We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inglewood Nursing Home Deal Road, Redcar, TS10 2RG Date of Inspection: 15 November 2012 Date of Publication: December 2012 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Safety and suitability of premises Requirements relating to workers Complaints Inspection Report Inglewood Nursing Home December

2 Details about this location Registered Provider Registered Managers Overview of the service Type of service Regulated activities Bupa Care Homes (GL) Limited Mrs. Susan Ashton Mrs. Lesley Smith Inglewood Nursing Home is a purpose built service that provides nursing care for up to 49 older people with dementia. Care home service with nursing Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Inglewood Nursing Home December

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 7 Safety and suitability of premises 8 Requirements relating to workers 9 Complaints 10 About CQC Inspections 11 How we define our judgements 12 Glossary of terms we use in this report 14 Contact us 16 Inspection Report Inglewood Nursing Home December

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, reviewed information sent to us by other organisations, carried out a visit on 15 November 2012 and observed how people were being cared for. We checked how people were cared for at each stage of their treatment and care, talked with people who use the service, talked with carers and / or family members and talked with staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. What people told us and what we found The home is dedicated to the care of people who had dementia care needs and most people had marked problems with their memory. They found it difficult to think about recent events or at times to have a conversation. We used a specific way of observing care, which involved spending a substantial part of the visit observing groups of people in the various lounges to see how they occupied their time; appeared to feel; and how staff engaged with them. During the visit, we spoke with eight people who used the service and three relatives. From our observations and discussions with people, we found that care staff worked in ways that supported the people and treated individuals with humanity as well as empathy. People told us that they like the home and staff. Relatives were extremely complimentary about the service. People said, "I have absolutely no complaints this is an excellent home", "The care is good and this is always consistent irrespective of when I visit", "There are always plenty of staff who I find are very helpful" and "I must say they treat people with humanity." People also discussed how they found the manager and staff were very approachable and although none had needed to raise a complaint they found their views were regularly sought. We were told by the staff that people who used the service and relatives views were sought about all aspects of the running of the home and this was done via residents meetings and surveys. You can see our judgements on the front page of this report. Inspection Report Inglewood Nursing Home December

5 More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Inglewood Nursing Home December

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Their views and experiences were taken into account when decisions were made about the way the care was provided and delivered. Reasons for our judgement Throughout the inspection, we observed staff treated people with respect and dignity. They supported people in a friendly, engaging manner. We found that staff were very courteous towards all the people who used the service and visitors. Staff were seen to treat people with respect, compassion and dignity at all times. People told us that they were fully involved in making decisions about their care. Relatives said, "The staff are great and always keep me up to speed with what is happening" and "I'm fully involved in discussions and my views are very much taken into account." One person told us that they were in the process of becoming the appointed deputy for their relative so they could make the care and welfare decisions on their behalf. We spoke with five staff who worked at the home and the clinical lead. These staff knew a great deal about the people who lived there and were able to tell us about likes and dislikes, preferences and information about individual's lives. The activity co-ordinator told us that people were involved in making decisions about how the home was run and people who used the service discussed how they were consulted. We reviewed eight care records (18% of the files) and consistently found evidence that people had contributed their views to the development of their care plans and goals. We found that care plans were in place, which showed when people needed support to make decisions. However these plans did not always include information about what decisions the person was able to make. The home provides palliative care and staff told us that they had completed accredited programmes for delivering this care. They discussed how this training made them understand the importance of ensuring people remained in control of their care. We saw the portfolio staff had put together to achieve the Gold Standard Framework for end of life care. We found that the focus of this work was on maintaining people's choice, ensuring care was delivered in a respectful manner and upholding dignity in care. We also found that there were dignity champions working at the home who cascaded information about best practice in this area to the staff. Inspection Report Inglewood Nursing Home December

7 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement We observed how staff worked with the people who used the service and we found that they consistently ensured that all their care needs were met. We saw that the various staff understood how to work with people; addressed personal care issues in a sensitive manner; and were attentive to people's needs. People told us that they liked the home and staff were kind. They said, "I have absolutely no complaints it is an excellent home", "The care is good and this is always consistent irrespective of when I visit", "There are always plenty of staff who I find are very helpful" and "I must say they treat people with humanity." We spoke with six of the care staff on duty including the clinical lead. They were very confident that as people's needs changed they could rapidly involve the right healthcare professional in reviewing the care being provided. These staff could confidently outline people's care needs. We reviewed eight care records and found these provided a wide range of information about how people's care needs were to be met. From discussions with the staff, the people who used the service and relatives, we found that the team were supporting individuals to meet their care needs. We found that as people's needs changed, staff had ensured they remained skilled to meet people's physical care needs and understood the best approach to use when working with people. Staff had a good understanding of how to work well with people who had dementia care needs and the triggers that may lead people to display challenging behaviour. However the provider might wish to note that one of the care records had not been updated since 2008 and referred to an out of date model of practice for working with people who have dementia. We discussed models of practice with the clinical lead who outlined how staff adopted current evidenced based practice. From our observations we found that staff were using life history work and supportive approaches when working with people rather than reality orientation as mentioned in the care plan. From our observations we found that staff used their knowledge of people to develop a good rapport with all of the people who used the service and a lot of friendly banter went on throughout our visit. We found that the new manager actively supported people to obtain the care they wanted and acted as an advocate for both people and their relatives. She discussed with us how she was working to support one person's return home and the actions she was taking to ensure this happened in a timely manner. People who used the service understood the day-to-day care and treatment choices available to them. Inspection Report Inglewood Nursing Home December

8 Safety and suitability of premises People should be cared for in safe and accessible surroundings that support their health and welfare Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement During the visit we spent time looking around all the home and found that, on the whole, all areas were in good decorative order. We saw that all of the units were clean and well maintained. In a couple of areas we noted that there was an odour but saw that the domestic staff were in the process of deep cleaning these parts of the building. The clinical lead discussed plans that were in place to complete a refurbishment of the home and expected this to commence in the New Year. She told us that they had noted that some of the carpets retained an odour so the plan included the replacement of these. We saw that there was both indoor and outdoor space available for people to use and throughout the inspection we observed people moving around the units, where possible, choosing the areas they wanted to be in. The new maintenance person showed us the maintenance records, which we found addressed day-to-day issues and annual service certificates. We saw that regular maintenance and safety checks were made, these included, fire alarm system, water checks, manual handling equipment, water temperatures and call bell system. We found these were comprehensive, however noted that there was no evidence that the passenger lift had been checked during The clinical lead told us that she believed this had occurred during November The new maintenance person told us that when taking over the role he had found that the files needed to be organised and was in the process of sorting this out. He checked and confirmed with the provider that the passenger lift test had been completed. The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. Inspection Report Inglewood Nursing Home December

9 Requirements relating to workers People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. People were cared for, or supported by, suitably qualified, skilled and experienced staff. Reasons for our judgement We looked at the recruitment files of six members of staff who had been employed at the home. We found that each of the files had a curriculum vitae or an application form on record. Action had been taken either prior to accepting the application or at interview to explore any gaps in the employment history and only those people with complete histories moved past the interview stage. The provider had obtained references from a previous employer and a second referee prior to appointing a staff member. However the provider might wish to note that one person's referee was the clinical lead as opposed to the manager of the home they had worked in. Although both their references were good there was no note on the file to say whether the manager had been approached to confirm dates of employment and that the person conducted themselves appropriately whilst at that home. We found evidence in all files checked that enhanced Criminal Records Bureau (CRB) and Independent Safeguarding Authority checks had been carried out prior to employment. This showed that the provider had carried out appropriate pre-employment checks to ensure the suitability of staff. We found that the provider had explored whether staff were physically and mentally fit to work within the home, during the recruitment process. We also found that the provider had checked evidence of qualifications and training undertaken prior to appointment. The provider had appropriate processes in place to ensure that staff were fit and able to perform their role. People's health and welfare needs were being met by staff that were appropriately qualified. Inspection Report Inglewood Nursing Home December

10 Complaints People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Reasons for our judgement We looked at the process for dealing with complaints, spoke with three staff and the clinical lead about this and looked at the complaints received by the service within the last 12 months. There was information on display about how people could make complaints. The staff discussed how they worked with people to seek their views and involved families to ensure people were content with the service. The activities coordinator discussed the various ways staff assisted people to share their likes and dislikes. She confirmed that views that people shared in these discussions were taken forward and action was taken, when necessary, to make improvements to the service. The clinical lead showed us the company complaints procedure, which we found was in line with our expectations. We saw that there was a process in place to deal with complaints which included responding within a specified timescale. We reviewed all of the information relating to a recent complaint and found that comprehensive investigations were completed. The outcome of all of the complaint investigations were shared with the person who raised concerns in a timely fashion and they then had the opportunity to appeal. We found that the investigations were impartial and if omissions in practice were noted action was taken to reduce the potential of this occurring again. The relatives we spoke with during our visit told us that they felt able to raise "any niggle and concern" and this was dealt with to their satisfaction. We found that people who used the service, relatives and staff were asked for their views about their care and these were acted on. People were given support by the provider to make a comment or complaint where they needed assistance. Inspection Report Inglewood Nursing Home December

11 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of dentists and other services at least once every two years. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times but we always inspect at least one standard from each of the five key areas every year. We may check fewer key areas in the case of dentists and some other services. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Inglewood Nursing Home December

12 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Inglewood Nursing Home December

13 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. We make a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation) from the breach. This could be a minor, moderate or major impact. Minor impact people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Inglewood Nursing Home December

14 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Inglewood Nursing Home December

15 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Inglewood Nursing Home December

16 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Inglewood Nursing Home December