Care Home: Uplands Nursing Home

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What the care home does well The home has a system in place to manage new admissions. This includes where able a visit to the home by proposed new person and their family/representatives and an assessment of their needs. A safe system is in place for the management of controlled medication. The home has a robust recruitment procedure in place to make sure people are protected from possible risk of harm or abuse. We saw evidence that a system in now in place to supervise new staff whilst waiting for returned of their CRB and during their induction process. The home has also met a number of requirements that were either issued at the last inspection or remained outstanding, which is good. What the care home could do better: Pre admission assessments forms need to be dated as evidence they were completed prior to the new person moving into the home and the member of staff who undertakes the assessment needs to sign the form. It is not good practice for a new person to be in the home for eight days and not have any care plans, completed risk assessments and assessment of their needs. The homes AQAA states "once the resident is admitted care plans are drawn up, with a photograph and full history which is agreed with resident or relative." This clearly has not happened for this person. The AQAA also says that care plans have a monthly evaluation but for one person this has not taken place as there was a change in their care and they were not updated. We would expect to see care plans updated before the monthly evaluation when peoples` care needs change. The system the home has in place for the monitoring of peoples nutritional needs must be improved as staff are not always following the instructions in the peoples` care plans and not completing fluid and food record sheets. The system in place for the management of peoples` mouth care is not working properly therefore, this needs to be addressed to make sure people receive the appropriate care. The staff must make sure the pressure relieving equipment is set at the correct weight setting for the person otherwise this could cause them harm. More care is required with the administration of medication as it is unsafe practice to leave medication unattended with people who have dementia. Improvements are needed with the environment in relation to cleaning, not leaving cleaning equipment in corridors, the laundry door being left open when no staff are working in there and the appearance of bed linen and towels and flannels. Random inspection report Care homes for older people Name: Address: Uplands Nursing Home Church Road Maisemore Gloucester Glos GL2 8HB one star adequate 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: Sharon Hayward-Wright Date: 2 5 0 5 2 0 1 0 Information about the care home Name of care home: Address: Uplands Nursing Home Church Road Maisemore Gloucester Glos GL2 8HB 01452505629 01452307399 uplandsnursinghome@lineone.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Frances Haskins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Graham James Rigby care home 54 Number of places (if applicable): Under 65 Over 65 0 16 dementia old age, not falling within any other category Conditions of registration: 38 0 To accommodate an additional named service user under 55 years. When this service user reaches the age of 55 years or leaves the home, the condition will revert to the original category with the above condition. To accommodate three (3) service users under the age of 65 years but a minimum of 55 years in either category OP or DE(E) Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home The care home is an extended house within the village of Maisemore, near to the River Severn. It sits back directly off the main road and has car parking to the front and rear of the building. There is a small enclosed garden within the centre of the building, and a church and public house are nearby. The home is also on a main bus route from Gloucester City. A number of care needs for older people are catered for in this home; these include general personal and nursing care, and care of those with dementia within a designated unit. Current fees are from 469.15 pounds to 768.50 pounds per week. The Registered Providers have a system in place to manage the Funded Nursing Care Contribution FNC. People who fund their own placements have additional services included in the fees and these include toiletries, newspapers and chiropody. People who have their care funded by the local County Council are able to arrange, on an individual basis, different payment options for these additional services. Information about the home is available in the Service User Guide, which is issued to all prospective residents. The home does not display its previous inspection report, although does display a notice confirming it is available, and inviting people to request a copy to read if they wish. Care Homes for Older People Page 3 of 13 What we found: This unannounced inspection took place on one day in May 2010 by two inspectors. Prior to the visit to the home we sent them an Annual Quality Assurance Assessment (AQAA). This was returned to us on time and contained information about what the service feels they do well and any areas they are looking to improve on. The AQAA also contained numerical data called Dataset. We also sent to the service some questionnaires for people who use the service and staff. We received 6 from people who use the service and 5 from staff. Some of the results from these have been used in this report. At this inspection we focused on pre admission assessments of people recently admitted to the home, some peoples care plans, arrangements in place for the management of controlled medication, tour of the environment and recruitment records of recently appointed staff. We also followed up some of the requirements that were issued at or were outstanding since the last key inspection in July 2009. We examined the pre admission assessment of a person who was recently admitted to the home. The Registered Manager had completed an enquiry form and from the information we saw a visit had taken place. This form also contained brief information about this persons care needs and a list of their medication. A pre admission assessment took place at this persons normal residence but we are unclear as to when this happened as the form was not signed or dated by the member of staff who undertook the assessment. The way the assessment form is devised it asks for information about peoples physical needs and very limited details about any mental health needs. The Registered Manager had mentioned in their AQAA that they are looking to address this especially as the home is registered to care for people with dementia. This person also had a diagnosis of dementia and the information on the pre admission assessment form was mainly about their physical needs. We examined the care records of three people and one of these people had recently been admitted to the home. Since the last inspection the staff in the home have completed the transfer of all peoples care records onto their new system. The new person had been at the home for 8 days and we were disappointed to see that no assessment of needs other than the pre admission assessment was in place and only one care plan that was a provisional night time care plan. Not all risk assessments had been completed. We would have expected to see at least provisional care plans in place for the needs that were identified on the pre admission assessment. Without care plans, an assessment of their needs and risk assessments care staff do not have clear directions to follow on meeting this persons needs. On examining the care plans for one of the other two people they had not been reviewed since the beginning of April 2010 and from our own observations and from speaking to the deputy manager they were not up to date as this person is no longer on total bed rest as they were sat downstairs in one of the lounges. From discussions with the Registered Manager the third person is receiving palliative care from external health care professionals and we saw evidence of this in their care records. We did not see a specific care plan in place for this or for end of life care. The Registered Manager said she feels this person is not at the stage of requiring end of life care and she is obtaining more information about how to implement and use end of life care plans effectively. Care Homes for Older People Page 4 of 13 We looked at the system the home has in place for monitoring people who are assessed as being nutritionally at risk. We saw records of peoples weights and the use of a nutritional risk assessment tool. We also saw records that a dietitian had visited one person. However we found that staff are not always following the directions that are recorded in the care plan for example, weekly weighing of people. We also found that staff are not always completing the fluid and food record sheets. This must be addressed to make sure people are being appropriately monitored. We checked the settings of one persons pressure relieving mattress and found that it was set too high for their weight. This correct information about the setting for this person was written on a label on top of the motor. This needs to be monitored as this could cause people further damage to their skin. One requirement we followed up related to the home demonstrating that people are receiving mouth care. We randomly selected two peoples rooms and checked their personal care chart which said they had received mouth care. However the mouth care equipment was dry in both peoples rooms. One person had their dentures soaking in a container but the water did not look very fresh. We fed this back to the Registered Manager. In the questionnaires we sent to the home for people, we asked them do you receive the care and support you need?, 3 people said always and 3 people said usually. We examined the arrangements the home has in place for the management of controlled medication. A safe storage facility is provided. The qualified nurses have recently transferred all controlled medication records into a new register. We checked the records and controlled medication with the deputy manager and all were correct. Records were seen of twice daily checks on these. On arriving at the home we went into one of the communal lounges and we noticed a number of people were having their breakfast. When we were speaking to one person sat at the back of the lounge we noticed that a tablet was left on their saucer. No members of staff were in the lounge at this time and we were concerned about why this tablet was there. We also observed several people wandering around this room and they could have taken this tablet. We reported this to the Registered Manager who dealt with it immediately. However this is unsafe practice as it places people at risk. We require the Registered Manager to investigate why this tablet was left on this persons saucer and notify us under Regulation 37. We toured parts of the environment and viewed some peoples bedrooms. We found that the standard of cleanliness was not to a good standard in all places around the home. We found that carpets in some of the communal areas were heavily stained and cobwebs were visible in windows in some communal areas and some peoples rooms. We found one window where faeces had been smeared and this was removed once we told the deputy manager, however the rest of this window really needed to be cleaned but the domestic only removed the faeces. We found that bins in toilets and peoples rooms did not have lids on them. Curtains in some peoples rooms were not hung properly and bed linen, towels and flannels were looking very worn. The appearance of some of the bed linen could be improved as the duvet covers and sheets are not ironed and they look very untidy and do not create a good impression. We fed this back to both the Registered Manager and Provider. The Registered Manager said she is looking at the cleaning Care Homes for Older People Page 5 of 13 schedules and hours and is in the process of reviewing this. The Registered Provider said that new bed linen and towels are available. We were also concerned to see during the tour that the domestic staff are leaving cleaning equipment in corridors for example, vacuum cleaners, black bin liners and dusters. A number of people wander and one person is blind so this is unsafe for them. The laundry door is also left open when the assistant is not in there and people then have access to washing powder and a door at the back of the laundry that leads outside as this was also left open. We asked people in the questionnaires we sent them, is the home fresh and clean? 2 people said always and 4 people said usually. We examined the recruitment records of two new members of staff. All the required pre employment checks were in place . The home was able to demonstrate that new staff are appointed a mentor and were supervised whilst waiting for return of their Criminal Records Bureau Disclosures (CRB) and during their induction process. In the questionnaires we sent to people who use the service we asked them, what does the home do well? and some examples of the comments we received; The staff are cheerful and caring and they talk to us in a friendly way, They look after me well, The staff are caring, helpful and cheerful and The home appears to run quite smoothly. We also asked what could the home do better? and we received the following comments; I have to have a soft diet and I am a diabetic and sometimes the meals are not always liquidised down enough and sometimes the meals are very salty. I quite often get given a yoghurt for dessert lunchtime and evening which I get fed up with, Laundry and Cleanliness of my room at the weekend. We asked staff in the questionnaires we sent them, what does the home do well? and we received the following comments; Provide a safe environment for the residents to live and all residents get the care they need/require, Welcomes relatives and friends of residents as staff are always approachable and we have regular on-site training which is much appreciated and well attended and Provides good basic care. We also asked what could the home do better? and we received the following comments; More staff are needed for nights because 3 carers look after 44 people, Improve staff to resident ratios, improve food choices and quality of food and praise its staff when things go well and Provide more staff or time for activities with residents. What the care home does well: The home has a system in place to manage new admissions. This includes where able a visit to the home by proposed new person and their family/representatives and an assessment of their needs. A safe system is in place for the management of controlled medication. The home has a robust recruitment procedure in place to make sure people are protected from possible risk of harm or abuse. We saw evidence that a system in now in place to supervise new staff whilst waiting for returned of their CRB and during their induction process. The home has also met a number of requirements that were either issued at the last inspection or remained outstanding, which is good. Care Homes for Older People Page 6 of 13 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 13 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 8 15 The registered person must 15/08/2009 make sure that detailed care plans are in place for the management of wound care that includes ongoing evaluations. This will help to monitor peoples health needs and determine if the wound is improving or not. This requirement remains outstanding since the last key inspection. This was not followed up at this random inspection. 2 8 12(1) The registered person must 15/08/2009 make sure that any pressure relieving equipment is used safely and that staff have the knowledge and skills on how to use them correctly. This will help to make sure people are not placed at unnecessary risk. This requirement remains outstanding since the last two inspections. 3 8 12(1a) The registered person must 15/08/2009 Page 8 of 13 Care Homes for Older People 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 demonstrate that people are receiving mouth care based on their individual needs. This will help to make sure that people health and welfare are being monitored and that people are receiving mouth care. This requirement remains outstanding since the last inspection. 4 9 13(2) The registered person must 31/08/2009 ensure that for any medication labelled for use when required, as directed or with a variable dose, there is always clear written direction for staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. Repeated from previous inspections when timescale for action was 15/03/09 and 31/08/09. 5 9 13(2) The registered person must ensure that when any medication (including 31/08/2009 Care Homes for Older People Page 9 of 13 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 prescribed treatments for external use) is administered or applied to people who live in the home it is always clearly and accurately recorded. (This particularly relates to the shortfalls in records seen at the inspection and included in the text of the report). This is to help to make sure people receive their prescribed medication correctly and to help reduce risks of mistakes. Repeated from previous inspections when timescale for action was 28/02/09 and 31/08/09. 6 36 18(2a) The registered person must 01/10/2009 ensure that a structured staff supervision programme is implemented, so that staff can receive clear direction and support in their work, and so that their performance can be monitored for the benefit of the residents. This requirement has been partly met since the last inspection. This was not followed up at this inspection. 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 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 15 The Registered Persons must 30/06/2010 make sure that all people have care plans in place for their assessed needs. All care plans must be kept under review and updated to reflect a change in the persons needs. This will help to make sure that clear directions on how staff are to meet peoples needs are available and kept up to date. 2 9 37 The Registered Persons must 30/06/2010 investigate why medication was left unsupervised on one persons saucer. A copy of this investigation must be sent to as required under this Regulation. To identify why this incident happened and to put actions in place to prevent it from happening again. Care Homes for Older People Page 11 of 13 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 3 Pre admission assessments should be dated and signed by the member of staff that undertook the assessment. Care Homes for Older People Page 12 of 13 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. 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