Care Home: The Elms Nursing Home

What the care home does well The service users are provided with a homely and well maintained environment that meets their needs. The meals at the home looked well presented and balanced and the service users said met with their needs. Interaction observed showed that the staff and the service users had developed and maintained good relationship with each other. There is an ongoing refurbishment programme for the service. There is a training programme in place to support the staff. What the care home could do better: The care plans and risk assessments should be further developed to ensure that all care needs are identified and action plan put in place to meet them. The medication management need to be reviewed to ensure that these are managed safely at all times. The recording of food and fluids were not adequate to demonstrate that people were receiving their diet as required. The recruitment process was inadequate and poses risk to the safety of people using the service.All substances that are hazardous to health must be maintained safely at all times. Inspecting for better lives Thematic inspection report Care homes for older people Name: Address: The Elms Nursing Home Swains Road Bembridge Isle of Wight PO35 5XS 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a thematic inspection of this care home. A thematic inspection is a short, focussed inspection. 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: User doesnt belongs to any group Date: 2 4 1 1 2 0 0 8 Information about the care home Name of care home: Address: The Elms Nursing Home Swains Road Bembridge Isle of Wight PO35 5XS 01983872248 01983875206 info@sciohealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Scio Healthcare Ltd care home 48 Number of places (if applicable): Under 65 Over 65 0 48 0 dementia old age, not falling within any other category physical disability Conditions of registration: 48 0 48 The registered person may provide the following category/ies of service only: Care home only - (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 Physical disabilities, service users who are over 65 years of age but do not fall within the category of old age - PD(E) Dementia, service users who are over 65 years of age but do not fall within the category of old age DE(E). The maximum number of service users to be accommodated is 48. The home may accommodate one named service user in the category learning disability. Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home The Elms Nursing home is a registered care home providing both residential and nursing care and accommodation to up to forty-eight people. The home is also registered for eight intermediate care beds, for which separate facilities are available. The home is located near the centre of the town of Bembridge with local bus stops and shops reasonably nearby. The home occupies an extended older property in its own grounds with car parking available to the front and side of the property. There have been several extensions to the original home. All bedrooms are single en-suite facilities of at least a wash basin and WC. Various communal facilities including three lounges, two dining rooms and a conservatory are provided. Care Homes for Older People Page 3 of 13 What we found: An unannounced visit was carried out on the 2Oth November 2008 as part of our monitoring process of the service. We looked at the care records of two service users who had been recently admitted to the service to look at the assessment process that the home had in place. One of these people had been admitted for intermediate care. We found that there was a detailed record in place as part of the hospital transfer information. A record of the medication received on admission was maintained. The staff we spoke to stated that they used this information to set out the plan of care for the person. Another service users record showed that an assessment was carried out as the person was admitted in February 2008, however this was not dated and it was unclear whether this assessment was carried out prior to their admission. The assessments in the care records seen included moving and handling and skin integrity. The home has a dedicated area where intermediate care is provided with the support of the Primary Care Trust team. We looked at four care plans for people accommodated at the service. We found that following assessments a care plan had been formulated to demonstrate how peoples assessed care needs would be met. Care plans had been developed and details of care needs were available except for people receiving respite care where there was no care plan for one of the service users records that we looked at. This was brought to the attention of the nurse who reported that as these people are receiving intermediate care this was not available. We found that people receiving intermediate care had detailed daily records and referrals made to external health care teams as appropriate. The three care plans that we looked at for the long term service users showed that assessments such as moving and handling were completed and details of equipment used were recorded. Other assessments included included skin integrity and Waterlow score as appropriate. One record showed that a swallowing assessment had been completed and details of diet such as pureed diet was recorded in order to inform practice. Further development in care plans and assessments as discussed was required as we found that a service user who had fallen did not have falls assessment or moving and handling assessment completed. Other areas included dietary needs, swallowing assessments and continence assessments were inadequate,as these were not fully completed as required. We found that only part of the assessments had been completed. There was evidence of some reviews of care plans and assessments, however these were not consistent. Further development would ensure that these are completed and Care Homes for Older People Page 4 of 13 reviewed at regular intervals ensuring that the information in care plans are current to inform practice. Areas lacking included weight monitoring and reviews. We found that wound care records did not contain adequate information about wound condition and evidence of regular reviews in order to inform practice. These should include size of wound and detailed plan for wound care and management should be in place. We observed that one of the service users had choked on their meal on the day of the visit. Staff were available and took action to help this person and remained with them until they had recovered. We looked at the care records for this service user and this did not contain a nutritional risk assessment and records indicated that this person was at risk due to their diagnosis. Staff must ensure that assessments are completed and swallowing assessments and referrals are available as required, to protect the service users. We looked at the two records of food and fluids intake for two of the service users at the time of the visit. One was adequately completed with records of fluids and food intake. The other persons fluid chart records were inadequate to demonstrate how their dietary needs were being monitored. We found that there were gaps in the recording of fluids and food that showed that they had not received any sustenance for between five to ten hours during the day. We looked at the medication management at the service for the service users who were admitted for intermediate care. We found that the home recorded and maintained a list of medication that was brought in on admission. A sample of the Medication Administration Record (MAR) sheets seen indicated that satisfactory records of medication administered was available. The staff reported that they administered the service users medication on admission and following an assessment they supported that service users to self- administer their medication. We spoke to two of the service users about them taking control of their medications and both saw this as a positive step in preparation for their discharge. This was carried out within a risk assessment framework as required and recorded in their care plans. The staff discussed that that on discharge from hospital the service users are provided with a prescription and bring with them medicines dispensed to them from hospital. We checked the list of medication received and found that there were some medication that did not arrive with the service user on discharge. There was no record to show that any action was taken by staff to ensure that the person did not require these medications. A procedure should be put in place to ensure that the service users receive their medication as prescribed on transfer. Any changes from the prescription should be accurately recorded to inform practice. We looked at the storage of medication for people who were self-medicating. A locking facility was available in the service users bedrooms to keep their medications. One of them had locked their medication as required, the other service users medication was found unlocked. The unlocked drawer contained a large number of medicines that posed a risk to other people living at the home. This was brought to the attention of the person in charge and an immediate requirement was made for action to be taken in order to ensure the safety of the Care Homes for Older People Page 5 of 13 service users. The provider has written to us to let us know of the action that they have taken. We also found when we walked around the home, that creams and ointments were in some bedrooms and bathrooms, as these were not labelled as required and could be used as communal and pose infection control risks to people. This was brought to the attention of the person in charge at the time of the visit and must be rectified. A bottle of aperient was found in a communal area , the staff reported that this person had been discharged. The registered person must ensure that staff follow procedures for the safe handling and disposal of medication at all times for the safety of people living at the service. Information that we have received showed that a service user had not received their prescribed pain killer on two occasions and the home had referred this to the safeguardig team for investigation. During the visit the registered person gave us a list and discussed the service looking at introducing pharmacy bulk ordering for certain medication and wound dressing in conjunction with the local Primary Care Trust (PCT) . As discussed clear procedures will need to be put in place, in conjunction with the external agency such as PCT and Pharmacist to ensure that these are managed safely and do not put people at risk. Other consideration should include prescribing rights, records that need to be kept and staff training. We observed the lunchtime meal and this indicated that the service users were provided with a balanced, well presented meal that they said met with their needs. The service users stated that choices were available to them and staff helped them choose from the menu. The staff were available to offer support with meals as required. We looked at the complaint procedure and records of complaint as maintained in the complaint log for the service. This showed that details of concerns are recorded and records of investigation and outcomes are maintained. The three service users we spoke to were satisfied with their care and said that they would talk to the staff if they were unhappy. There has been a number of concerns and allegations that had been either sent to us or to social services as safeguarding. Some of these had been investigated as part of safeguarding and resolved while there are others that are ongoing and being investigated at the time of the visit. The provider had kept us informed and reported some of these allegations to us and others had been referred directly to social services. As discussed records of all allegations of abuse, their outcome and any action that the home is required to take must be clearly recorded to enable a clear audit trail. We were told that the home was taking steps to record these as required. We walked around the service as part of the visit and looked at the communal bathrooms, lounges, dining room and some of the service users bedrooms. The home looked clean and homely and the service users bedrooms were personalised. Comments from the five people we spoke to were that they liked their rooms and Care Homes for Older People Page 6 of 13 spent as much time in their bedrooms as they preferred. The rooms were personalised and it was evident that people are supported to bring with them items of personal belonging on admission. We looked at the staff roster as part of this visit to see the staffing arrangement that the home had in place to meet the needs of people accommodated. The nurse in charge reported that the service plans to have three registered nurses and eleven carers on the day shifts and one trained nurse and four carers until ten when the number was reduced to three carers overnight. We have received concerns regarding the lack of staffing at the service that allegedly the lack of staffing puts the service users at risk. This has been investigated as safeguarding and is ongoing. We noticed that during the morning a random check of call bells showed that these took up to five minutes to be responded to. Two service users we spoke to said that sometimes it takes a long time to get help and stated that the staff are very busy. A sample of the duty roster we looked at indicated that the home was relying on agency to support the staff. The roster showed that the home did not have the full compliment of staff on a number of occasions according to the record we looked at. This was discussed with the registered person who stated that they had difficulty at times to get agency staff. The duty roster showed that the home was falling well below the eleven carers that the staff said would be required. We noted that the record on the duty roster did not have clear information of the agency staff who had been working at the service. The roster showed the time of the shifts were recorded such as 2-8, however this did not show who was working those shifts. The registered person must ensure that the home maintains a roster of persons working at the care home, and a record of whether the roster was actually worked. Concerns had been raised in particular in relation to trained cover on night duty where there is only one trained staff. We discussed with the nurse in charge and evidence from the duty roster showed that there is one trained nurse and three carers on night duty. The registered person must ensure that there is adequately trained staff and in sufficient numbers to meet the assessed needs of the service users at all times. The home has a training manager who discussed that there is an ongoing training programme in place to support staff in maintaining their skills and this included an induction programme for new staff. Staff we spoke to confirmed that they had regular training and one of them said that they were undertaking the dementia update at the time of the visit. We looked at the induction process that the home had in place for all new staff. The records of three recently recruited staff was looked at as part of this visit. We found that people completed an application form and record of interview was maintained. We found that one of the carers did not have any evidence of proof of identification, only one reference was available and no Criminal Record Bureau (CRB) check had been received prior to her employment. Care Homes for Older People Page 7 of 13 The other two staff records contained application forms and two references and POVA first checks. The records seen did not contain CRB clearance and there was no evidence that these staff were supervised as part of their practice while awaiting for their CRB clearance. This was brought to the attention of the registered person who must ensure that all necessary staff checks must be completed prior to employment. The lack of a robust recruitment process puts the service users at risk of harm and poor practice. The service does not currently have a registered manager since the last registered manager left in July 08. The registered person reported that a senior person had been responsible for the management of the service and a managers appointment has been made. Confirmation of this was requested to be sent to us in writing at the time of the visit. The manager will be required to submit an application to be registered with the commission as part of the fit person process. We noted that medications and substances that are hazardous to health were not maintained safely at the time of the visit. We issued the registered person with immediate requirements and he has responded to to tell us of the action that he has taken to ensure that people are safeguarded from the risk of harm. What the care home does well: What they could do better: The care plans and risk assessments should be further developed to ensure that all care needs are identified and action plan put in place to meet them. The medication management need to be reviewed to ensure that these are managed safely at all times. The recording of food and fluids were not adequate to demonstrate that people were receiving their diet as required. The recruitment process was inadequate and poses risk to the safety of people using the service. Care Homes for Older People Page 8 of 13 All substances that are hazardous to health must be maintained safely at all times. 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 9 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a thematic inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 13 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 1 9 13 The registered person must 17/12/2008 ensure that arrangements are in place for the safe mangement of medication at all times. So that people are not put at risk of harm and all medications are stored safely. 2 38 13 The registered person must 17/12/2008 ensure that unnecessary risks to the health and safety of the service users are identified and as far as possible eliminated. So that the service are not put at risk of harm from hazardous substances atht are stored safely. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 15 The registered person must 15/01/2009 ensure that risk assessments and care plans are developed to ensure that all assessed needs are appropriately met. So that you can ensure that the peoples care needs are met safely. Care Homes for Older People Page 11 of 13 2 8 14 The registered person must ensure that detailed assessments and care plans relating to nutrional needs are maintained. So that they receive their diet and fluids safely and records are mantained 15/01/2009 3 27 18 The registered person must 15/01/2009 ensure that at all times there are adequately trained staff and in sufficient numbers to meet the needs of the service users. So that you can ensure that service users receive the care as appropriate and safely. 4 29 9 The registered person must ensure that all necessary checks are completed prior to staff employment at the service. So that you can ensure that the service users are not put at risk. 15/01/2009 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 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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