programme. As a result the home had agency staff preparing meals. The general manager was present in the home leading a session for a small number of staff on fire awareness. We were informed of some forthcoming training in dementia care, catheter care and tissue viability. Management and Administration. The previous registered manager left Southcrest shortly before our last key inspection in June 2010. As of date we have not had formal written notification that this person has left. The provider has appointed a new manager designate who needs to make an application to become the registered manager as soon as possible. Care Homes for Older People Page 9 of 16 The manager designate is aware that further improvements are needed in a range of areas such as care planning, risk management, wound management and medication. Throughout the inspection the manager designate took an interest in the process and took action where necessary when we noticed particular shortfalls. The service has a general manager who is a registered nurse working night shifts. During this visit this member of staff attended the home in order to carry out some fire awareness training with some care staff. We saw a file containing copies of notifications made to the commission regarding certain events that have occurred. We requested that the manager designate informed the local authority under safeguarding some of the medication errors that we became aware of. In addition to the local authority a notification of the events needed to be forwarded to the commission. Under Regulation 26 the registered provider or their representative is required to make a monthly visit to the home and prepare a written report following this visit. We saw a file containing these reports. The most recent visit was conducted during April 2010. The manager designate was not aware of any more recent reports which were in need of placing within the file. We are aware that a questionnaire was recently sent out to people in order for the designate manager to carry out a quality audit. We saw that some of these have been returned however, these have not as yet been collated to establish what people think of the service provided. We briefly viewed some records regarding health and safety aspects within the home. It was evident that the fire alarm is tested weekly and in sequential order. Visual checks are carried out in relation to bed rails. Records regarding the testing of hot water showed a small number of outlets whereby the temperature was too high. These were however of concern because they were in places where full body immersion could take place such as a bath. We checked the hot water temperature in one bathroom. It was found to be 65.5 degrees Centigrade which is well in excess of the guidelines from the Health and Safety Executive. The maintenance member of staff took immediate action to reduce the temperature however further safeguards need to be put into place if temperature readings are finding such high temperatures of water supply. We were informed that the work which was taking place during our last visit to comply with a letter from Hereford and Worcester Fire Service was completed. No documentary evidence that the alarm is now to the required standard was available. What the care home does well: As the focus of this inspection was to check upon the previous requirements we did not look at all aspects of the service and may not, therefore, have identified some of the positive areas regarding the home. During our previous inspection we saw that information is available to people who are considering moving into Southcrest. Although we did not look over this information during this visit is was nevertheless available within peoples bedrooms. Care Homes for Older People Page 10 of 16 People who were sat in the lounges appeared well attired and most comments about the home from people were favorable. There is open visiting and people were welcomed, so that people living at the home are able to maintain important friendships and relationships. Relatives who spoke to us were complimentary about the service offered. We saw some activities taking place in the lounge on the top floor. The home has managed to appoint a new activities coordinator following the resignation of the previous post holder. People are able to bring personal belongings into the home to make their bedroom more familiar to them and more homely. 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 11 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 (1) You must ensure that the 16/07/2009 use of bed rails is governed by a full written risk assessment. This is so that people are not at risk of harm or injury. 2 8 12 Regulation 12 (1) Systems to 06/08/2010 ensure that peoples wound care is appropriately and timely managed must be reviewed. This is to ensure that peoples health care needs are managed. 3 8 12 Regulation 12 (1). A system must be in place to ensure that bed rails and their bumpers are used correctly and safely. This is to ensure that people using the service are safeguarding against risk of injury. 25/06/2010 4 9 13 Regulation 13 (2). The 25/06/2010 service must ensure that people receive medication as prescribed and directed by the prescriber and accurate records must be maintained. Care Homes for Older People Page 12 of 16 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 This is so people can be confident that medication is managed safely and peoples health care needs are met. 5 9 13 (2) You must ensure that an 14/08/2009 accurate record is kept of all medication which is to given on an as required basis. This is so that people receive their medication as prescribed. 6 27 12 (1) You must ensure that the 14/08/2009 numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of people living at the home, taking into account the size, layout and purpose of the home, at all times. This is so that people can be confident that their needs will be met in a timely manner. Care Homes for Older People Page 13 of 16 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 12 Care plans and risk assessments must be in place, up to date and in sufficient detail so that staff have the instructions and guidance to meet each persons needs. This is to ensure that risks to individuals health and wellbeing are minimised. 30/09/2010 2 7 12 All care plans and risk assessments must be accessible to staff delivering the care. This will enable all staff to meet individuals needs at all times and ensure that peoples health and safety are promoted and met. 30/09/2010 Care Homes for Older People Page 14 of 16 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 Care Homes for Older People Page 15 of 16 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 16 of 16 - 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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