Care Home: Stamford Nursing Centre

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What the care home does well We issued ten requirements at the last inspection, including two immediate requirements. Equipment used for lifting residents such as hoists were much cleaner on inspection. However we did note that paint on some hoists had become worn. This may make proper infection control more difficult. We spoke with the manager about this and suggested hoists should be checked and replaced as necessary. The home has now carried out an audit on all residents who can not communicate and developed a pain monitoring tool. This should ensure that residents who cannot communicate are given effective pain relief as required. We noted that some staff did not fully understand the pain assessment tool. We have issued a new requirement that all staff must be trained in the use of such procedures.The two immediate requirements have been complied with. Of the remaining eight requirements issued at the last inspection, four requirements have been met and four requirements have been partially met. The regional manager explained the process for pre admission assessments for potential residents to the home. This included the need to provide any equipment and support before the person was admitted to the home. The support manager assured us that no person would be admitted to the home without first having all the equipment and support they have been assessed as needing. The regional manager told us that the organisation was developing a protocol to ensure that all staff have access to tissue viability support and information. The regional manager is currently negotiating outside tissue viability support with the local PCT. A quality assurance manager within BUPA is a tissue viability nurse and provides support and expert advice to staff. This should ensure that nurses have up to date and appropriate advice about the treatment and prevention of pressure ulcers. The service has appointed a cleaning services supervisor in the home. Cleaning schedules have also been developed and are in place in the home. The supervisor is visible in the home and conducts random checks on a daily basis, addressing issues as they arise. Formal monthly cleaning audits are also undertaken. The service has also carried out an audit of pressure relieving mattresses and developed a regular cleaning programme. They have reviewed the position of the home maintenance person and have now reallocated a post holder to cover two care homes. His responsibilities include overseeing the Legionella flushing programme within the care home. As a result the home was much cleaner. Sluice rooms have all been cleaned and were much less cluttered. There is still a problem with the clinical waste bins which were not fitted with a suitable lid, causing an unpleasant odour. This issue will need to be addressed and a new requirement has been issued. On the day of the inspection the redecoration and refurbishment of the home was underway. As this affects the whole home some disruption and inconvenience for residents is expected however the management have plans in place to keep the disruption to a minimum and the end result should be a more comfortable and pleasant environment for all residents and staff. As part of this refurbishment the regional manager confirmed that hand washing facilities for staff would be upgraded and in line with infection control guidelines. The new maintenance person was interviewed and had a good understanding of policies and practices in relation to the control of Legionella. We saw a suitable and appropriate flushing regime for unused water outlets. What the care home could do better: The organisation has started an audit of care records throughout the home. We saw some improvements in relation to record keeping. Although the records we examined wereneatly filed they were not always in chronological order which could make reviewing records difficult. We noted that one resident was assessed as being at risk from developing pressure ulcers and as a result a four hourly turning regime had been developed. There were gaps in the recording of four hourly turning which indicated the person was not being turned as often as needed. The staff informed us that this was a recording error and that the person was regularly turned. Without clear, written records there was no evidence that this was taking place. Records in relation to the treatment of pressure ulcers were not always accurate. Clinical notes in relation to a specific pressure ulcer treatment were sometimes being recorded in a different part of the care plan. Monthly pressure care monitoring was not always being recorded in the appropriate part of the care plan. Both these issues could make monitoring of any improvements to the resident`s condition more difficult. The requirement relating to record keeping has been restated. A new requirement has also been issued in relation to gaps in clinical recording. We were informed that staff have started training in relation to pressure care and record keeping. The regional manager and the support manager have been developing a supervision audit for all staff. Group supervision for staff is now taking place and the management told us that individual supervision is being planned. This is not yet in place and the previous requirement about supervision is restated. The management is also developing observed competency assessments for nursing staff to ensure that clinical procedures are being carried out appropriately and that staff are communicating effectively with residents while nursing treatments are being undertaken. As this has not started as yet the two requirements relating to observed competencies have been restated. The management and staff at the home have been working very hard to improve the service and this was evidenced in several areas mentioned in this report. It was clear from discussion with the regional manager and support manager that they understand the further improvements needed and are working towards improving this service for the people who use it. Random inspection report Care homes for older people Name: Address: Stamford Nursing Centre 21 Watermill Lane Edmonton London N18 1SU 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: David Hastings Date: 0 9 0 9 2 0 1 0 Information about the care home Name of care home: Address: Stamford Nursing Centre 21 Watermill Lane Edmonton London N18 1SU 02088074111 02088079479 moriarth@bupa.com www.bupacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 90 Number of places (if applicable): Under 65 Over 65 0 43 0 dementia old age, not falling within any other category physical disability Conditions of registration: 33 0 14 The maximum number of service users who can be accommodated is: 90 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: Dementia Code DE (of the following age range: 50 years and over) (maximum number of places: 33) Old age, not falling within any other category - Code OP (of the following age range: 65 years and over) (maximum number of places: 43) Physical disablity - Code PD (maximum number of places: 14) Date of last inspection Care Homes for Older People 1 3 0 1 2 0 1 0 Page 2 of 11 Brief description of the care home Stamford Nursing Centre is a care home registered to provide nursing care for older adults and a specified number of younger adults with physical disabilities. The home was previously owned by ANS Homes Limited. BUPA purchased the home in October 2005. BUPA is a national organisation and owns other care homes across the country. The home aims to provide a high quality of nursing care to adults convalescing after surgery or illness, older people who require nursing care, adults aged over fifty with physical disabilities and those requiring palliative care. The home is a large modern purpose built three storey building. The kitchen, laundry, reception and administrative offices are all located on the ground floor. The bedrooms are located on all three floors. All bedrooms have en-suite facilities. Floors are connected by stairways and a passenger lift. Each floor has a lounge and separate dining room. There are two additional smaller lounges. Fourteen younger adults are accommodated in a separate wing on the first floor. The home is located close to the North Middlesex Hospital and along the North Circular Road. It is within walking distance of shops; restaurants and transport facilities located the High Street in Edmonton. The fees charged by the home range from Seven hundred and thirty five pounds to Nine hundred and twenty nine pounds per week. The provider must make information about the service available (including reports) to service users and other stakeholders. Care Homes for Older People Page 3 of 11 What we found: The Care Quality Commission carried out this unannounced inspection of Stamford Nursing Centre on Thursday 9th September 2010. The reason for this inspection was to check compliance with the requirements we made at our last visit on 3rd August 2010. The service has been subject to a number of safeguarding issues relating to the treatment and care of residents who have pressure ulcers. We wanted to make sure that residents with pressure ulcers were being appropriately treated and supported. We spoke with the regional manager of BUPA who is now currently based at this home. As a result of the most recent safeguarding issue five nursing staff and the manager of the home were suspended pending an internal investigation. We were informed that these investigations were still ongoing. A home support manager from another home is currently managing the service and we were informed that the home is recruiting new nursing staff The organisation is working closely with the local safeguarding team and has developed an action plan detailing how improvements to the service will be made within given timescales. We spoke with a number of residents who either have pressure ulcers or have been assessed as being at risk of developing pressure ulcers. These residents told us they were satisfied with the care and treatment they receive at the home and described the staff as kind and caring. We also spoke with a relative of a resident who was also positive about the staff at the home. Interactions we observed between staff and residents were supportive and friendly. We also spoke with nursing and care staff and examined care records in relation to pressure care treatment and prevention. What the care home does well: We issued ten requirements at the last inspection, including two immediate requirements. Equipment used for lifting residents such as hoists were much cleaner on inspection. However we did note that paint on some hoists had become worn. This may make proper infection control more difficult. We spoke with the manager about this and suggested hoists should be checked and replaced as necessary. The home has now carried out an audit on all residents who can not communicate and developed a pain monitoring tool. This should ensure that residents who cannot communicate are given effective pain relief as required. We noted that some staff did not fully understand the pain assessment tool. We have issued a new requirement that all staff must be trained in the use of such procedures. Care Homes for Older People Page 4 of 11 The two immediate requirements have been complied with. Of the remaining eight requirements issued at the last inspection, four requirements have been met and four requirements have been partially met. The regional manager explained the process for pre admission assessments for potential residents to the home. This included the need to provide any equipment and support before the person was admitted to the home. The support manager assured us that no person would be admitted to the home without first having all the equipment and support they have been assessed as needing. The regional manager told us that the organisation was developing a protocol to ensure that all staff have access to tissue viability support and information. The regional manager is currently negotiating outside tissue viability support with the local PCT. A quality assurance manager within BUPA is a tissue viability nurse and provides support and expert advice to staff. This should ensure that nurses have up to date and appropriate advice about the treatment and prevention of pressure ulcers. The service has appointed a cleaning services supervisor in the home. Cleaning schedules have also been developed and are in place in the home. The supervisor is visible in the home and conducts random checks on a daily basis, addressing issues as they arise. Formal monthly cleaning audits are also undertaken. The service has also carried out an audit of pressure relieving mattresses and developed a regular cleaning programme. They have reviewed the position of the home maintenance person and have now reallocated a post holder to cover two care homes. His responsibilities include overseeing the Legionella flushing programme within the care home. As a result the home was much cleaner. Sluice rooms have all been cleaned and were much less cluttered. There is still a problem with the clinical waste bins which were not fitted with a suitable lid, causing an unpleasant odour. This issue will need to be addressed and a new requirement has been issued. On the day of the inspection the redecoration and refurbishment of the home was underway. As this affects the whole home some disruption and inconvenience for residents is expected however the management have plans in place to keep the disruption to a minimum and the end result should be a more comfortable and pleasant environment for all residents and staff. As part of this refurbishment the regional manager confirmed that hand washing facilities for staff would be upgraded and in line with infection control guidelines. The new maintenance person was interviewed and had a good understanding of policies and practices in relation to the control of Legionella. We saw a suitable and appropriate flushing regime for unused water outlets. What they could do better: The organisation has started an audit of care records throughout the home. We saw some improvements in relation to record keeping. Although the records we examined were Care Homes for Older People Page 5 of 11 neatly filed they were not always in chronological order which could make reviewing records difficult. We noted that one resident was assessed as being at risk from developing pressure ulcers and as a result a four hourly turning regime had been developed. There were gaps in the recording of four hourly turning which indicated the person was not being turned as often as needed. The staff informed us that this was a recording error and that the person was regularly turned. Without clear, written records there was no evidence that this was taking place. Records in relation to the treatment of pressure ulcers were not always accurate. Clinical notes in relation to a specific pressure ulcer treatment were sometimes being recorded in a different part of the care plan. Monthly pressure care monitoring was not always being recorded in the appropriate part of the care plan. Both these issues could make monitoring of any improvements to the residents condition more difficult. The requirement relating to record keeping has been restated. A new requirement has also been issued in relation to gaps in clinical recording. We were informed that staff have started training in relation to pressure care and record keeping. The regional manager and the support manager have been developing a supervision audit for all staff. Group supervision for staff is now taking place and the management told us that individual supervision is being planned. This is not yet in place and the previous requirement about supervision is restated. The management is also developing observed competency assessments for nursing staff to ensure that clinical procedures are being carried out appropriately and that staff are communicating effectively with residents while nursing treatments are being undertaken. As this has not started as yet the two requirements relating to observed competencies have been restated. The management and staff at the home have been working very hard to improve the service and this was evidenced in several areas mentioned in this report. It was clear from discussion with the regional manager and support manager that they understand the further improvements needed and are working towards improving this service for the people who use it. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 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 17 Regulation 17 (1) The 30/09/2010 registered person shall - (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. This means that records relating to the treatment of pressure sores or related issues must be stored in a manner that benefits both staff and service users. This is to ensure that records are being maintained in such a way as to inform staff of the progress or otherwise of an individuals treatment plan. 2 8 12 Regulation 12 (4) The 30/09/2010 registered person shall make suitable arrangements to ensure that the care home is conducted - (a) in a manner which respects the privacy and dignity of service users. This means that staff must communicate with service users when they are providing clinical treatments. This should ensure that service users are aware of Care Homes for Older People Page 7 of 11 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 what is going on when they receive treatment from nursing staff. 3 36 18 Regulation 18 (1) The 30/09/2010 registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users (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 service users. This means that observed competency assessments must be carried out for all nurses who provide pressure care treatment for service users at the home. This is to ensure that there is evidence that nursing staff have understood any pressure care training and are carry out this treatment safely and appropriately. 4 36 18 Regulation 18 (2) The 30/09/2010 registered person shall ensure that persons working at the care home are appropriately supervised. This should ensure that all staff working at the home understand their roles and responsibilities at the home. Care Homes for Older People Page 8 of 11 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 17 The registered person shall 30/09/2010 (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. This means that there must be no gaps in clinical records for service users at the home. This should ensure that there is accurate and up to date recording of clinical procedures for each service user. 2 8 12 12.(1) The registered person 30/09/2010 shall ensure that the care home is conducted so as (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. This relates to all nursing staff being properly trained in the use of pain control procedures Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This should ensure that effective systems are in place so that service users are provided with effective pain control whilst clinical treatments are being carried out. 3 26 13 13(3) The registered person 30/09/2010 shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This means that the management of clinical waste must be reviewed. This should ensure that clinical waste is properly stored and managed. 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 10 of 11 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. 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