CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Addison Court Nursing Home Addison Street Accrington Lancashire BB5 6AG Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 8th March 2006 10:00 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Addison Court Nursing Home Address Addison Street Accrington Lancashire BB5 6AG 01254 233821 01254 393628 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Speciality Care (Rest Homes) Limited Care Home 50 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (25), Physical disability (25) Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. A maximum of 25 service users requiring nursing care who fall into the category of either OP or PD A maximum of 25 service users requiring personal care who fall into the category of OP A maximum of 25 service users requiring nursing care who fall into either the category of DE(E) or MD(E) A maximum of 10 service users requiring personal care who fall into the category of either DE(E) or MD(E) Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 16 August 2000 Total number of service users within the categories not to exceed 50 (fifty) 12th October 2005 Date of last inspection Brief Description of the Service: Addison Court is a purpose built home situated in a small cul-de-sac in a mainly residential area. It is close to a number of shops and a church. The centre of Accrington is approximately 10 minutes walk away. The home has a small garden, which is accessible to residents who wish to sit outside when the weather permits. There is adequate parking for staff and visitors. Addison Court offers 24 hour nursing and personal care for up to 50 residents. This includes the Baxenden unit, which offers care for up to 25 residents who suffer from mental health problems or dementia. Accommodation is provided in single en-suite rooms. A passenger lift facilitates access to all areas of the home. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours by two inspectors. Three additional visits have been made since the last unannounced inspection. At the time of this inspection 49 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
To ensure the needs of the resident can be met it is essential that a member of staff from the home complete a pre-admission assessment for all residents prior to admission. The resident must also be informed in writing that their needs can be met at the home. Care planning must be improved to ensure that all the needs of each resident are identified and fully met. A falls risk assessment, which clearly identifies the level of risk, must be completed for each resident. If a resident has been identified as being at risk of falling or developing pressure sores a care plan
Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 6 must be in place to address this risk. Records relating to wound care must be up to date. All care plans and risk assessments must be reviewed monthly and up dated when the needs of the resident change. Residents accommodated on the Baxenden unit who want to smoke should be taken to a designated smoking area in the home. In order to promote safety and prevent medication error all hand written instructions on the medication administration records should be signed and witnessed. The menu displayed should accurately reflect the meals offered and be printed in a larger font size to enable residents to read it more easily. This will enable residents to make informed menu choices. The whistle blowing policy should be amended to explain clearly the protection available for the whistle blower. This should give members of staff the confidence to report poor practice. The environment on the top floor of the home was unpleasant and requires urgent improvement. The carpets in the dining room and kitchenette were dirty and must be cleaned or replaced. The drawer and cupboards in the kitchenette must be kept clean and the drawer handle repaired. The lounge continues to be dimly lit and lighting must be improved sufficiently to enable residents to read if they wish. Appropriate and sufficient bathing and shower facilities must be provided on this floor. Requirements made to address these problems at previous inspections have not been met. The exposed wires seen near the floor outside one of the bedrooms on the top floor must be covered. The boxes of incontinence pads stored in the bathroom on the middle floor could be hazardous for residents and should be removed. Staff absence and sickness is an ongoing problem. This must be addressed to ensure there is always a sufficient number of staff on duty to provide effective care for the residents. The manager was advised to explore and obtain a satisfactory explanation of any gaps in employment history for new employees prior to appointment. This will ensure that residents are protected by thorough recruitment procedures. Records of the food provided for individual residents must be kept in order to determine that all residents are receiving a nutritious, well balanced diet. To prevent food related infection the fridge in the top floor kitchenette must be defrosted regularly and kept clean. All items of food and drink stored in this fridge must be covered and dated. The microwave oven and storage jars must also be kept clean. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Older People) 2 (Adults 18-65) A pre-admission assessment was not completed for each resident prior to admission. Residents did not receive confirmation in writing that their needs could be met at the home. EVIDENCE: The care records of seven residents were inspected. The records for one of these residents did not contain any evidence that a pre-admission assessment had been carried out by a member of staff from the home. There was no evidence to suggest that the resident had received written confirmation that their care needs could be met at the home. The pre-admission assessments provided useful information for the care plan. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 (Older People) 9,19 and 20 (Adults 18-65) Care plans did not contain detailed information relating to all aspects of healthcare. This meant there was the potential for some healthcare needs not to be fully met. Medication was administered correctly promoting good health. EVIDENCE: The individual care plans of seven residents were inspected. These plans did not identify and address all the care needs of each resident. Information about the care needed for a resident with a recently diagnosed healthcare problem was not included in the care plan. The care plan for a resident on the Baxenden unit did not include details of dementia care. A falls risk assessment
Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 10 was not in place for one resident. Falls risk assessments did not clearly identify the level of risk. One resident had been identified as having a high risk of developing pressure sores but a care plan was not in place to address this problem. One care plan stated the resident needed a therapeutic bath but the nurse on duty was unable to explain what this meant. Care plans relating to personal hygiene, wearing stockings and spiritual needs were generic and did not specify the needs of individual residents. The wound care chart for one resident wasn’t up to date. There were no records relating to the care and condition of a wound for another resident. The care plan for a resident who smoked stated that she should be taken to the smoking room. However, there is not a designated smoking area on the Baxenden unit and the resident was taken to the staff office or the staff room to have a cigarette. This arrangement is inappropriate. The care plan for one resident had not been reviewed since the previous admission for respite care in 2004. A written report about the care given to individual residents was completed during each shift. Records of the visits of other healthcare professionals e.g. GP, chiropodist, etc. were included in the care plans. Records relating to the management of medication were seen. However, hand written instructions on the medication administration records should be signed and witnessed. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 (Older People) 7 and 17 (Adults 18-65) The daily routine was flexible to meet the needs of the residents. Meals were wholesome and varied. EVIDENCE: Residents were encouraged to make decisions about their lifestyle and daily routine. One resident said, “I sat up and watched the match last night.” Another resident explained how when she asked for horlicks at night she was told there wasn’t any and given tea. The meal served at lunchtime on the day of the inspection looked wholesome and appetising. However, the menu displayed was written in small print and inaccurate. Members of staff were observed assisting residents in a patient
Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 12 and sensitive manner. Lunch was unhurried allowing residents time to chat and enjoy their meal. Although several residents consulted said the meals were good three residents were not entirely happy with them. One resident said, “The food’s average.” Another resident said, “There’s no variety.” Fresh fruit was available and one resident said she had been offered some. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 (Older People) 23 (Adults 18-65) A detailed ‘whistle blowing’ policy and procedure was not available. EVIDENCE: A ‘whistle blowing’ procedure was displayed in the home. This procedure needed amending to clearly explain how the ‘whistle blower’ would be protected. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26. (Older People) 24, 27, and 30 (Adults 18-65) The general unit was clean and well maintained providing a pleasant environment for the residents. Areas of the top floor were dirty, the lounge was dimly lit and all bathing facilities were out of order. Laundry facilities were appropriate for the size of the home. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 15 EVIDENCE: The general unit on the ground floor of the home was clean, tidy and free from offensive odour. However, the top floor dining room carpet was badly stained and the carpet in the kitchenette was filthy. The walls in these rooms were stained with tea and food splashes. The drawer handle was missing and the drawer and cupboards in the kitchenette were dirty. Two lamps had been placed in the top floor lounge to supplement the lighting. This provided minimal improvement because the two main lights on the ceiling didn’t work. In addition to this there was condensation between the doubleglazing on the windows. Exposed wires were seen near the floor outside one of the bedrooms on the top floor. All facilities on the top floor for residents to have a bath or a shower remain out of order. The bathroom has been unusable for sometime and the shower is broken. To improve the environment on the middle floor of the home the corridor had been painted and additional lighting installed. However, the bathroom on this floor was being used to store a substantial quantity of incontinence pads. All areas of the home were warm. Several radiators had been replaced or repaired. Laundry facilities were appropriate for the size of the home. However, the hand soap dispenser was empty. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 (Older People) 33 and 34 (Adults 18-65) Staffing levels were not always sufficient to meet the needs of the residents. Recruitment procedures were thorough. EVIDENCE: Examination of the duty rota confirmed that high staff absence levels meant the home was frequently understaffed. Absence levels were highest at the weekends. Some members of staff did not contact the home in advance to inform the manager they were not fit for duty. The files of five members of staff appointed since the last inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents had been completed. However, the application form for one of these employees did not provide any information about employment after 2004. The manager was advised to explore and record the reasons for any gaps in employment identified on the application form. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 37 and 38 (Older People) 37,40 and 42 The manager was an experienced nurse. Detailed records of the food provided for individual residents were not kept. The standard of food hygiene on the top floor was poor. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 18 EVIDENCE: The manager is an experienced nurse and is working towards NVQ level 4 in management. She maintains an up to date knowledge of current practice by reading appropriate information on the Internet. The manager was advised to complete and return the application forms for registration with the commission as soon as possible. Records maintained by the cook did not include a daily record of the food provided for individual residents. The fridge in the top floor kitchenette was dirty and needed defrosting. Items of food and drink stored in the fridge were uncovered and undated. The microwave oven was also dirty and smelt. Storage jars were dirty on the outside and the inside. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 1 22 X 23 X 24 X 25 2 26 X STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 X 34 X 35 X 36 X 37 2 38 2 Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. OP3 14(1)(a)(b)(c)(d) The registered person shall 08/03/06 not provide accommodation to a service user unless, so far as it shall have been practicable to do so (a) the needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user; (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Timescale of 13/01/06 not met 2. OP7 13(4)(b)(c) The registered person shall 28/04/06 ensure that- (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks;
Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 21 3. OP7 15(1) 4. OP7 15(2)(b) 5. OP8 17(1)(a) and (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. All residents must have a falls risk assessment, which clearly identifies the level of risk. Timescale of 01/01/06 and 03/02/06 met. Unless it is impracticable to 28/04/06 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Care plans must accurately address all identified needs including prevention of pressure sores and falls, hygiene, wearing stockings and spiritual needs. Timescales of 02/12/05, 01/01/06 and 03/02/06 not met. The registered person shall 28/04/06 - (b) keep the service user’s plan under review. All care plans and risk assessments must be reviewed monthly. Timescale of 1/7/05, 2/12/05 01/01/06 and 03/02/06 not met. The registered person shall- 08/03/06 (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the
DS0000022489.V287419.R01.S.doc Version 5.1 Page 22 Addison Court Nursing Home 6. OP14 12(3) 7. OP19 23(2)(d)(p) 8. OP19 23(2)(d)(p) service user. (k) a record of any nursing provided to the service user, including a record of his condition and any treatment or surgical intervention. Records relating to wound care must be kept up to date. The registered person shall, 31/03/06 for the purpose of providing care to service users, and making proper provision for their health and welfare, so as practicable ascertain and take into account their wishes and feelings. Horlicks must be provided for residents on request. The registered person shall 28/04/06 having regard to the number and needs of the service users ensure that (d) all parts of the home are kept clean and reasonably decorated. The carpet in the top floor dining room and kitchenette must be cleaned or replaced. All food splashes on the walls must be removed. The cutlery drawer must be cleaned and the handle replaced. The cupboard must be kept clean. Timescale of 03/02/06 not met. The registered person shall 31/03/05 having regard to the number and needs of the service users ensure that (p) ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users.
DS0000022489.V287419.R01.S.doc Version 5.1 Page 23 Addison Court Nursing Home 9. OP19 13(4)(a)(c) 10. OP21 23(2)(j) 11. OP27 18(1)(a) The lighting in the top floor lounge must be improved sufficiently to enable residents to read if they wish. Timescale of 30/12/05 not met. The registered person shall 31/03/06 ensure that – (a) all parts of the home to which service users have access are sot far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The exposed wires on the top floor must be covered. The registered person shall 28/04/06 having regard to the number and needs of the service users ensure that (j) there are provided at appropriate places in the premises sufficient numbers of lavatories, and of wash basins, baths and showers fitted with a hot and cold water supply. The shower on the top floor must be repaired or replaced. Timescale of 03/02/06 not met. The registered person shall, 28/04/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users - (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are
DS0000022489.V287419.R01.S.doc Version 5.1 Page 24 Addison Court Nursing Home 12. OP37 17(2) Sch 4 13. OP38 16(2)(j) appropriate for the health and welfare of service users. Staff shortages due to absence levels must be addressed Records of the food 08/03/06 provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and any special diets prepared for individual service users. Accurate records of the food provided must be kept for all residents. Timescale of 18/11/05, 4/12/05 and 13/01/06 not met. The registered person shall 31/03/06 having regard to the size of the care home and the number and needs of service users - after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. The fridge in the top floor kitchenette must be defrosted and cleaned. All items of food and drink must be covered and dated. The microwave oven and storage jars must be kept clean. Timescale of 16/12/05 and 20/01/06 not met. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP7 OP9 OP15 OP18 OP19 OP19 OP26 OP29 Good Practice Recommendations Residents accommodated on the Baxenden unit who want to smoke should be taken to a designated smoking area in the home. Hand written instructions on the medication administration record should be signed and witnessed. The menu displayed should accurately reflect the meals served and be printed in a size that can easily be read by the residents. The whistle blowing policy needs amending to include details of the protection available for the ‘Whistle Blower’. Action should be taken to deal with the condensation between the double-glazing in the top floor lounge. Large quantities of incontinence pads should not be stored in the bathroom on the middle floor. The hand soap dispenser in the laundry should always be refilled when empty. Any gaps in employment history should be explored and a satisfactory explanation given prior to appointment. Addison Court Nursing Home DS0000022489.V287419.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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