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Coundon Manor Care Home Good

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Inspection report

Date of Inspection: 9 September 2014
Date of Publication: 25 October 2014
Inspection Report published 25 October 2014 PDF

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Meeting this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 9 September 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, were accompanied by a pharmacist and talked with commissioners of services.

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.

Our judgement

There were enough qualified, skilled and experienced staff to meet people’s needs.

Reasons for our judgement

At our last visit we were concerned that the provider did not have a method for determining the number of staff needed to meet the dependency needs of people. During this inspection, the provider had just issued the home with a new ‘staff dependency tool’ to calculate the number of staff there should be on shift based on the levels of dependency people had been assessed as having. The manager used the tool and confirmed the staffing levels were above those required by the tool.

At our last visit we were concerned people were not receiving a continuity of care because the home used a high number of agency staff and bank staff. During this visit we saw the staff rota which showed there had been a significant decrease in the use of agency and bank staff. The rota also clearly showed the names of, and how many qualified nurses were on duty each shift, as well as the names of the care assistants who provided care each shift. At our last visit this was not the case.

We arrived early in the morning at 6.45am to observe the support staff gave people as they woke up and got ready for the day and to speak with night staff. This was because we had received concerns about the night time staffing levels. One inspector observed the support given on the ground floor and one inspector observed the support given on the first floor. Both inspectors spoke with staff on each floor.

Staff on both floors told us there were not enough staff to meet people’s needs during the night. On the ground floor, staff told us it was difficult to predict whether staff numbers would be sufficient because it very much depended on the varying behaviours of some people. They told us some people ‘walked’ during the night, but not every night. When they were walking, people needed to be observed to ensure they remained safe and that other people were kept safe. This meant it reduced the time available to provide personal care.

On the ground floor we observed staff were busy during the morning but the atmosphere was calm and staff were working well to meet people’s needs at that time of day.

The first floor was more hectic. Staff did not have sufficient time to undertake all the care tasks required. For example, we heard some alarms ring in excess of 10 minutes. One member of staff told us, ”We haven’t got enough staff to dress people, we are told we have enough staff, we haven’t… Overnight there was me and two carers to look after 28 people…we have 17 people who are doubles (require two people to support them).” Another member of staff told us, “When there is enough staff, then everything goes well. If understaffed, it all gets behind…we are trying to get personal care done before breakfast but it’s difficult sometimes.”

We spoke with the manager and deputy manager about the concerns raised by staff. They informed us there should have been another person on duty that night but they had phoned to say they were sick. They told us there were problems with staff sickness particularly at night and this could impact on the care provided. They said they were addressing this issue. They also told us they were in the process of changing the culture so that staff did not feel they had to get everyone out of bed and ready for breakfast before they finished their night shift. They told us they wanted to ensure people got up at the time that suited them. Both the manager and deputy manager told us they felt there was sufficient staff on the rota to meet people’s needs.

Because the service was one member of staff down, it was difficult for us to determine whether there were sufficient staff on duty during the night. We were concerned about what staff had told us, and what some of the relatives of people living at the home told us. The provider agreed to meet with night staff and to schedule a series of visits at night time over the next six weeks to monitor staffing levels. It was agreed the provider would inform us of the outcome of these meetings and night time visi