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Inspection on 12/11/07 for Austenwood Nursing Home

Also see our care home review for Austenwood Nursing Home for more information

This inspection was carried out on 12th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home ensures that prospective people to use the service needs are assessed prior to moving into the home and individuals are assured that he/she assessed needs would be met. The home ensures that people using the service are supported to keep in touch with family and friends. The home ensures that people using the service are provided with wholesome and nutritious meals in pleasing surroundings. The home has a complaints procedure to ensure that people using the service could raise a concern and be confident that it would be addressed. The home ensures that staff in sufficient numbers with the appropriate skill mix are employed to meet people using the service diverse needs. The home ensures that people using the service are supported by staff that have been appropriately recruited and trained, which should protect them from any potential risk of harm or abuse. The home reflected in its annual quality assurance assessment (AQAA) that `staff were keen and competent with a genuine interest in care of the elderly.` The home reflected in its annual quality assurance assessment (AQAA) that it `strives to provide appropriate care in comfortable, safe surroundings.` The home reflected in its annual quality assurance assessment (AQAA) that `it listens to relatives and residents and take their views into account.`

What has improved since the last inspection?

The home`s complaints procedure has been improved to ensure that it fully conforms to the standard. The organisation of information on staff training records has improved to ensure that records were current and up to date. The home has obtained up to date copies of relevant control of substances hazardous to health (COSHH) sheets to comply with the health and safety guidance. The home reflected in its AQAA that within the last twelve months the following improvements had been made: 1. There has been an ongoing programme of redecoration and refurbishment 2. Staff training and supervision had increased 3. There has been an improvement in the food menus 4. Equipment used in the home is constantly upgraded

What the care home could do better:

It is recommended that in the interests of safety the service must ensure that entries on medication administration record (MAR) sheets are not written over. It is recommended that in the interests of safety the service must ensure that the approved codes recorded on the MAR sheets should be used when medication is refused or not administered. It is recommended that risk assessments for people using the service must be developed for any potential risks and kept under review to ensure individuals` safety and well-being. It is recommended in the interests of people using the service safety that the hoist frames must be clean regularly to prevent the spread of cross infection. Requirements have been made for the following: When medication is administered to people who use the service it must be clearly recorded to ensure that people receive the correct levels of medication. In the interests of people using the service safety suitable arrangements must be made for the disposal of used gloves and aprons to prevent the spread of infection. When staff are using COSHH solutions they must not be left unattended to ensure that so far as reasonably practicable people using the service would be free from avoidable risks.

CARE HOMES FOR OLDER PEOPLE Austenwood Nursing Home 29 North Park Gerrards Cross Bucks SL9 8JA Lead Inspector Joan Browne Unannounced Inspection 10:00 12 November 2007 th 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 Austenwood Nursing Home DS0000019177.V345563.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. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Austenwood Nursing Home Address 29 North Park Gerrards Cross Bucks SL9 8JA 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) 01753 890134 01753 893535 j.gittens@virgin.net Westview Limited Mrs Jeanette Gittens Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly Physically Frail Elderly Mentally Impaired (organic) Date of last inspection 22nd November 2006 Brief Description of the Service: Austenwood Nursing Home is situated a short distance from the town centre of Gerrards Cross, which provides a variety of shops and local amenities. The town is served by buses and Chiltern Line trains. The premises consist of an older two-storey building and a more recent ground floor extension. The home has gardens to the rear and a large enclosed courtyard garden. There is parking for several cars. The home is registered to provide care with nursing for up to 29 older people, who can be accommodated in one of 19 single or 5 shared rooms. Of these rooms, 11 possess en-suite facilities. The home has 4 bathrooms for communal use, all of which enable disabled bathing. In addition to the en-suite facilities there are a further 4 toilets, situated at convenient positions around the home. Toilets and bathrooms contain grab rails. The home’s communal areas comprise of a large lounge, which opens out onto the courtyard, and a well-presented dining room, which can seat all residents at one time. Both floors of the home’s main house are accessible by a passenger lift. A registered nurse is on duty 24 hours a day, and is supported by a team of carers, housekeeping, administrative and catering staff. All residents are registered with a general practitioner (GP) and access to other healthcare professionals is either by direct contact or through GP referral. Fees at the time of this inspection range between £560 and £740 per week. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’ and was carried out on 12 November 2007. The inspector spent approximately seven hours in the service and looked at how well the service was doing. The inspection took into account detailed information provided by the service’s manager. Comment cards were sent to some residents, relatives and health and social care professionals. At the time of writing this report response to comment cards were received from twelve residents, ten relatives, one health and social care professional and two general practitioners. Their views and those of residents, relatives and staff spoken to during the inspection have been reflected in this report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Care plans were examined, which was followed by meeting with the individuals to see if the plan matched the assessed care needs. The medication system and accompanying records were examined along with staff rosters, staff recruitment files, training records and health and safety records. A tour of the premises was carried out and some time was spent meeting with residents, relatives and staff. Residents and relatives spoken to said that they were happy with the provision of care and valued the service. At the end of the inspection feedback was given to the manager. From the evidence seen it was considered that the home was providing an adequate service to meet the diverse needs of individuals of various religion, race and culture. The inspector would like to thank everyone who assisted in this inspection in any way. What the service does well: The home ensures that prospective people to use the service needs are assessed prior to moving into the home and individuals are assured that he/she assessed needs would be met. The home ensures that people using the service are supported to keep in touch with family and friends. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 6 The home ensures that people using the service are provided with wholesome and nutritious meals in pleasing surroundings. The home has a complaints procedure to ensure that people using the service could raise a concern and be confident that it would be addressed. The home ensures that staff in sufficient numbers with the appropriate skill mix are employed to meet people using the service diverse needs. The home ensures that people using the service are supported by staff that have been appropriately recruited and trained, which should protect them from any potential risk of harm or abuse. The home reflected in its annual quality assurance assessment (AQAA) that ‘staff were keen and competent with a genuine interest in care of the elderly.’ The home reflected in its annual quality assurance assessment (AQAA) that it ‘strives to provide appropriate care in comfortable, safe surroundings.’ The home reflected in its annual quality assurance assessment (AQAA) that ‘it listens to relatives and residents and take their views into account.’ What has improved since the last inspection? What they could do better: Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 7 It is recommended that in the interests of safety the service must ensure that entries on medication administration record (MAR) sheets are not written over. It is recommended that in the interests of safety the service must ensure that the approved codes recorded on the MAR sheets should be used when medication is refused or not administered. It is recommended that risk assessments for people using the service must be developed for any potential risks and kept under review to ensure individuals’ safety and well-being. It is recommended in the interests of people using the service safety that the hoist frames must be clean regularly to prevent the spread of cross infection. Requirements have been made for the following: When medication is administered to people who use the service it must be clearly recorded to ensure that people receive the correct levels of medication. In the interests of people using the service safety suitable arrangements must be made for the disposal of used gloves and aprons to prevent the spread of infection. When staff are using COSHH solutions they must not be left unattended to ensure that so far as reasonably practicable people using the service would be free from avoidable risks. 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. Austenwood Nursing Home DS0000019177.V345563.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 Austenwood Nursing Home DS0000019177.V345563.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): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People are confident that the home can support them. This is because the home carries out an assessment of their diverse needs, which they or they relative have been involved in. Standard six was not assessed because the home does not provide intermediate care. EVIDENCE: The pre-admission assessment for three residents was examined. Case tracking confirmed good practice. The manager had visited prospective residents at home or in hospital and undertaken a thorough initial assessment of their care needs. The relative of a resident whose care was case tracked was spoken to. She confirmed that she had visited the home and was showed around by a member of staff who explained how the home was run and what would be available. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 10 A resident who was admitted to the home recently stated that ‘all the staff were kind and polite’. She was happy with her room and surroundings and felt that staff provided personal care to suit her preferences. The manager explained that whenever there was a new admission a staff member is allocated to spend time with the resident to make sure that the individual is made to feel welcome and the home’s routine explained. Relatives spoken to during the inspection confirmed that they had been issued with a copy of the home’s brochure, statement of purpose, service user’s guide, contract and terms and conditions of occupancy. Those who were selffunding were quite clear about the fees and felt that they were clearly laid out. The following comments were noted from a relative who responded to the Commission’s comment cards: ‘my mother has been in the nursing home since the end of May 2007. At last we have peace of mind over her care, which we did not have at all in the last care home. I feel we are still new and learning about the home, but the whole place is very open and direct.’ Evidence seen during the inspection indicated that individuals with poor mobility and prone to falls were provided with the appropriate aids and equipment such as, profiling beds and floor mats to ensure their safety. This ensures that individuals’ diverse needs were being met. Austenwood Nursing Home DS0000019177.V345563.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): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Inconsistency in staff’s medication practice and the lack of adequate recording has the potential of putting people who use the service at risk. EVIDENCE: A care plan was in place for each resident. However, the content recorded in plans were variable. Problems /needs identified did not always outline in detail the action required by staff to ensure that individuals’ assessed needs would be met. Staff were signing and dating the care plans monthly to indicate that individuals’ needs were reviewed and evaluated. The evaluation process was not evident. For example, there was no written evidence reflecting what or how identified needs had been reviewed. Entries recorded in the daily record sheets did not inter-relate with the care plan and reflected mostly on personal care provided and the physical condition of individuals. In one care plan examined for a particular resident that was recently admitted to the home there were no moving and handling or falls assessments in place. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 12 A risk assessment had been developed for a particular resident who was prone to choking. However, there was no evidence seen to indicate that the assessment had been reviewed since it was developed. It is recommended that risk assessments be developed for any potential risks to residents and are kept under review to ensure individuals’ safety and well-being. There was evidence in care plans examined reflecting that individuals’ weights were monitored monthly. The manger said that work was in progress to introduce the malnutrition universal screening tool (MUST) to routinely assess the nutritional status of residents. At the time of the inspection the dietician was supporting one resident who was being fed by a percutaneous endoscopic gastrostomy (PEG) tube. The tube permits feeding directly into the stomach. All residents were registered with a general practitioner (GP) of their choice. However, the majority of residents living in the home were registered with a local surgery and the general practitioner undertook weekly visits. Residents also had access to health care services such as physiotherapy, audiology or other specialist treatment. Arrangements were in place for an optician to visit the home annually and dental care was provided by a local dental surgery in the area. The chiropodist visited the home every four to six weeks. The manager said that the home was receiving support from the tissue viability nurse and other health care professionals such as the continence advisor and the dietician. Residents and relatives who responded to the Commission’s comment cards and those spoken to during the inspection expressed satisfaction with the care provided. Residents said ‘that they were well cared for and the care provided was of a high standard.’ The medication administration record (MAR) sheets were examined and varied in quality. Records of the receipt and disposal of medication were clear and accurate but the recording of the administration of medication was unsatisfactory. There were a number of gaps with no explanation of why the medication had not been given. Controlled drugs were safely stored and recorded correctly. Written over entries were noted in some medication sheets examined. This made it look like medication was signed for before it was offered and then refused. This practice is unsafe and should be reviewed. It was also noted that staff were not always using the approved appropriate codes recorded on the MAR sheets when medication was refused or not administered. Staff should use the appropriate codes to ensure that there is a consistent practice in place. Staff were observed treating residents with sensitivity and knocking on bedroom doors before entering. Residents and relatives spoken to during the inspection were confident that staff upheld their privacy and dignity. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 13 It was noted that staff were enabling residents to spend their final days in their own rooms surrounded by their personal belongings, appropriate attention and pain relief. Austenwood Nursing Home DS0000019177.V345563.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): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use the service are able to keep in touch with family and friends. They are provided with nutritious and attractive meals served in pleasant surroundings. EVIDENCE: It was reflected in the home’s annual quality assurance assessment (AQAA) that wherever possible the home would ensure that residents’ choices on activities were promoted and a range of activities are provided to meet individuals’ needs. Those residents who completed the Commission’s comment cards said that there were ‘always’ or ‘usually’ activities arranged in the home that they can take part in. However, one respondent did not share the same view and felt that the home did not provide any activities. It is acknowledged that there was a programme of planned activities due to take place displayed in the home. The programme consisted of Christmas shopping in Uxbridge, a Christmas party, a singer was booked to perform and carol singers performing on Christmas Eve. The manager said that the home had celebrated Halloween and staff and some residents had participated recently in the cancer awareness day to raise funds for charity. There were Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 15 pictures displayed in the home of those who participated in the event. Residents were encouraged to try different types of food. There was a day when the chef prepared French food and turned the dining area into a French bistro. On the day of the inspection residents spent the day reading, watching television, chatting to visitors or just resting. The home does not have any restrictions on visiting. Throughout the day family members or friends visited residents. One visitor dropped in twice a day to help care for a relative. Visitors spoken to described the atmosphere in the home as ‘good, calm and efficient.’ They indicated that ‘they were very happy with the care provided to residents.’ The home’s manager said that a local priest use to visit the home on a regular basis but visits now only occur on request. This is because the priest had been transferred to another parish and was not replaced. Arrangements would be made to escort residents to the local church in the village by taxi if requested but very few residents request to attend church service. The hairdresser visits on a weekly basis. Residents’ autonomy is respected and personal preferences are taken into consideration when providing personal care. The home ensures that individuals are made aware of their entitlement to move in with personal possessions if they wish to. Some rooms were personalised with personal belongings. On the day of the inspection no residents were using the services of an advocate. The home manager said that she would support residents and their relatives to access the services of an advocate if a request was made. The home does not handle residents’ finances and family members or professionals would be expected to deal with such matters. The home provides three meals daily and snacks and hot and cold drinks were available throughout the day and night. The midday meal was observed. Lunch consisted of salmon served in a white sauce, boiled potatoes and vegetables. Dessert served was rice pudding with jam. Lunch was sampled and it was tasty. The dining room tables were covered with tablecloths with table napkins to match and the appropriate cutlery and condiments provided. There was a choice of hot and cold drinks. Staff were observed assisting those residents who needed assistance sensitively and discretely waiting for residents to open their mouths before offering more portions. Residents and relatives spoken to were complimentary about the food and said that the food was presented attractively and was of a high standard. Soft diets were well presented allowing individuals to identify what they were eating. The chef and the home manager confirmed that it would be no trouble providing an alternative dish if a resident requested it. Austenwood Nursing Home DS0000019177.V345563.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): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a complaints procedure, which should ensure that people using the service could raise a concern and be confident that it would be addressed. Staff are trained in the safeguarding of vulnerable adults and they are procedures in place, which should ensure that people using the service are protected from any potential risk or harm. EVIDENCE: At the previous inspection a requirement was made for the home’s complaints procedure to be reviewed. The manager confirmed that the procedure was reviewed and a copy of the document was displayed at the front of the building. The home had received two complaints during the past twelve months and the home’s manager confirmed that they were dealt with appropriately with satisfactory outcomes recorded. The Commission had not received any complaints about the service. Of the ten relatives who responded to the Commission’s comment cards eight confirmed that they knew how to make a complaint. One responded could not remember how to make a complaint. A second said ‘no but I would speak to matron.’ At the last inspection a recommendation was made for the home to obtain a copy of the Buckinghamshire joint agency guidelines on the safeguarding of vulnerable adults. The manager confirmed that a copy was obtained. The home has not reported any incidents relating to the protection of vulnerable Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 17 adults since the last inspection and the Commission has not been made aware of any incidents. Staff had undertaken training in the safeguarding of vulnerable adult, which was ongoing. Those spoken to were aware of the action that should be taken if they suspected or witnessed an incident of abuse to a resident. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 18 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): 19 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use the service live in an environment that is generally clean, tidy and free from odours. However, poor infection control practice by staff could compromise on individuals’ health and safety. EVIDENCE: The home is located in a quiet road approximately half a mile from Gerrards Cross town centre. Buses to Slough, Uxbridge, High Wycombe and Beaconsfield were accessible. The premises consist of an older two-storey building and a more recent ground floor extension. There is a garden to the rear and a large enclosed courtyard. The entrance hall leads to the administration office and through a set of doors to the living room. The dining room is adjacent to the open plan kitchen. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 19 Bedrooms were situated on the ground and first floors. There are nineteen single bedrooms (ten with en suite facilities wash hand basin and toilets) and five double bedrooms (one with en suite facilities). A ceiling curtain screen separates the sleeping areas in four of the five double rooms. In the fifth this is achieved by means of a portable screen. At the last inspection a recommendation was made for the manager to explore suitable alternatives to a portable screen to ensure the privacy of residents in the shared rooms. The recommendation was not met and is being repeated. The appearance of some bedrooms viewed during the inspection was variable. Not all bedrooms were homely and well presented. Some beds looked hurriedly made and residents’ personal clothing was left lying around on armchairs. In one particular bedroom the beading on the dressing table was lifting and required attention. This was pointed out to the manager who immediately entered it in the maintenance book for it to be seen to by the maintenance person. It was noted that the home had acquired several electrically controlled profiling beds to assist those residents who were at risk of falling out of bed and were being nursed in bed. Grab rails and other aids in corridors, bathrooms, toilets and where necessary in residents’ bedrooms were provided to maximise independence. The manager confirmed that the requirements from the fire service inspection that was carried out last year had been fully complied with. The home employs a part-time maintenance person who ensures that bedrooms were re-painted as they become vacant. In one particular bedroom the door was re-sited to ensure easy access when entering and exiting the room. The laundry room was located away from where food was prepared or stored and was equipped with two driers and two washing machines with the specified programming ability to meet disinfection standards. The walls and floor in the laundry room were clean and showed signs of the area been recently decorated, which should promote a high standard of cleanliness. Poor infection control practice was noted. For example, used gloves and aprons were disposed of in a general waste bin in a resident’s bedroom and in a bathroom. Used gloves were also observed on top of one of the washing machines in the laundry room. Two portable hoists used to assist residents with moving and handling were dusty and in need of cleaning. It is required that staff must comply with the infection control policy and dispose of used gloves in the clinical waste bins provided to prevent and control the risk of infection. The hoist frames should be surface cleaned on a regular basis to protect residents’ well-being and safety. It was noted that the general waste Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 20 bin in the sluice area was not of the foot pedal type. It is recommended that the bin be replaced with one of the foot pedal type to prevent the spread of infection. Alcohol hand-rub was available at the front entrance and visitors entering the building were observed using it without prompting. This is a good practice. The home was free from offensive odours on the day of the inspection. Residents and relatives who responded to the Commission’s comment cards said that the home was ‘always’ or ‘usually fresh and clean’. The following additional comments were noted: ‘the home presents a cheerful welcoming atmosphere. Always appear to be clean. No unpleasant smells’. ‘The home smells fresh and clean.’ Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The home ensures that people using the service diverse needs are met by staff in sufficient numbers who are trained and appropriately recruited, which should support the smooth running of the service. EVIDENCE: The home employs a multicultural staff team to meet the diverse needs of residents. The staffing levels reflected in the home’s roster were as follows: One registered nurse and six care staff in the morning, one registered nurse and four care staff in the afternoon and evening and one registered nurse and two care staff at night. In addition to nursing and care staff the home employs domestic, laundry, kitchen and catering staff and a maintenance person. The activity co-ordinator post was vacant. The inspector observed that all staff had taken their tea break at the same time and residents were left in the lounge unsupervised. This practice should be reviewed to ensure that there is a member of staff available to assist residents seated in the lounge area who may require assistance. Relatives who responded to the Commission’s comment cards said that the staff ‘always’ or ‘usually’ have the right skills and experience to look after individuals properly. The following additional comments were noted: ‘Staff Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 22 are very kind and caring when dealing with my father.’ ‘The people who work there treat the residents very well.’ The home employs sixteen care staff. At the time of this inspection thirteen staff had acquired the national vocational qualification (NVQ) in direct care at level 2 or 3. This means that the home had exceeded the 50 ratio of care staff achieving an NVQ in direct care. The recruitment records for the most recently appointed staff member was examined. There was a completed application form. Two references had been obtained and one of the references was from the individual’s most recent employer. Evidence that an enhanced criminal record bureau (CRB) had been obtained was in place along with a signed declaration of health fitness form and a photocopy of the individual’s pin number. The photograph in the file was a photocopy of the passport. This was not recent and it is recommended that a recent photograph other that a photocopy of the passport should be provided to confirm proof of identity. The manager confirmed that she now requests that the agency submits the level of the criminal record bureau disclosure when requesting the use of agency staff. The organisation of information on staff training had improved. The manager had developed a training matrix, which was clear and easy to follow. Mandatory training for staff members was up to date. Trained nurses had been trained as fire marshals and were expected to cascade training to care staff. There was evidence to indicate that all new staff undertake an induction programme. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 36 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Safety practices in the home would need to be closely monitored to ensure that the home is run in the best interests of people using the service to protect their safety. EVIDENCE: The registered manager is a registered general nurse (RGN) and has been manager of the home for approximately four years. She has completed the registered managers award (RMA) and is therefore appropriately experienced and qualified for the post. A deputy manager and registered nurses support the manager. Staff described the manager as ‘approachable’. She regularly updates her knowledge and skills by attending training courses. She has attended ‘train the trainer’ training in moving and handling, safeguarding of Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 24 vulnerable adults, nutrition, prevention of falls and fire safety. There were clear lines of accountability within the home. Relatives spoken to during the inspection said that ‘the manager always seemed happy to talk over any issues at anytime.’ A relative who responded to the Commission’s comment card said that ‘the manager is a hands on type of person who obviously knows her staff very well.’ The home does not have a comprehensive quality assurance audit. It seeks the views of residents and visitors on topical subjects. As a result of feedback from a nutritional questionnaire a nutritional group was set up in the home. The home’s quality assurance needs to be further developed to ensure that care documentation is appropriately maintained and care plans contain detailed information on how individuals’ care needs should be met. Care practices would need to be monitored to ensure that staff are accountable and are providing a consistent service to ensure that individuals’ health and safety are promoted and positive outcomes for people using the service can be achieved. The manager has put in place a supervision framework to ensure that staff are supervised. The supervision covers individuals’ practice. Individuals’ career development needs do not appear to be included in the supervision framework. It is envisage that with the recent appointment of the home’s deputy manager the manager would be able to delegate some responsibility to the deputy manager to assist with the supervision process, which should improve on the existing framework that is currently in place. The home does not retain or manage monies on behalf of residents. Family members or professional advisers are expected to support individuals with their finances. A recommendation was made at the last inspection for the home to obtain the relevant control of substances hazardous to health (COSHH) data sheets. The manager confirmed that sheets had been obtained. To meet the diversity of the staff team sheets were available in an alternative language. This is deemed as good practice. Most chemicals were stored appropriately. The inspector observed cleaning solutions that were left unattended in the corridor in a bucket, which could be a potential risk to residents and visitors in the home. These were removed when it was pointed out. A requirement is made in this report for COSHH solutions not to be left unattended. At the last inspection a requirement was made to replace cracked and missing tiles in the kitchen. It is pleasing to report that the requirement has been complied with. Work was in progress to repaint the kitchen area. The electrical work in the building was not fully completed and as a result the electrical safety certificate has not been issued. The manager stated that the Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 25 electrical engineer has advised that the work should be carried out in phases to avoid minimum disruption to people living in the home. Examination of a sample of the fire records indicated that they were up to date and in order. The lift is checked by an engineer quarterly. Records relating to water temperatures for the prevention of Legionella were in order. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 26 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 2 X X X X X X 2 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 3 X 2 Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Partly 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(2) Requirement When medication is administered to people who use the service it must be clearly recorded to ensure that people receive the correct levels of medication. In the interests of people using the service safety suitable arrangements must be made for the disposal of used gloves and aprons to prevent the spread of infection. When staff are using COSHH solutions they must not be left unattended to ensure that so far as reasonably practicable people using the service would be free from avoidable risks. Timescale for action 31/12/07 2 OP26 13(3) 31/12/07 3 OP38 13(4) 31/12/07 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. Refer to Standard OP7 Good Practice Recommendations Identified needs in care plans should have clear action DS0000019177.V345563.R01.S.doc Version 5.2 Page 28 Austenwood Nursing Home 2. 3. 4. OP7 OP7 OP9 5. OP9 6. 7. 8. 9. 10. OP19 OP26 OP26 OP29 OP33 plans in place outlining how people’s assessed needs should be met. Entries recorded in the daily record sheets should interrelate with the care plan to ensure that progress on individuals’ needs are evaluated. Risk assessments for people using the service should be developed for any potential risks and kept under review to ensure individuals’ safety and well-being. To comply with best practice guidelines and in the interests of people using the service safety the approved appropriate codes recorded on the MAR sheets should be used when medication is refused or not administered. In the interests of people using the service safety and to comply with best practice guidelines entries recorded on MAR sheets should not be written over because sheets are legal documents and can be used in court or in an investigation. The manager should explore suitable alternatives to a portable screen to ensure the privacy of individuals in shared rooms. In the interests of people using the service safety and to prevent the spread of infection the swing top bin in the sluice area should be replaced with the foot-pedal type. In the interests of people using the service safety the hoist frames should be clean regularly to prevent the spread of cross infection. To comply with current guidelines a recent photograph of individuals should be provided to confirm proof of identity. The home’s quality assurance system should be developed further to ensure that care documentation is appropriately maintained and staff’s practice is consistent, which should achieve positive outcomes for people using the service. Austenwood Nursing Home DS0000019177.V345563.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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