Inspection on 22/11/06 for Austenwood Nursing Home

This inspection was carried out on 22nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Austenwood Nursing Home 29/10/08

Austenwood Nursing Home 12/11/07

Austenwood Nursing Home 14/03/06

Austenwood Nursing Home 03/01/06

Austenwood Nursing Home 25/05/04

Austenwood Nursing Home 17/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Austenwood Nursing Home 29 North Park Gerrards Cross Bucks SL9 8JA Lead Inspector Mike Murphy Unannounced Inspection 22nd November 2006 09:30 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 DS0000019177.V312710.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. DS0000019177.V312710.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 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 DS0000019177.V312710.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 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 home has parking for several cars. 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. 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 WCs, situated at convenient positions around the home. WCs 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 were between £500 and £720 per week. DS0000019177.V312710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in one day in November 2006. The inspection methodology consisted of discussion with residents, with the manager (who kindly came in on her day off when notified of the inspection by the nurse in charge), and staff. It also included consideration of information provided by the manager in a pre-inspection questionnaire, consideration of comment cards completed by residents, relatives and health and social care professionals in advance of the inspection, observation of activities, examination of documents including residents’ care plans, staff files and other records, and inspection of areas of the building including some bedrooms, communal areas, the kitchen and the grounds. The inspection finds that there is a high level of satisfaction with the service provided by this nursing home. Residents, relatives and health and social care professionals have expressed satisfaction in writing and during the course of the inspection visit. The home has systems in place for assessing the needs of prospective residents and for drawing up a care plan to meet those needs. It has suitable equipment to assist residents who have problems with mobility and the home maintains effective liaison with GPs and other health professionals in meeting residents’ needs. Staff appear to do well in providing social activities for residents. The standards of the environment are variable. Improvements since the last inspection have included the acquisition of a ceiling mounted tracking hoist, three profiling beds, the installation of a large screen TV, and recovering a flat roof. The general standard of cleanliness and hygiene in bedrooms and communal areas is good, but some areas of high activity would benefit from an increase in the frequency of cleaning. The home is in a convenient location for the amenities of Gerrards Cross and residents have access to an enclosed courtyard in good weather. Staffing levels are considered satisfactory and the home has a registered nurse on duty at all times. The post of assistant manager was vacant at the time of this inspection. The organisation of information on staff training could be improved, staff supervision for care staff needs to be re-established, and the supervision arrangements for new staff appointed under a ‘POVA first’ needs to be more explicit and to conform to Department of Health guidance. Attention to these matters, and others identified at the end of this report, would provide added support to the home in providing a service which is clearly valued by residents and their families. What the service does well: DS0000019177.V312710.R01.S.doc Version 5.2 Page 6 Residents are well cared for in a clean, warm, pleasant and homely environment, by a team of caring staff. Residents cared for in bed appear to be equally well cared for and attended to. The health and safety of residents and staff is protected through staff training and the regular servicing of equipment and fire detection systems. Staff liaise with healthcare professionals external to the home promptly and appropriately. Staff actions take into consideration the privacy and dignity of residents in their provision of care. Residents may receive visitors at any reasonable time. No complaints have been received by CSCI about the home over the last year. An on-going process of maintenance and decoration takes place within the home. What has improved since the last inspection? What they could do better: DS0000019177.V312710.R01.S.doc Version 5.2 Page 7 Daily reports in care plans should include psychological and social aspects of residents’ lives in order to provide a fuller and more rounded account of residents lives in the home. The home’s complaints procedure should be updated to ensure that it fully conforms to the standards and that residents and their families know that a complaint can be referred to CSCI at any stage. The manager should review the schedule of cleaning in areas of high activity to maintain high standards of hygiene in all areas of the home for the benefit of residents. The manager should also ensure that cracked or missing tiles in the kitchen are replaced. The manager should ensure that staff training records are up to date so that residents are cared for by staff with appropriate skills. The manager should review the home’s arrangements for staff supervision and ensure that nurses and care staff receive formal supervision six times a year. This will provide staff with time to reflect on their work, develop their skills and potentially provide opportunities for improving the quality of care to residents. 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. DS0000019177.V312710.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 DS0000019177.V312710.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s systems and procedures for assessing the needs of prospective residents and for a trial admission aim to ensure that it is satisfied it can meet resident’s needs. EVIDENCE: Referrals to the home may arise from four sources: (i) referral via social services; (ii) referral via the NHS (through the primary healthcare trust (PCT); (iii) direct contact through ‘word of mouth’ recommendation; and, (iv) direct contact through a search by an older person (and their family) seeking a nursing home. On receipt of an enquiry or referral the manager provides information to the enquirer and considers what information is available on the person’s needs at that point. This is followed up by direct contact between the manager and the prospective resident. An assessment of needs is carried out using an assessment form to record the information. This may be carried out in hospital or other place where the DS0000019177.V312710.R01.S.doc Version 5.2 Page 10 person is currently living. The assessment takes account of the person’s needs and wishes, information provided by other services or professionals, and consideration of information acquired by the manager. The process usually includes a visit to the home. Sources of information may include, hospital staff and records, information provided by social workers including the assessment of needs, GPs and district nurses (DNs). Recent admissions have included a number of residents from another home and the manager’s consideration of whether the home could meet the prospective residents needs was informed by information provided by the home and the referring social worker. The information is considered by the manager and nurses in the home and a decision is made on whether it is likely to be able to meet the prospective resident’s needs. An offer of a place is then made and a trial admission offered. At the end of a month or so all parties – the resident and their relatives, the manager and home staff, and where involved, the social worker – decide on whether to move on to permanent residency. Care plans examined included comprehensive assessment information including that recorded prior to admission and that acquired since the admission of the resident. The home can offer respite, short stay, admission, but has not done so recently. The home does not offer intermediate care, therefore standard six does not apply. DS0000019177.V312710.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans are based on comprehensive assessment of needs, are generally well written and support the provision of care appropriate to the needs of individual residents. Liaison with healthcare agencies is good. However, weaknesses in recording the implementation of the care plan, and in particular psychosocial aspects of care, could compromise the quality of care provided to some residents. The home’s arrangements for the control, storage and administration of medicines are generally satisfactory and aim to ensure that medicines are administered in accordance with the medical prescription and to minimise the risk of errors in administration and risk to residents. EVIDENCE: A care plan was in place for each resident. Care plans included: general information on the resident, social information, an assessment of needs, a typed plan of care (based on a care plan template adapted for individual residents), a completed Barthel dependency index (a measure of self-care and mobility in physically impaired people), a completed Braden scale (assessment DS0000019177.V312710.R01.S.doc Version 5.2 Page 12 of risk of developing pressure sores), manual handling risk assessment, records of weight, reviews of the care plan, and daily reports. Four care plans were examined. Each had the above content and supplementary information according to assessed needs. Some sheets in some care plans, such as that entitled ‘Daily Statement of Patient’s Condition’ were no longer in general use. Some had a ‘Cot side Risk Assessment’ where bedrails to prevent the resident falling out of bed were in use. Falls are assessed according to a protocol drawn up by the falls assessment team at High Wycombe hospital. This involves enquiring if a fall has taken place recently, if so then assessing the risk of a fall leading to a fracture, adjustments to care, and communication with the resident’s GP on the outcome of the assessment and consideration of medication to reduce the risk of fracture. A fall in the home will also trigger the process. The manager said that the home intends to introduce the MUST (Malnutrition Universal Screening Tool) to routinely assess the nutritional status of residents. Risk assessments included those specific to individual residents such as the hazards in a resident’s bedroom (e.g. reaching for a call bell or bathing). Completion of care plans varied. Some of those examined had excellent assessments and care plans but the qualities of entries thereafter appeared to decline. Nurses and care assistants complete separate sections each day. The advantages and disadvantages of this approach were discussed with the registered manager. In the records examined, there were almost no entries on psychosocial aspects of care – matters such as mood, thought content, interactions with others, participation in social activities, and interest or enjoyment in everyday events for example. Entries were almost exclusively confined to brief summaries of physical care given and the physical condition of the resident. All residents are registered with a GP. Three practices are used by the home. A registered nurse is responsible for each resident. Dieticians advise on PEG (Percutaneous Endoscopic Gastrostomy - i.e. a tube which permits feeding direct into the stomach for residents with an eating or swallowing disorder) feeds. Three residents had PEG feeds at the time of this inspection – in one case the resident was also eating small amounts of solid food. Physiotherapists are usually sought via the PCT on referral but may also be accessed on a private basis. An optician visits the home annually but opticians are also available in Gerrards Cross. Residents requiring dentistry normally travel to an NHS dental clinic in Amersham. A wheelchair taxi service is available in Chalfont St Peter if needed. Boots in Amersham provide a pharmacy service. A chiropodist visits every six weeks. Residents, both those who completed comment cards and those spoken to during the course of this inspection, expressed satisfaction with the care provided. They reported being well cared for, being treated well by staff and DS0000019177.V312710.R01.S.doc Version 5.2 Page 13 having their privacy respected. One resident described the staff as caring and said “If I have to be somewhere then I’d like to be here”. Another described the staff as very good and said that the home was a nice place. All relative respondents expressed satisfaction with the overall care provided. Comments from relatives included ‘The staff are caring and kindly towards patients. They always pay attention to any problem brought to their notice’, ‘I am a daily visitor to my husband who is unable to communicate. He is always kept very clean and comfortable…’, ‘My [relationship and name] has been a resident for [length of time]. During that time she has received very good kindness and care’ and ‘I visit my old neighbour, now resident at Austenwood Nursing Home. She is well cared for and her room is very pleasant’. GPs reported that they were able to see their patients in private, that medication is appropriately managed in the home and that their advice or instructions are incorporated into the residents care plan. The arrangements for the control and administration of medicines appear satisfactory. Medicines are prescribed by the resident’s GP and is dispensed by Boots Chemists in Amersham. Medicines required outside of Boots normal delivery schedule are ordered by faxing a copy of the prescription. The original prescription is then given to Boots on delivery of the medicine. The home endeavours to obtain a copy of the medicines administration records (‘MAR’ sheet) when residents are transferred but the manager reports that some homes have refused to provide a copy on occasions. Medicines are recorded on receipt in the home. A list of ‘Homely Remedies’ is pre-printed but medicines from the list are not administered without the signature of the GP. The home does not use the Boots monitored dosage system. Medicines are supplied in stock containers for each resident. The home has a contract with PHS for the disposal of surplus stock and uses containers of chemicals to ‘denature’ drugs. Medicines are stored in a portable trolley, wooden cupboards, a metal cupboard inside the main cupboard for controlled drugs, and a medicines fridge. Fentanyl skin patches and Temazepam were stored in the CD cupboard. The balance of stock was checked against the records and found to be correct. The temperature of the medicines fridge is monitored with a digital thermometer. At the time the inspection, although the fridge was due for defrosting the temperature was 2.5 degrees Celsius. A tablet splitter was available if needed. A tablet counter was required. The manager reports that the home’s arrangements for the storage of medicines are checked every six months by a Boots pharmacist. No errors were noted on MAR charts examined. Only registered nurses administer medicines. The home did not have a formal procedure in place to check the competency of nurses administering medicines. New nurses are supernumerary during their induction period and administer medicines under the supervision of another nurse for the first two weeks or so. Care staff do not receive training in countersigning medicines. Records of staff signatures are retained. Update training is not currently provided. DS0000019177.V312710.R01.S.doc Version 5.2 Page 14 Staff were observed to treat residents with sensitivity and to knock on bedroom doors before entering. Personal care is carried out in bedrooms or bathrooms. Residents who are dying are cared for in the home in partnership with GPs and other services as required. These may include specialist palliative care services such as Marie Curie nurses. Analgesia may be delivered by oral medication, skin patches (such as Fentanyl), injection or syringe driver. The family and friends of residents may visit whenever they wish. There is no specific training for staff on the care of the dying person but broader based training on death and dying has included the participation of a local firm of undertakers. DS0000019177.V312710.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home maintains a programme of activities for residents and residents may have visitors at any time. These support the physical and emotional well-being of residents and maintain contact with family, friends and the local community. Residents may bring personal possessions in to the home which personalises their room, increases a sense of comfort and well-being, and maintains associations with family, friends and life events. The choice and quality of food is satisfactory and helps maintain the health of residents while contributing to quality of life. EVIDENCE: It was noted that residents had a steady flow of visitors throughout the day from around 10:00 am and continuing beyond the end of the inspection after 7:00 pm. Visitors were familiar with the home’s routine and all were observed to sign in and out and to use alcohol rub on their hands before going into the lounge. The routine of the home comfortably accommodated this flow of friends and family and at almost any time on the day of this unannounced inspection the living room was populated by residents, staff and visitors. Some visitors paid a short visit, at least one dropped in twice a day to help care for a resident, one visitor stayed for most of the day sitting with the resident, and DS0000019177.V312710.R01.S.doc Version 5.2 Page 16 one gentleman continued to visit the home even though his wife had died there three months earlier. Visitors described the home as “a nice place”, “a delightful place” and indicated that they were generally satisfied with the care provided to residents. The home is located in a quiet road, not too far from the centre of Gerrards Cross, and is conveniently situated for the amenities of the town. One visitor commented in appreciation of the efforts the home makes to celebrate occasions – the most recent being Halloween where the staff dressed up for the evening. A staff member said that in the summer a group of residents and staff occasionally went to a local pub together. An album of photographs of social occasions involving residents, staff and visitors was on the table near the entrance. The home has a part-time activities organiser. Residents’ interests are recorded in care plans. Because of the frailty of many residents many activities tend to be on a ‘one to one’ basis. Transport for outings for residents with limited mobility may be organised in conjunction with a wheelchair taxi service based in Chalfont St Peter. Recent outings have included a visit to a garden centre to choose bedding plants for the courtyard and to local areas of interest such as Windsor. A singer entertains residents monthly. Activities for Christmas were being planned at the time of this inspection in late November. Residents spend the day reading, watching TV, chatting to each other, visitors or staff or just resting. A rather lazy cat was observed to spend most of the day resting in different areas of the lounge. The courtyard is accessible from the lounge but was not used on the day of inspection because of the cool weather. The vicar or curate from the local church visits regularly. A Roman Catholic priest visits monthly. The church magazine is regularly received and copies were available for residents to read. Residents’ autonomy is respected and personal preferences are taken into account in providing care. Residents may bring furniture and other possessions in to the home as agreed with the manager. The home does not deal with resident’s finances and residents are expected to make arrangements with their families or relevant professionals in connection with these matters. Breakfast is served between 8:00 am and 9:15 am, lunch is at 12:45 pm, and the evening meal is served at 6:00 pm. Most residents have their meals in the dining room although some prefer to have meals in the lounge or in their bedroom. Some residents are bedridden and require assistance with eating. Some relatives said that they like drop in and provide support to a resident (husband or wife) at mealtimes. DS0000019177.V312710.R01.S.doc Version 5.2 Page 17 Menus are handwritten and do not include a choice of dishes. However, both the registered manager and the chef said that there would be no problem in providing an alternative dish if a resident requested it. Breakfast is usually cereal, porridge or toast although a cooked breakfast is offered twice a week and on one day at the weekend. The menus supplied for inspection included such dishes as fish pie, lamb hotpot, fried haddock, turkey escalope and roast chicken. All were served with vegetables. Desserts included treacle sponge and custard, rice pudding and jam, trifle and rice pudding and jam. The evening menu included fish fingers, potato and onion flan, sandwiches and ham salad. Drinks are provided as required. Morning coffee and afternoon tea are served with biscuits. Three residents were on PEG feeds on the day of this inspection. Meals are supplied under the supervision of a dietician. Staff are trained by experienced nurses and gain experience under the supervision of a senior and experienced care worker before being involved in PEG feeds. DS0000019177.V312710.R01.S.doc Version 5.2 Page 18 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policies and procedures on complaints and on the protection of vulnerable adults aim to ensure that complaints are properly investigated and that residents are protected from abuse. These could be improved by updating the complaints procedure, ensuring conformance to the standard, and by acquiring the most recent version of multi-agency guidance in Buckinghamshire and associated documents. EVIDENCE: The complaints policy is displayed on the wall in the entrance hall. The policy sets out the process to be followed should a resident or visitor be dissatisfied with an aspect of the service. A copy of the policy is not available in residents’ bedrooms, it is not outlined in the statement of purpose (although there is a section which states that the home will provide ‘…a simple, clear and accessible complaints procedure’) or in the home’s brochure. There is a reference to complaints in paragraph 19 of the ‘Agreement’ (contract) but this simply outlines ‘..lines of communication..’ through which a complaint may be referred. The policy on display does not fully conform to the national minimum standard by not informing a prospective complainant that they may refer a complaint to CSCI at any stage of the process. The policy appears to be due for review and updating. No complaints have been made to CSCI about this home since the last inspection. One complaint had been received by the manager and the home’s management of this appeared satisfactory. It included liaison with relevant DS0000019177.V312710.R01.S.doc Version 5.2 Page 19 agencies in the community and with CSCI. All resident respondents and all but one relative respondent who completed comment cards for this inspection stated that they were aware of the home’s complaints procedure. The manager said that the names of all residents are included in periodic returns to the local electoral registration office. In recent elections about of the residents used a postal vote. The home does not have contact with an advocacy service. The manager said that if a resident requested an advocate then she would endeavour to obtain one through organisations such as Age Concern or Help the Aged. The home has a policy governing the protection of vulnerable adults (POVA). The manager is a POVA trainer. Training is planned for 2006 through new ‘cluster’ training arrangements in Buckinghamshire. The home did not have a copy of the 2006 Buckinghamshire joint agency guidelines, nor copies of the information leaflet and card on the free confidential reporting service ‘Careline’. The manager undertook to obtain these documents from the office of the Head of Adult Protection at Buckinghamshire Social Services and to discuss them with staff. The subject of adult protection may also be included in the next quarterly stakeholder survey. The home does not look after monies on behalf of residents. DS0000019177.V312710.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, well equipped and generally well maintained environment which provides residents with a pleasant and safe place to live. However, standards of cleanliness in some areas of high activity were considered variable and potentially compromise the well-being of residents. EVIDENCE: The home is located in a quiet road, about a half to three quarters of a mile from Gerrards Cross town centre and station. Gerrards Cross is accessible by train (Chiltern Line) and by buses serving Slough, Uxbridge, High Wycombe and Beaconsfield. There is some parking to the front of the home and in the road. Information on local taxi numbers and a bus timetable was available for visitors. The premises consist of an older pleasantly proportioned large two-storey building, and a more recent ground floor extension. The home has a garden to the rear and a large enclosed courtyard. The entrance hall leads to the DS0000019177.V312710.R01.S.doc Version 5.2 Page 21 administration office and then through a set of doors to the living room. The dining room is adjacent to the open plan kitchen. Both the living room and dining room have access to the courtyard. Most bedrooms and services are on the ground floor. A passenger lift allows access between the two floors. There are 19 single bedrooms (10 with en-suite facilities (sink and WC)) and five double bedrooms (1 with en-suite facilities). A curtain separates the sleeping areas in four of the five double rooms, in the fifth this is achieved by rather less satisfactory means of a portable screen. There are five WCs and four bathrooms. Hoists, Arjo/Parker baths, and adaptations are in place to assist residents, and the home has a number of electrically controlled profiling beds. Since the last inspection a tracking hoist has been installed in one bedroom. The home was busy on the morning of the inspection and most activity tended to take place in the living room. The hairdresser was styling hair, a number of residents were watching TV, others were sitting reading, chatting or observing activity, while other residents were being attended to by staff. One visitor thought the living room more cluttered than usual. One room has been converted to a storage area for wheelchairs and other equipment. All areas of the home are accessible by wheelchair. The laundry room, which is located well away from areas of food preparation, is compact and is equipped with two relatively new washing machines and two dryers. Staffing allows for seven hours of laundry assistant time per day.. It was felt that the room was quite well organised when the laundry assistant was present but standards appeared to have slipped a little by the evening. The kitchen is open to view from the dining room. The kitchen appears to be adequately equipped for its purpose and was generally considered to be in good order. It did however appear in need of a thorough deep clean and replacement of broken or missing tiles over the servery. The insectocutor was broken and due to be replaced. Standards of cleanliness were considered variable. As noted above visitors (relatives and friends of residents and a visiting GP) were observed to use alcohol hand rub without prompting. This is a good practice. All bedrooms visited were clean and well furnished. As suggested above a more rigorous schedule of cleaning may be required in the kitchen, laundry and other areas of high activity. The ongoing redecoration of bedrooms is noted. DS0000019177.V312710.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staffing levels and the recruitment of new staff appear satisfactory and the home provides training across a broad range of subjects. This helps to ensure that there are sufficient numbers of appropriately trained staff to meet residents’ needs. However, apparent weaknesses in recording information on staff training may undermine this position and potentially lead to gaps in staff skills which could compromise the well being of residents. EVIDENCE: The present staff establishment provides the following staffing levels: One registered nurse and six care staff in the morning (08:00 to 14:00), one registered nurse and four care staff in the afternoon and evening (14:00 to 20:00), and one registered nurse and two care staff at night (20:00 to 08:00). These figures exclude the registered manager. In addition to nurses and care staff the home also employs an administrator, chef (one full-time and one at weekends), kitchen assistants, a part-time activities co-ordinator, a laundry assistant, domestic staff and a handyman. The home employs 15 care staff. At the time of this inspection 3 care staff had acquired NVQ3 and 5 acquired NVQ2. Recruitment is managed from the home. There are three different application forms depending on the post applied for. Applicants are required to provide two referees, including their most recent employer. Candidates appointed are DS0000019177.V312710.R01.S.doc Version 5.2 Page 23 required to provide an enhanced CRB although they might be appointed on a ‘POVA first’ basis working under supervision until the full CRB certificate is received. The arrangements for the supervision of staff appointed under ‘POVA first’ did not appear to conform fully to Department of Health guidance as set out in annex C to POVA guidance published in July 2004 and May 2006. The home uses an umbrella body to process its CRB application and the manager reports that it provides an excellent service. Agency staff are occasionally used and the home receives summary information on staff supplied. This includes personal details, information on training and CRB number. However, in the forms examined on this inspection, it does not give the level of the disclosure or date received. Three staff files were examined. Files contained completed application forms, references, health questionnaires, interview notes and some information on training. In the files examined photographs tended to be photocopies of passport and driving licence photos. These may not be recent. It would be preferable for the home to have a recent photograph of staff appointed. Files also contained copies of relevant Home Office documents regarding work and residency permits. Photocopies of Nursing and Midwifery Council (NMC) personal identification numbers (PIN) were on file for registered nurses. The manager ticks and dates these to confirm that ‘PIN’ numbers have been checked with the NMC before a nurse starts work. New staff were not routinely provided with copies of the General Social Care Council (GSCC) codes of practice. The manager said that stocks had run out and a new supply had not yet arrived. She undertook to follow this matter up with the GSCC. All staff receive a copy of their terms and conditions of employment with the organisation. The organisation of information on staff training appeared to have room for improvement. According to information on the pre-inspection questionnaire (PIQ), over the past twelve months staff have attended training on; infection control, fire safety, medicines administration, syringe drivers, food hygiene, first aid and nutrition in elderly care. Training planned for October and November 2006 included;oral care, moving and handling, first aid, health and safety, and male catherisation. Training planned but to be confirmed included; basic fire safety, fire training (fire marshal), and infection control. All three files examined included a training record but did not appear to have been kept up to date. These, however, were new staff but there did appear to be a more general problem of maintaining training records and of storing the information in an accessible and readily retrievable form. The home had recently begun to plan for some staff to attend training events funded by Buckinghamshire County Council and organised on the basis of a group or ‘cluster’ of care homes across the county. It was reported that this had not developed as smoothly as intended and that some training events had DS0000019177.V312710.R01.S.doc Version 5.2 Page 24 not been as successful as hoped because of a lack of support, in terms of staff numbers, on the part of some members of the cluster group, but not this home the manager emphasised. NVQ training is provided through Amersham College supplemented by distance learning (including video or DVD). Other training providers include Buckinghamshire and Milton Keynes Fire Authority (fire safety), the local PCT (infection control), and an independent consultant (food hygiene). The registered manager said that she is approved to train staff in POVA and moving and handling. First aid training should be provided through the cluster arrangement. New staff receive a comprehensive induction pack. This includes copies of a range of policies including the ‘Training and Development’ policy. This states that all new staff will receive induction training to NTO specification within six weeks of appointment, foundation training to NTO specification within the first six months, that all care staff will receive three paid days training per year, and that all nursing staff will receive five paid days training per year. Evidence in respect of the homes achievement of this was not readily available on the day of this inspection. Staff interviewed reported having attended training events over the past year including; manual handling, oral hygiene, fire safety, diabetes, medication, PEG feeds, dementia and use of syringe drivers. DS0000019177.V312710.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This is a well managed home and feedback from residents, relatives and a health and social care professional indicate that it is providing good care outcomes for residents. However, staff supervision needs to be re-established, and, while the home’s arrangements for health and safety appear thorough, it needs to have evidence in the form of a certificate by a suitably qualified person that the home’s fixed electrical wiring is considered safe. Residents can then be assured that they are receiving care from professionally supervised staff in an environment in which, as far as possible, all aspects of health and safety are addressed. EVIDENCE: The registered manager is a registered general nurse (RGN) and has been manager of the home for three years. She has completed the Registered Managers Award (RMA). The manager is therefore, appropriately experienced DS0000019177.V312710.R01.S.doc Version 5.2 Page 26 and qualified for the post. Staff described the manager (“matron”) as “caring and approachable”. Over the past year or so the manager attended ‘train the trainer’ training in moving and handling and POVA, and other training in nutrition, gastrostomy care, falls prevention, ear syringing, fire safety, and food hygiene. Lines of accountability as described by the manager are clear. The registered manager is accountable to the directors of the company, primarily to the director who acts as the ‘responsible individual’ on behalf of the organisation. Within the home, all staff are accountable to the manager. The post of deputy manager has been vacant for over eight months. A chart in the staff induction booklet shows the manager as accountable to all four directors of the organisation and all staff accountable to the manager. It does not include the post of deputy manager. The home does not carry out a comprehensive quality assurance audit but has recently started to seek the views of residents and visitors on topical subjects or subjects such as communications and nutrition. The manager is considering looking at resident and visitors views on complaints next. There appeared to be a good flow of information between staff, residents and visitors. The location of the administration office, where the manager is also based, facilitates this. Indicators of the quality of the service may also be found in care plan reviews and in reviews with care managers. Comment cards completed by residents, relatives and health and social care professionals and returned to CSCI for this inspection were overwhelmingly favourable in their views of the home. Residents reported feeling safe, being well cared for, having suitable activities, and having their privacy respected. All relative respondents expressed satisfaction with the overall care provided, reported being made welcome in the home, being kept informed of important matters affecting the resident, and being able to visit the resident in private. GP respondents expressed satisfaction with the overall care provided to residents and were satisfied with communications with the home, with staff understanding of care needs, and with staff incorporating medical advice into care plans. Care managers expressed satisfaction with the overall care provided to ‘service users’ (residents) placed in the home, were satisfied that staff demonstrated a clear understanding of residents needs, that staff followed the (care management) service user plan, and were satisfied with communications with the home. The home is responsive to CSCI inspection requirements and recommendations. As mentioned above the home’s policy is that it does not retain or manage monies on behalf of residents. This is seen as a matter for the resident, their family or professional advisers. DS0000019177.V312710.R01.S.doc Version 5.2 Page 27 Staff supervision was not operating consistently at the time of this inspection. This may be a reflection of the ongoing vacancy position at deputy level but may also reflect problems in establishing a process of regular supervision in a situation where all staff are accountable to the manager. A system of regular and effective supervision is likely to require some delegation of responsibility to staff, in particular to qualified and experienced nurses, senior and experienced care staff, and other experienced staff. Both the manager and staff acknowledged the position and, therefore, a review of the organisation’s policy and of its implementation in practice is recommended. Arrangements for ensuring the health, safety and welfare of residents, staff and visitors appear satisfactory. In addition to management action on these matters the manager said that the home’s insurers also require evidence of conformance to good practice, in particular in relation to technical systems. Staff receive initial training on moving and handling, fire safety, first aid, food hygiene and infection control during their induction. Update training on first aid, fire safety, moving and handling and infection control was included in the training programme for the final quarter of the calendar year. The registered manager is an approved moving and handling trainer. The home appears to have a sufficient range of equipment to assist residents with impaired mobility. Arrangement for the safe storage of COSHH (Control of Substances Harmful to Health) materials appear satisfactory but the home needs to obtain up to date COSHH data sheets. Copies should be available in relevant areas of the home (the cleaners store cupboard and laundry for example) and a master file in the administrative office. The home has recently had three new boilers installed. According to information supplied by the manager the gas installation was checked in September 2006, portable appliances (PAT) were checked in June 2006, and the fixed electrical wiring was checked in September 2006 but a certificate of safety was not available at the time of this inspection. Evidence of that the inspection was carried out was supplied in the form of a letter from the electrical engineers. Fire safety training was next due in November 2006, a fire drill was carried out in October 2006, fire extinguishers were checked by contractors in April 2006, fire point and emergency lighting checked in July 2006, and fire ‘Dorgards’ and alarm points are checked weekly. The manager said that fire exits are regularly checked but records are not retained. The lift is checked by an engineer quarterly, Portable hoist were last checked in September 2006, the Arjo baths in July 2006, and the tracking hoist checked in October 2006. The home has a contract with PHS for the removal of soiled waste and surplus medicines. DS0000019177.V312710.R01.S.doc Version 5.2 Page 28 DS0000019177.V312710.R01.S.doc Version 5.2 Page 29 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 17 3 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 X 3 DS0000019177.V312710.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP26 Regulation 16(2) Requirement Timescale for action 31/01/07 2 OP29 Schedule 2 3 OP38 13(4) The registered manager is required to ensure that cracked or missing tiles in the kitchen are replaced The registered manager is 31/12/06 required to ensure that the supervision arrangements for staff appointed under ‘POVA first’ arrangements conform to guidance issued by the Department of Health on 26 May 2006. The registered manager is 15/01/07 required to ensure that a certificate of safety for the fixed electrical wiring is obtained from a suitably qualified electrical engineer. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000019177.V312710.R01.S.doc Version 5.2 Page 31 1 OP7 2 3 OP16 OP18 4 5 OP19 OP26 6 7 8 OP29 OP30 OP36 9 OP38 It is recommended that the registered manager address weaknesses in daily records in care plans so that records reflect a more rounded view of the residents’ day, including psychological and social aspects of residents’ lives. It is recommended that the registered manager review and update the home’s complaints procedure and ensure that it fully conforms to the standard. It is recommended that the registered manager obtain a copy of the 2006 joint agency guidelines on the protection of vulnerable adults in Buckinghamshire and copies of leaflets and cards giving details of the local confidential reporting telephone service. It is recommended that the registered manager explore suitable alternatives to a portable screen to ensure the privacy of residents in shared rooms. It is recommended that the registered manager review the schedule of cleaning in areas of high activity, including the laundry room and kitchen, to ensure high standards of hygiene in all areas of the home. It is recommended that the registered manager obtain copies of the GSCI codes of practice and ensure that all nurses and care staff are provided with a copy. It is recommended that the registered manager ensure that staff training records are up to date It is recommended that the registered manager review the home’s current arrangements for staff supervision and establish a system which ensures that nurses and care staff receive formal supervision at six times a year. It is recommended that the registered manager obtain up to date copies of relevant COSHH data sheets. DS0000019177.V312710.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 DS0000019177.V312710.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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