Inspection on 03/06/08 for Adelaide Nursing And Residential Care Home

This inspection was carried out on 3rd June 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Adelaide Nursing And Residential... 09/07/07

Adelaide Nursing And Residential... 15/10/06

Adelaide Nursing And Residential... 18/11/05

Adelaide Nursing And Residential... 22/04/05

Adelaide Nursing And Residential... 06/11/04

Adelaide Nursing And Residential... 29/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Adelaide Nursing And Residential Care Home 35 West Street Bexleyheath Kent DA7 4BE Lead Inspector Ms Pauline Lambe Unannounced Inspection 3rd June 2008 09:00 X10015.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 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 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. 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. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adelaide Nursing And Residential Care Home Address 35 West Street Bexleyheath Kent DA7 4BE 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) 020 8304 3303 020 8301 0133 adelaide@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Catherine Komuhangi Care Home 76 Category(ies) of Dementia (42), Dementia - over 65 years of age registration, with number (1), Old age, not falling within any other of places category (34) Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - 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 (maximum number of places: 42) 2. Dementia - Code DE (maximum number of places: 42) The maximum number of service users who can be accommodated is: 76 9th July 2007 Date of last inspection Brief Description of the Service: The Adelaide Care Centre is a purpose built nursing and residential care home. It was first registered in July 1997 and was then purchased by Southern Cross Healthcare in September 1998. The home is situated in a side road off Bexleyheath Broadway near the railway station, bus services and the shopping centre. There is car parking space to the front of the property. The home is registered to provide care and accommodation to 76 older people. The home has two floors divided into four separate units providing care for the different categories of service users. On the ground floor, there are 20 general nursing beds and 14 beds for conventional residential care. On the first floor, there are 25 nursing beds and 17 beds for residential care, all for older people with dementia. All of the bedrooms in the home have en-suite facilities. The laundry is sited in a separate building to the side of the home. At the rear of the building there is an enclosed garden. The current fees range from £482.00 - £820.00. Residents pay privately for personal items such as hairdressing, newspapers and chiropody care. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 5 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Two inspectors from the Commission started the site visit for this unannounced inspection on 3rd June 2008 and one inspector completed the visit over two dates, the 6th June and 1st July 2008. The manager was in charge of the home during visits and she and staff assisted with the inspection. The service had a key unannounced inspection on 7th July 2007. The inspection process included a review of information held on the service file, a review of the information provided in the Annual Quality Assurance Assessment (AQAA), a tour of the premises, a review of records, talking to residents, staff, management, relatives and reviewing compliance with previous requirements. Information provided in resident, relative and surveys was also reviewed. The visit made to the service on 1st July 2008 was done to review pressure area care and pressure sore development in the home. The reason for the additional visit was based on information received from social services about this aspect of the service. See comments under standard 8. Overall staff and management worked to maintain standards within the home. The manager provided useful information in the AQAA to show what improvements had been made and were planned for the service. Residents, relatives and staff were generally satisfied with the way the service was managed and the positive input the new deputy manager was making. What the service does well: What has improved since the last inspection? Care plans seen were up to date. Staff informed the GP when residents refused to take medicines regularly. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 7 Social care plans were prepared, however these could be improved further to ensure they reflect resident interest and hobbies. Minimum staffing levels were maintained. To ensure medicines were administered on time the night staff started the morning medicines and the day staff completed the task. Domestic staff had introduced a system to ensure bedrooms were deep cleaned regularly. Staff were seen in lounges assisting and supervising residents. New laundry equipment was provided. New furniture was provided in some areas on the dementia-nursing unit. A rolling programme was in place to redecorate and refurbish the home. What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information was provided about the service. Residents were admitted based on an assessment of care needs and received written confirmation that based on assessment the home was suited to meeting their needs. EVIDENCE: Care plans viewed included pre-admission assessment of care needs and some contained care manager assessments. A senior member of staff from the home completed pre-admission assessments. Copies of the service user guide were seen in some of the bedrooms viewed. Residents received written confirmation to show that following assessment the home was suited to meeting their needs. In the Annual Quality Assurance Assessment (AQAA) supplied to the Commission the manager said that the home had a waiting list for admission and planned to introduce a ‘Home Book’ with Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 10 additional information about the service to leave in the reception area for visitors and prospective residents to see. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments were written for all residents, those seen reflected care needs and were up to date. Systems were in place to meet resident’s health care needs and to safely manage medicines. No concerns were noted in relation to resident privacy and dignity. EVIDENCE: A total of six care plans were viewed overall, two on each unit. Care plans were generally well written, identified resident’s needs and showed how these were to be met. There was evidence that care plans were discussed with residents and relatives and kept under review. A number of care plans seen were personalised for example to show resident preference in relation to hair and nail care, personal appearance, allowing residents to choose what to wear and reminding staff to encourage residents to be involved with care and with making choices. Care records seen included risk assessments in relation to areas such as pressure area care, safety, prevention of falls, use of bedrails, moving and handling and nutrition and these were reviewed monthly. Resident dependency was assessed and reviewed monthly however the tool Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 12 used did not take into account issues such as the number of care staff required or the time taken to provide personal care to meet individual resident needs. The scoring on the dependency tool did not always match resident’s dependency. For example residents considered by staff to be highly dependent were rated as medium dependency. The organisation should consider reviewing the assessment tool to ensure dependency levels are accurate and reflect staffing levels required. Resident and relative feedback was positive about the care provided and a number of people commented on the recent improvements to care on the dementia nursing unit with the recent management changes. In the AQAA the manager said that a system was in place to monitor a ‘resident of the day’. This included reviewing the resident’s care, environment, health and general well-being. The manager also said that since the last inspection staff had received training on care planning and the Mental Capacity Act. Staff were observed respecting residents privacy when assisting with personal care by closing doors, telling residents what they were about to do and talking respectfully to residents. Residents and relatives spoken with were satisfied with the way care was provided. One area that should be improved was resident the daily care records. Records seen provided limited information about the implementation of care plans or the day-to-day life of the resident. Recommendations 1 and 2. Residents were registered with a GP and residents on the residential units could access the service of the district nurse team as needed. Care plans seen on all units included a record of professional visits. These showed that residents had access to other professionals such as the GP, psycho-geriatrician, district nurse, tissue viability nurse, chiropodist and dietician. Residents were supported to access routine or emergency dental and optical care. The purpose of the site visit on 1st July 2008 was to review care records in relation to prevention and treatment of pressure sores. The care records for all the residents on the nursing units were viewed with a focus on this care issue. All residents had been assessed in relation to their risk of developing pressure sores. A system was in place to review risk assessments monthly but reviews for 14 people on the dementia nursing unit were overdue. From the records six residents were noted to have pressure sores, two people were admitted from hospital with these and four people had developed these in the home. Six residents had wounds, which required treatment. Care records seen in relation to pressure sore and wound management were up to date, included guidance on dressing type and frequency and on-going wound assessment records were in place. Where needed residents had been referred to the GP and tissue viability nurse for advice. The deputy manager said that four nurses had recently attended wound management training. Pressure relieving equipment was provided for residents where needed. Residents and relative feedback showed they were satisfied that health care needs were being met. Recommendation 3. Medication policies and procedure were provided and were last reviewed in 2006. Medicine management was inspected on all units and included viewing Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 13 medicine administration charts for eight residents. Satisfactory medicine storage facilities were provided and records kept for the receipt, administration and disposal of medicines. On the residential unit medicine supplies for two residents were checked and correct. Issues noted were that the standard of hygiene in the medicine storage room required improvement, there was insufficient storage for medication waiting disposal and staff had changed details of one medicine dosage from twice a day to one per night. This meant that the information on the medicine container did not reflect the information printed on the administration chart, however staff were unable to evidence that the GP had altered the prescribed dose. On the nursing unit medicines were very well managed and no errors noted. Medicine supplies were checked for three residents and were correct. However although staff recorded medicines sent for disposal they did not record the date when the items were removed from the unit. On the dementia nursing unit none of the residents managed their own medicines. Medicine supplies were checked for four residents. Two were correct and for one person the amount of one medicine remaining did not tally with the amount supplied and administered and for the same person one dose of two different medicines had not been signed for at the time of administration. Staff had not countersigned hand written entries seen on one administration chart. On this unit staff had introduced medicine profiles for all residents. Requirement 1 and recommendation 4. Staff were seen knocking on bedroom doors and asking permission to enter bedrooms. Good interaction was seen between staff and residents and assistance was provided to residents when needed. Bathroom and toilet doors had locks fitted, bedrooms were for single occupancy and all bedrooms had ensuite facilities. The home had a trolley telephone to enable residents to make and receive calls in the privacy of their bedroom and a number of residents had private phones in their bedrooms. Residents and relatives spoken with did not raise concerns as to how staff respected their privacy and dignity. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities had improved but social care plans and activity records could be more informative. Residents and relatives were satisfied with visiting arrangements and the quality of meals provided. EVIDENCE: Since the last inspection a new activity organiser had been appointed who worked five days a week. This person had a good understanding of her role and the importance of providing age appropriate activities. She acknowledged that not everybody enjoyed structured activities and said she tried to make time to be with residents who just liked a one-to-one chat. The activity coordinator said that care staff did not regularly provide assistance with activity sessions and a relative seen supported this statement. Both the activity coordinator and the manager agreed that taking into account the number of residents and their different needs and ability the current activity hours provided was insufficient. Social care plans were seen on all units however these did not generally show the person’s individual interests and hobbies. Resident’s involvement with activities was recorded on individual record sheets but this did not provide any detail as to the resident’s enjoyment or benefit from the session. Feedback received from staff, residents and Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 15 relatives were positive about the activities provided and overall the view was that this aspect of the service had improved. Recommendation 5. The home had an open visiting policy to make it possible for residents to maintain contact with family and friends. Residents seen said they enjoyed family visits and relatives were encouraged to attend social functions and relative meetings. Relatives spoken with stated they were made feel welcome when visiting and found care staff approachable, helpful and informative. Some residents seen said they could make choices about issues such as meals, what to wear, where to sit and whether to participate in activities. Residents were able to bring in personal items from home to make their bedrooms more personal. Some residents were observed having breakfast as late as 10.30. There was therefore not much time gap between breakfast and lunch for some residents as lunch was served at 13.00. The deputy manager was aware of this issue and planned to make changes to ensure residents had breakfast at a more reasonable time. Lunch was observed on the dementia nursing and dementia residential units. A choice of meal was provided with alternative dishes such as a salad, omelette or baked potato for those who did not like either meal on the daily menu. One of the meals looked appetising but the second choice, chicken casserole had curdled and looked pale and unappetising. However residents said or were observed enjoying their meal. Tables were properly laid for lunch and staff provided assistance where needed and serving the meal was well managed. Four weekly menus were provided and a computer system used to assess the nutritional value of the meals. One resident said the menus were repetitive. On viewing the menus it was noted that some meals were repeated over the four weeks but that the menus were quite varied overall. Care records seen included nutritional risk assessments and care plans were prepared to show how people’s nutritional needs were to be met. On the dementia nursing unit new dining tables and chairs had been provided, which suited the residents needs. In the AQAA the manager said that they had introduced photographs of meals, showed the two meal choices to residents at lunch, included oriental foods and residents birthdays were celebrated with a birthday tea party. One resident and their family were seen enjoying a birthday party during the inspection. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems were in place to manage complaints and ensure resident protection. EVIDENCE: A complaints procedure was provided and systems were in place to record complaints made about the service. The AQAA showed that since the last inspection six complaints had been made to management and following investigation none of these were substantiated. On viewing complaint records it was noted that three of the complaints were safeguarding adult issues and these had been referred to or were investigated by the local authority. The records for the three remaining complaints included details of the complaint, the investigation and the response. Two of the complaints had been substantiated based on the findings of the investigation. A policy and procedure was in place in relation to safeguarding adults. Staff spoken with had a good understanding of their role in safeguarding adults and understood the ‘whistle blowing’ policy. When an allegation of abuse was reported management took the appropriate action to ensure resident safety and have the matter investigated. At the time of this inspection one allegation of abuse was reported to the manager and the appropriate procedures were implemented. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives were satisfied with the private and communal space provided. The home was kept clean and a rolling programme of maintenance and redecoration work maintained. Systems and equipment was in place to enable staff to practice infection control. EVIDENCE: A tour of home was completed as part of the inspection. The premises were clean, tidy, well ventilated and the standard of décor was satisfactory. A second maintenance person was employed who spent most of their time painting and decorating. Residents and relatives seen said they were satisfied with the standard of cleanliness and with their personal and communal space. The dementia nursing unit had different colour bedroom doors, which were made to look like street doors and staff said this helped residents identify their rooms, communal rooms and bathing and toilet facilities. In the AQAA the manager said that the domestic hours were spread over the day to ensure staff Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 18 were on duty till 20.00, new laundry equipment was provided and the housekeeper had 2 hours a week allocated for staff supervision. A rolling programme for decoration and refurbishment was maintained with the help of a second maintenance person. In the residential units dining chairs were extremely stained and the carpet in one of the units was showing signs of wear and tear and would benefit from replacement. Requirement 2. On all units bathing and toilet facilities were clean, tidy and odour free. An assisted bath on the residential unit was out of action and awaiting repair. As residents favoured this bath over the other bathing facilities provided it was quite a problem for them not to be able to use it. The manager said that she hoped the repair would be completed within the coming week. While we were in the home a second bath on the residential unit was found to be past repair. The manager and regional manager said this would be replaced with a bath more suited to resident needs. On the nursing unit the ceiling in bathroom 2 was water damaged. All other bathing and toilet facilities seen on the nursing units were satisfactory. Hot water temperatures checked were within safe limits. Requirement 3. A number of bedrooms were viewed and found to be clean, tidy and personal. Residents and relatives spoken with said they were satisfied with the environment. The manager said that domestic staff deep cleaned one bedroom a day, which was part of the ‘resident of the day’ procedure. Areas of the home viewed were clean and tidy. Sluice rooms were provided to store waste and staff had access to protective clothing, hand washing facilities and hand cleansing gel. Staff said they had access to adequate supplies of protective clothing. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 - 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were maintained. Management were committed to providing NVQ and other relevant training for staff. Recruitment procedures were good and complied with regulation. EVIDENCE: On the units inspected staff rosters seen were an accurate reflection of staff on duty. The Commission had concerns raised about staffing levels in the home prior to this inspection therefore staff rosters were monitored weekly for a four week period. During that time minimum staffing levels were maintained. Please see the comments regarding the resident dependency tool under standard 7 and recommendation 1. The manager said in the AQAA that the service had the correct staffing levels and appropriate skill mix. Also that since the last inspection two nurses with a mental health qualification had been employed and currently the service had vacancies for a full time unit manager and 2 full time care assistants on the nursing unit. The lack of regular staff on the nursing unit was difficult for residents, as they did not benefit from continuity of care. Information included in the AQAA showed that 71 of the 75 care staff employed had achieved level 2 NVQ or above. Four care staff were currently working towards this qualification. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 20 Three staff recruitment files were inspected in relation to recruitment and training. Records seen showed recruitment procedures were followed and complied with regulation to ensure residents living in the home were protected. Staff spoken and feedback surveys received showed that staff were satisfied with the amount and relevance of training provided. A training matrix was maintained to ensure that statutory training such as manual handling and food hygiene was updated on a regular basis. Two members of staff stated they had also received training relating to the use of bed rails and bed rail risk assessments were seen in care records. Staff also said they had received training on safeguarding adults from both the provider and the local authority. Over half the staff working in the home had a current first aid qualification. Some staff had attended a dementia training course called yesterday today and tomorrow, which gave them an understanding of dementia and its effect on resident’s lives. The course was completed over a six-week period. The staff training matrix showed that this training was last provided in 2006. The manager said that she was currently seeking a suitable organisation to provide this training for staff that had not yet received it. On the residential unit staff were observed repeatedly telling residents with dementia to sit down, which may indicate a lack of understanding of dementia. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home manager was registered with the Commission. Some quality assurance systems were in place however a report had not been sent to the Commission. Attention was given to providing a safe environment. EVIDENCE: The manager was registered with the Commission and had been assessed as having the skills, qualifications and experience needed to manage the service. Since the last inspection the manager had completed the registered manager’s award. A new deputy manager was employed and positive feedback was received from staff, residents and relatives about this post. A number of staff, residents and relatives said they did not feel the manager visited the units often enough, however information in the AQAA said that the manager walked Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 22 about the house at least three times a day. This issue was brought to the attention of the manager and regional manager to address. Systems were in place to review the service. These included regulation 26 visits, relative/resident meetings, staff meetings, in-house audits and getting residents and relatives views of the service through the use of satisfaction surveys. The regional manager completed an annual report of the service, which was sent to head office and used to complete an organisational report on all its services. She agreed to send the Commission a copy of the home’s review report when it is next completed. Relatives and residents commented on the meetings held and said they found it easy to make comments and give feedback at these meetings. In-house audits were completed based on the national minimum standards and covered areas such as accidents, medicines, complaints, pressure sore care and prevention and safeguarding adults. Minutes were seen for meetings with residents, relatives and nursing, care and domestic staff. Requirement 4. There had been some changes to the way resident’s personal allowances were managed. The home no longer held resident money but had a float of cash to use. This money was used to pay for hairdressing, chiropody and other personal items residents required. Receipts were obtained for money spent and the amount charged to the individual resident. Resident’s personal allowance was held in a non-interest bearing account for ‘residents of Adelaide Care Centre’. Money received for residents was paid into this account and receipts provided. Individual records were held on the computer and made available to residents and relatives on request. The manager and administrator managed the bank account and signed cheques. Personal allowance records were checked for two residents and were found to be correct. Resident’s jewellery items found or waiting collection and petty cash for the home was stored in a safe, which was fixed to a solid wall. A list of the safe contents was stored on the computer. The manager and administrator ensured all residents had access to personal allowances and where needed contacted relatives to obtain this money. Safety records seen showed attention was given to providing a safe environment for residents and others. Records seen were up to date and showed that service checks had been done when due. Records seen included service for hoists (one was waiting repair and was taken out of use), the fire alarm, the lift, the assisted baths, the gas and electricity certificates. The maintenance technician completed in-house safety checks on items such as bed rails, wheelchairs, hot water temperatures and window restrictors. Fire safety arrangements were good. Regular checks were undertaken to ensure that the fire alarm system, emergency lights, fire extinguishers and fire doors were in working order. Staff received fire safety training and attended fire drills. Accident records were viewed and were generally well completed. The records showed that where required residents received medical attention following accidents and notifications were sent to the Commission as required by regulation 37. A system was in place to monitor residents for up to 48 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 23 hours following an accident. The manager monitored accidents and completed a monthly audit, which was sent to head office. Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 24 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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. 1 Standard OP9 Regulation 13 Requirement Staff must countersign hand written entries they make on medicine charts. Medicines must be signed for at the time of administration. Medicine storage areas must be kept clean. The dining room chairs and carpet on the residential unit must be cleaned or replaced. The bath on the residential units must be repaired and made available to residents. The ceiling in bathroom 2 on the nursing must be repaired and redecorated. The registered person must ensure a report is written for quality reviews undertaken and supported by an improvement plan to address issues identified. This report must be made available to residents, relatives and others and a copy sent to the Commission. (Timescale of 31/08/07 was not met). Timescale for action 07/08/08 2 3 OP19 OP19 23 23 07/08/08 31/07/08 4 OP33 24 07/08/08 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 26 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 Refer to Standard OP7 OP7 Good Practice Recommendations The dependency tool used should be reviewed to ensure it provides an accurate assessment of the resident’s needs. Resident daily and weekly care records should be improved to ensure they support and evidence the implementation of care plans and the quality of the dayto-day life of residents. Pressure sore risk assessments should be reviewed monthly. Management should ensure adequate storage facilities are provided to store medicines waiting disposal and the date of removal of these items from the home should be recorded. Medicine profiles should be prepared for all residents in the home. Staff responsible for medicine administration and management should have their competency to do this assessed annually. Social activity care plans should show what leisure activity the person enjoys and activity records should support this and show whether people enjoyed and benefited from the session. 3 4 OP8 OP9 5 OP12 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Adelaide Nursing And Residential Care Home DS0000006752.V364789.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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