Care Home: The Village Nursing Home

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What the care home does well We found that the management of the home was structured and organised, while waiting for a named manager to be appointed. The areas in the action plan had been addressed, and the management was further developing systems to make the care provision moreeffective. The care planning system provided staff with the information they needed to meet residents` needs, and staff had a good understanding of those needs. The health needs of residents were being met with multi-disciplinary working taking place as required. Staff were being enabled to develop with training and support, and good communication systems were in place. What the care home could do better: A manager could be appointed and registered with the Care Quality Commission to lead and develop the home. The home could ensure that the resident, or their next of kin, participates in the development of their care plan, and evidences this with a signature of agreement. The information gathered from the pre-admission assessment could always be clearly recorded and made available for staff to refer to about how the resident needs to be looked after. Staff could ensure that each person`s capacity to make decisions has been assessed, and then continually reviewed. In order to avoid any transcription errors, handwritten entries on the MAR could be signed, witnessed and countersigned. Staff could have information about how and when to apply medicines such as creams or lotions in the care plans of individuals, and records of external medicines could be clearer. Menus could continue to be addressed and develop, in liaison with residents and relatives, in order to always provide varied choices linked to individual likes and dislikes. Kitchen staff could be more involved with residents to help gather information and suggestions. All staff could try to identify those residents who needed more 1:1 stimulation and support outside of the planned activities, and help provide it. The home`s complaints procedure could have the points of contacts` addresses amended so it is clear who people can discuss issues with. Random inspection report Care homes for older people Name: Address: The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET two star good service 09/10/2008 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: Jennifer Hughes Date: 2 0 0 1 2 0 1 0 Information about the care home Name of care home: Address: The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET 01704220061 Telephone number: Fax number: Email address: Provider web address: village.manager@craegmoor.co.uk www.craegmoor.co.uk Name of registered provider(s): Name of registered manager (if applicable) Parkcare Homes (No.2) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: 0 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 - Code OP. The maximum number of service users who can be accommodated is: 40. Date of last inspection Brief description of the care home The Village is a forty-bedded, purpose built, care home, set in its own well-maintained grounds. It is located in the village of Banks and there are sufficient amenities of shops, a Church and public house nearby. Transport links to nearby towns of Southport Care Homes for Older People Page 2 of 11 0 4 0 8 2 0 0 9 Brief description of the care home and Liverpool can be accessed. There is ample car parking space alongside the home. The home provides personal and nursing care for older people, and is well equipped to suit the needs of its residents. All accommodation is at ground floor level, and there is easy access for wheelchair users and the less mobile. All rooms have an en-suite facility and there are two shared rooms. Communal space for service users comprises a lounge, dining area and two small seating areas along the corridors. The home has a patio area to the front and garden and patio to the rear. Qualified nursing staff and care staff are provided over 24 hours, every day of the year. Residents receive information about the home in the form of the Statement of Purpose and the Service Users Guide. A small brochure is also given out to anyone making enquiries. As at October 2008 the fees charged ranged from £366.00 per week, to £550.00 per week, depending on the level of care needed. Further details about fees can be obtained from the manager. Care Homes for Older People Page 3 of 11 What we found: We carried out this visit to monitor the progress of the action the home had put in place to address shortfalls previously identified. The shortfalls had been in care planning, staffing levels and abilities, medication administration and the management of the home. Our last Random inspection on 4th August 2009 had shown that the home had an action plan in place, which was being followed, and we noted improvements had been made against the shortfall areas. At this visit, we case-tracked a sample of residents records, viewed the staff rota and medication records, viewed meals and activity records and plans, and spoke to the person managing the home, nursing and care staff on duty, and some residents. We saw that a comprehensive pre-admission assessment form was available to use. This had not been completed on one file we viewed. The senior care staff were able to provide detailed information about the residents care, with plans for future care provision, and any emotional impact on the resident. This information gathered about people at the time of admission should always be recorded and reflected within the plans of care, to show that all the needs of people living at the home are being consistently communicated, enabling them to be met by staff. We advised of the need to ensure all files held information regarding any need to assess the persons capacity to make decisions, with the outcome if required. The plans of care we viewed were well written, person centred documents. They provided staff with clear guidance about how people should be supported to meet their individual social, personal and nursing care needs. Records showed that the privacy, dignity and independence of people were importance aspects of the care provided, and that individual choices and preferences of those living at the home were taken into consideration during the care planning process. Any changes in peoples needs were reflected well within the plan of care, although these had not consistently been reviewed every month as recommended. There was also no evidence available to show that the person living at the home or their relative, had been given the opportunity to be involved in the care planning process. We were told by staff that they spoke to family and friends to gather more information about needs and background history of the resident, and this involvement needs to be recorded. A variety of external professionals had been involved in the care of people living at the home, so that their health care needs were being appropriately met, including care provided for the prevention and treatment of pressure wounds. We saw that daily notes written by staff were clear and detailed, giving a good picture of the life and care of the residents in the home. Residents were generally positive. Staff help me when I need it. They help me to walk., Staff do what they can. There was a mix up when I first came here, but its settled down now, and I know whats happening. I would be the first to say if I wasnt happy, and Its all ticking over nicely were some comments. Care Homes for Older People Page 4 of 11 We saw staff performing care tasks while respecting the privacy and dignity of residents. Staff knocked on doors allowing residents time to respond, they ensured doors were closed when performing personal care tasks, they sat and chatted with residents in their rooms, and tactfully helped people to eat their meals in their own rooms. We viewed medication procedures in the home. Nursing staff administer medication to residents needing nursing support in the day, plus non-nursing residents during the night and senior care staff administer medication to non-nursing residents in the day. Care staff involved in administering medication have attended appropriate training, and were able to discuss processes along with plans to improve them. We found that medications were generally well managed, with detailed audits in place to ensure that a satisfactory standard was being maintained. However, the handwritten entries for one person whose care we tracked had not been signed, witnessed and countersigned in order to avoid any transcription errors. The Medication Administration Records (MAR) showed that the recording of creams and lotions could have been better, and this had been identified through the homes recent internal audit. Therefore strategies were being discussed within the home so that this procedure could be improved. One plan of care made reference to the application of a lotion, but clear instructions were not provided for staff about when and where the lotion needed to be applied to ensure that this person received the treatment required. We viewed the planned menus, which the managment and the cook told us were under further development. The food provided seems well cooked, but we saw that the menus could try to offer a more varied choice for people, for example one days suggested choice was hotpot or meat and potato pie. The management confirmed that this need has been recognised, and they are planning to liaise with the cook and the residents to develop this. The cook is able to refer to a record of residents satisfaction with meals, although this was not up to date, and we advised more personal interaction between the cook and the residents may be useful in gathering information about likes and dislikes and suggestions. Comments from residents about meals were varied, from The meals are good, to The meals are just OK We saw that the meal time was peaceful and unrushed, with people being quietly assisted when necessary. Some residents chose to eat in their rooms. An Activities Coordinator plans activities in the home. He told us that these may be in large or small groups, or individually. A standard weekly programme may include table top games, music, gentle exercise, a reminiscence afternoon, and a magical mystery tour every Friday afternoon for those who are able to or want to go. We saw that some residents had televisions and radios on in their own rooms, and some in the lounge.The Activities Coordinator told us that he tries to have some contact with all of the residents, and how even a short chat can be some stimulation. We noted that several residents appeared to not be interested in any activities, and we discussed the need to have a central overview of participation in activities in order to identify who may need other forms of support and stimulation, or to monitor behaviour, and he was able to show his plans to start recording this. Care Homes for Older People Page 5 of 11 We walked around the home and saw that it was clean with no odours, and some of the corridors were being decorated. Nurse alarms were available for residents and those we randomly tested were operating. There was clear access to the fire escapes. Aids such as hoists were stored safely away from lounge areas. Automatic door closures had been fitted on all of the bedroom doors. Bedrooms we saw were nicely decorated and personalised. We viewed the staff rota. At the time of the visit there were 25 residents living at the home. The number of staff available for nursing residents varied between two and four depending on the time of day, with two staff available for non-nursing residents in the day, and 3 staff in total overnight.The manager told us that minimal agency staff were now used in the home, and if needed it would usually be the same person, which helped with consistency and continuity. The management informed us that they constantly monitor care needs against staff numbers. Some staff felt that as several nursing residents needed two staff to assist, there were not always enough staff available. The management confirmed that nonnursing staff would be directed to assist in these cases. The management need to continue to ensure staffing numbers are calculated against residents care needs and tasks, alongside numbers of residents. We advised that the designation of staff should be also noted on the rotas, to make it clear what level of staff are on duty. There was no registered manager in place at the time of this visit, and the organisation had appropriate plans in place for the home to be managed until a named manager was appointed. Staff we spoke to all felt that communication systems in the home had improved greatly and worked well. They all knew how to access information through the care plans, and verbal information through communication books. They all felt systems were in place for managerial support during the absence of a manager, and all were aware of who to approach should they have any concerns at all. The one thing staff felt could be improved was for there to be a stable management structure. They felt more pressure was on the nurses due to having no named manager in post. Two monthly 1:1 supervisions for staff have been booked through the year, and we will view the outcomes from these at our next visit. The management told us that there was continual support and informal 1:1s for staff, with an open-door policy for staff and residents alike. We advised that the complaints procedure for the home should be amended to show the contact details for the local authority in case of an unsatisfactory outcome from the home, along with the updated contact details for the Care Quality Commission for people to contact if they wish. We saw that there had been meetings for residents and relatives, with another relatives meeting to be held in mid-February 2010, for up to date two-way communication. What the care home does well: We found that the management of the home was structured and organised, while waiting for a named manager to be appointed. The areas in the action plan had been addressed, and the management was further developing systems to make the care provision more Care Homes for Older People Page 6 of 11 effective. The care planning system provided staff with the information they needed to meet residents needs, and staff had a good understanding of those needs. The health needs of residents were being met with multi-disciplinary working taking place as required. Staff were being enabled to develop with training and support, and good communication systems were in place. 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 7 of 11 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 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 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 2 3 3 Staff should ensure that each persons capacity to make decisions has been assessed. Information from the pre-admission assessment should be recorded and available for staff to refer to, so as they know how the person needs to be looked after. The home should evidence that the resident or their family has participated in the development of the care plan, with a signature of agreement. Any handwritten entries on the MAR should be signed, witnessed and countersigned in order to avoid any transcription errors. External medicines such as creams and lotions need to be recorded better and more information about how they should be used should be written into peoples care plans to help make sure they are handled correctly. Further development of menus should continue, so as to ensure a varied diet, suited to individual assessment and choice, is available. 3 7 4 9 5 9 6 15 Care Homes for Older People Page 9 of 11 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 7 31 An individual should be appointed to manage the home and lead it to meet its purpose, aims and objectives. 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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