Inspection on 12/04/07 for Beis Pinchos Nursing Home

This inspection was carried out on 12th April 2007.

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

Other inspections for this house

Beis Pinchos Nursing Home 14/11/07

Beis Pinchos Nursing Home 14/12/06

Beis Pinchos Nursing Home 23/01/06

Beis Pinchos Nursing Home 07/06/05

Beis Pinchos Nursing Home 30/11/04

Beis Pinchos Nursing Home 08/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Beis Pinchos Nursing Home 2 Schonfeld Square London N16 0QQ Lead Inspector Robert Sobotka Unannounced Inspection 12th April 2007 10:40 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 Beis Pinchos Nursing Home DS0000007351.V335522.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. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beis Pinchos Nursing Home Address 2 Schonfeld Square London N16 0QQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8802 7477 020 8809 7000 info@aihaltd.co.uk Agudas Israel Housing Association Eileen Gabb Care Home 43 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (35) Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Minimum Staffing Notice Four (4) service users under the age of 65 years to be accommodated in the home with dementia or in need of nursing care Up to 35 Beds for Nursing Care Date of last inspection 14th December 2006 Brief Description of the Service: Beis Pinchos Nursing Home provides specialist care services for older people from the Orthodox Jewish Community. The complex of Schonfeld Square is owned by Agudas Israel Housing Association and is a purpose built property. Beis Pinchos is a care home registered for 43 older people including 20 places for people with dementia and up to 35 service users with nursing needs. The home is based in the London Borough of Hackney on the border of Stoke Newington and Stamford Hill. It is in the midst of the largest Orthodox Jewish Community in Europe. Schonfeld Square is easily accessible by public transport and to several parks and is near shops selling kosher food. Beis Pinchos offers a wide range of religious and culturally appropriate services and activities to both service users and the well-established Orthodox Jewish Community in the immediate area. The home takes referrals from throughout the UK and abroad and is currently operating a waiting list. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and was unannounced. It was carried out by two inspectors from the Commission for Social Care Inspection, Robert Sobotka, the Lead Inspector and Tim Weller, Regulation Manager. As part of this visit, the inspectors spent some time with the Chief Executive of the Organisation, Mrs Ita Symons, the Deputy Manager and they interviewed several other staff working in the care home. Service users were spoken with in order to establish their views about living at Beis Pinchos Nursing Home. The inspectors also carried out a tour of the premises and viewed various records. The aim of this unannounced inspection was to check the home’s progress towards full compliance with the Care Homes Regulations and the National Minimum Standards for Care Homes for Older People. The inspectors would like to thank the staff and service users for contributing to this unannounced inspection. What the service does well: What has improved since the last inspection? Very limited progress has been made since the last inspection. As previously required, an application was made to the Commission to amend the number, ages and categories of service users accommodated in the home, so that the situation in the home accurately reflects its registration certificate. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 6 What they could do better: It is of concern to the Commission to identify that a large number unsafe practices in relation to health and safety were observed during this inspection visit. Following ongoing concerns in relation to the organisation’s recruitment and selection practices, the Commission has issued an enforcement notice to ensure that the requirement is met without any further delay. 24 new requirements and 3 good practice recommendations were issued during this inspection visit. The following new requirements were made: - The responsible person must ensure that the home’s statement of purpose is reviewed to include any changes of staff working in the home and their qualifications and all information listed in Schedule 1 of the Care Homes Regulations. - It is required that the responsible person ensures that service users are only admitted to the home once all relevant pre-admission documentation has been obtained. - The responsible person must ensure that service users’ care plans are reviewed on a monthly basis or more frequently if necessary. - It is required that each service user’s care plan includes his/her photograph. - The responsible person must ensure that all staff receive manual handling training and that staff are aware of safe moving and handling practices. - The responsible person shall make satisfactory arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. - The responsible person must ensure that kitchen areas are kept clean at all times. - The responsible person must ensure that a record of fridge/freezer temperatures is maintained. - The responsible person must ensure that a record of temperatures of cooked food is maintained. - The responsible person must ensure that record is maintained of all money and other valuables deposited by a service user for safekeeping or received on the service user’s behalf, which shall state the date on which the money or Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 7 valuables were deposited or received, the date on which any money or valuables were returned to a service user or used, at the request of the service user, on his behalf and, where applicable, the purpose for which the money or valuables were used; and shall include the written acknowledgement of the return of the money or valuables. - The responsible person must ensure that any complaint made under the complaints procedure is fully investigated. - The responsible person must ensure that the home’s Whistleblowing Policy is reviewed/improved to include information and contact details of the local office of the Commission for Social Care Inspection. - The responsible person must ensure that the Commission is informed without delay of any event listed in Regulation 37 of the Care Homes Regulations. - It is required that the home’s safety arrangements are reviewed where appropriate to ensure that those service users with dementia are allowed to move around areas designated for their use, unless they are supervised by members of staff in line with their care plan. - The responsible person must ensure that all fire doors are kept closed, unless magnetic door closures are installed and in use. - The responsible person must review arrangements in relation to staff responding to nurse call to ensure that any situations when an alarm facility is activated. - The responsible person must ensure that the home undertakes a consultation with the fire authority to discuss satisfactory fire safety arrangements and that adequate precautions against the risk of fire are maintained at all times. - The responsible person must ensure that all cleaning materials are kept locked away when not in use to comply with the Control of Substances Hazardous to Health (COSHH) Regulations. - The responsible person must ensure that appropriate security arrangements are in place to secure the boiler room when not in use. - The responsible person must ensure that carpet located outside the medication room is replaced, re-laid, or otherwise made safe. - The responsible person must review the current staffing levels to ensure that they are sufficient in numbers as are appropriate for the health and safety of service users. - The responsible person must ensure that all staff receive foundation training to National Training Organisation specification within the first six weeks of appointments to their posts, including training on the principles of care, safe Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 8 working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. - The responsible person must ensure that care staff receive all necessary training (including refresher training where needed) appropriate to the work they are to perform. This includes training in safe moving and handling techniques, administration of medicines, and health and safety. - The responsible person must ensure that confidentiality is maintained in the home at all times; this includes safe storage of confidential information, such as staff appraisal and supervision notes. In addition the following good practice recommendations were made during this inspection visit: - Visiting arrangements should be reviewed to ensure that small children are supervised in the home - It is recommended that hours worked by staff be reviewed to ensure that staff are not working excessive hours. - It is recommended that the times of fire drills be altered on a regular basis, so that staff working different shifts are given opportunity to participate in the fire evacuation procedure. 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. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 9 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 Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 10 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): 1, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose required updating. The responsible person did not always ensure that all information required by law was collected prior to service users being admitted into the home. This required improvement. EVIDENCE: The home had a statement of purpose in place. The document required updating/review to include any changes of staff working in the home and their qualifications. The responsible person must ensure that the home’s statement of purpose is reviewed to include any changes of staff working in the home and their qualifications. Since the last inspection, the registered manager has submitted an application to the Commission, so that the registration certificate accurately reflects the number, ages and categories of service users accommodated in the home. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 11 As part of this visit, the inspector checked files of two services users who had been admitted to the home since the last inspection. There was evidence that the registered manager completed the pre-admission assessment document, however in the case of one service user, who was funded by one of the London Boroughs, the home did not obtain a summary of the Care Management assessment and a copy of the Care Plan produced for care management purposes. It was noted that the registered manager completed the preadmission assessment on the day of admission, in respect of both service users. In addition one of the service users came to the home on a respite basis for 5 days, for which a pre-admission assessment had been carried out. The person then was readmitted to the home with the intention to remain in the home on a permanent basis 6 weeks later, however a further assessment of their needs had not been undertaken. It is required that the responsible person ensures that service users are only admitted to the home once all relevant preadmission documentation has been obtained. The home provides specialist care services for older people from the Orthodox Jewish Community and the inspectors were satisfied that their cultural needs were being met. Staff working in the home were aware of Jewish customs and traditions. At the time of this unannounced inspection none of the service users were receiving intermediate care, therefore the standard relating to the home’s ability to meet the needs of those requiring intermediate care was not assessed on this occasion. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 12 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, 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all care plans were being reviewed on a monthly basis, as required. Documentation viewed suggested that staff did not always follow correct moving and handling procedures following falls of service users. The home’s medication systems were unsatisfactory and require urgent improvement. Service users were being treated by staff working in the home with dignity and respect. EVIDENCE: As part of this visit, the inspectors viewed a selection of individual service user’s care plans, which were chosen at random. Each care plan listed actions needed by care staff to ensure that all health care, social cultural and personal needs of each service user are met. Care plans also contained appropriate risk assessments, including moving and handling assessments. Care plans viewed were generally reviewed on a monthly basis, however it was noted that one of the care plans had not been reviewed when the service user was re-admitted to the home. This was brought to the attention of the deputy manager during Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 13 this inspection visit. The responsible person must ensure that service users’ care plans are reviewed on a monthly basis or more frequently if necessary. In addition it was noted that not all care plans included a photograph of a service user as required. It is therefore required that each service user’s care plan includes his/her photograph. Documents viewed evidenced that service users received appropriate input from medical professionals and any required specialist facilities and each service user was registered with the General Practitioner. At the time of this visit, the inspector spoke with the district nurse who visits some of the service users on a regular basis and she said that she was very satisfied with the way the home provides medical care to the service users living at Beis Pinchos. Following the review of incident and accident records, the inspector noted that many records of falls described an incorrect sequence of checks undertaken by staff prior to moving a service user. One of the reports was not factual and a member of staff who completed the form assumed “loss of balance” even though the incident was not witnessed. During the staff interview a scenario regarding falls was given to a member of staff, who failed to respond appropriately. The responsible person must ensure that all staff receive manual handling training and that staff are aware of safe moving and handling practices. As part of this inspection visit, the home’s medication systems were checked. All medication is kept in a medication room. Only registered nurses are authorised to administer prescribed medication and one nurse was in charge of carrying out regular medication audits. One of the inspectors checked a random selection of medication kept in the home and relating records. It was noted that records of medication received by the home for one of the service users (who was receiving a course of antibiotics) was not accurately maintained. A medication administration record belonging to another service user also did not contain information about quantity of tablets received by the home. In the case of another service user, the home received medication (not prescribed) from the service user’s relatives along with requests for the drug to be crushed. This was being done without the General Practitioner’s prior consent. This practice is unacceptable, unless authorised by a doctor. Nursing staff were not aware of the dietary contraindications associated with a medication prescribed for several service users. Towards the conclusion of the inspection, inspectors were concerned to observe the night nurse carrying a tray with several unmarked medication containers filled with tablets, which were stacked on top of one another, along with several bottles of drops. Inspectors confronted the member of staff and she commented that she was aware that this constituted dangerous and Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 14 unacceptable practice. She also stated that evening time was a very busy period that that this was the only way for her to ensure that the workload is completed in time. This information was brought to the attention of the deputy manager during feedback given by the inspector the following day. The responsible person shall make satisfactory arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The inspectors spoke with several service users throughout the day. They felt that staff in the home were very approachable, friendly and they had time to listen to service users. Service users also felt that they were treated with dignity and respect. One service user however commented on high staff turnover and expressed a wish to see more familiar faces. The death of a service user is handled according to Jewish Law. Staff have received training in palliative care to ensure that service users receive appropriate attention and pain relief. Staff have also attended a lecture on cancer. Relatives are able to stay with service users for as long as they wish. In keeping with Judaic practice, the home has its own mortuary at the rear of the garden. Beis Pinchos Nursing Home DS0000007351.V335522.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home continues to provide a wide range of activities to people living at Beis Pinchos. Those living in the home are supported to exercise choice and to take control over their lives. Visiting arrangements within the home should be reviewed. Service users enjoyed food offered by the home, however more attention should be paid to cleanliness and ensuring that records of fridge/freezer temperatures as well as temperatures of food cooked are maintained. EVIDENCE: The home continues to provide a good range of activities to people living at Beis Pinchos. The home has a minibus, which is used for outings. Activities programmes are circulated to every service users each Sunday for the forthcoming week. These are also displayed throughout the house. Activities usually start at 10.15am and finish at around 9pm. There were also specialised activities for people with dementia. On the day of the inspection, there was an outing to Victoria Park in the afternoon and a film session in the evening. Members from the local community also support service users in attending daily prayers in the home’s Synagogue. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 16 Maintenance of family involvement is very much part of the Jewish ethos of the home. Visitors were seen visiting service users throughout the day. During the evening inspectors observed that a small boy was wandering around the floor occupied by people with dementia and after a couple of minutes he went into one of the rooms. The inspector asked a member of staff how the boy came to be on this floor without supervision, the member of staff replied: “visitors – they get free reign here”. Whilst it is appreciated that families and friends are welcome to visit service users, visiting arrangements should be reviewed to ensure that small children are supervised in the home. Any specific requests by service users as to whether and when they would like to receive visitors were clearly displayed in the home. Most service users’ finances are handled by their relatives, which is traditionally accepted. At the time of this visit the home was safe keeping some money for only one service user. This money was kept locked; however no record was maintained of this cash held, either in the home or in the Head Office. The responsible person must ensure that a record is maintained of all money and other valuables deposited by a service user for safekeeping or received on the service user’s behalf, which shall state the date on which the money or valuables were deposited or received, the date on which any money or valuables were returned to a service user or used, at the request of the service user, on his behalf and, where applicable, the purpose for which the money or valuables were used; and shall include the written acknowledgement of the return of the money or valuables. Service users are encouraged to bring their own possessions, as agreed on admission to the home. Those who lived in the home had access to their records, in accordance with the Data Protection Act. All meals provided by the home are Kosher and cooked to meet traditional Jewish cuisine. The kitchen conforms to Jewish Laws. The inspectors joined service users for lunch. Food served was well presented and nutritious. There was a wide range of dishes offered to the service users and those who spoke to the inspector said that they liked food offered in the home. Individual requests are collected from each service user each day, should they change their mind and request other food, this is accommodated. Any other requests and special diets are catered for. Menus are provided in large print. It was noted that two complaints have been made to the home by one of the volunteers about how long it takes for service users to be served breakfast, however there was no evidence that this complaint has been dealt with. Although communal dining is encouraged, room service was offered to those who preferred to eat in their own company. Separate eating arrangements are Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 17 also offered to those service users who have dementia and/or require additional assistance with their meals. As part of this visit, the home’s kitchen premises were checked. Attention to cleanliness must be improved, as some debris was found under kitchen units. The inspector also suggested deep cleaning of the catering premises. The chef confirmed that records of fridge/freezer temperatures had not been maintained possibly for as long as three weeks prior to this inspection visit. There was also no evidence that cooked food temperatures have been taken and recorded since January 2007. The responsible person must ensure that kitchen areas are kept clean at all times. The responsible person must ensure that record of fridge/freezer temperatures is maintained. It is also required that the responsible person ensures that record of temperatures of cooked food is maintained. Beis Pinchos Nursing Home DS0000007351.V335522.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all complaints have been dealt with in a timely fashion. The home’s Whistleblowing Policy required review/improvement. Not all significant events have been reported to the Commission, as required by law. EVIDENCE: The record of complaints was checked as part of this inspection. As previously mentioned the home has recently received two complaints from one of the volunteers about how long it takes for service users to be served breakfast, however there was evidence that this complaint has been dealt with. The responsible person must ensure that any complaint made under the complaints procedure is fully investigated. The home’s Whistleblowing Policy required review/improvement, as the current version stated that any concerns about unacceptable practices should be reported to the Chief Executive and does not make any reference to the Commission for Social Care Inspection. The responsible person must ensure that the home’s Whistleblowing Policy is reviewed/improved to include information and contact details of the local office of the Commission for Social Care Inspection. During this inspection visit, the inspector checked the record of accidents and incidents in the home. It was noted that there were two separate reports made about passengers being trapped in the lift, however this was not reported to Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 19 the Commission as required by law. The responsible person must ensure that the Commission is informed without delay of any event listed in Regulation 37 of the Care Homes Regulations. Beis Pinchos Nursing Home DS0000007351.V335522.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of areas within the home as well as staff practices were observed during this inspection, which may place service users at risk. EVIDENCE: The premises are situated in the heart of Stoke Newington. The home is situated in Schonfeld Square, which is purpose built and has won some architectural awards. Service users’ bedrooms are located on three floors. All bedrooms have en-suite facilities and are similar in design. There are 3 quiet lounges and a larger lounge on the ground floor, where most of the activities take place. There is also a synagogue. Work has started on building an additional synagogue at the rear of the building, which will also contain a day centre for activities. The premises were well maintained. The third floor accommodates 8 service users with dementia. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 21 All communal areas are spacious. The main lounge is used for a variety of specific cultural, social and religious activities and there are three lounges where service users can meet relatives. Lighting in communal areas was sufficiently bright and positioned to facilitate reading and other activities. The inspectors commenced this visit with a tour of the premises. The unit on the third floor, which is occupied by service users with dementia, was not securely locked and the keypad system was disabled, which meant that the service users could walk out from the unit onto the home’s staircase. This was brought to the attention of a member of staff of duty, who put it right straight away. The same keypad was again found disabled in the evening, which gave the inspectors concerns that this may be a usual practice in the home. In addition it was noted that the door that separated the top floor dementia unit with the newly built sheltered flats in another part of the building, was left wide open and people with dementia could freely wander away from the registered part of the building. This was again brought to the attention of a member of staff in charge during the evening shift. It is required that safety arrangements are reviewed where appropriate to ensure that those service users with dementia are allowed to move around areas designated for their use, unless they are supervised by members of staff in line with their care plan. As previously mentioned, the home’s visiting arrangement for relatives and friends, especially those with small children must also be reviewed. The carpet located in front of the medication room was old, frayed and torn and required replacing. During the tour of the premises, the inspectors viewed a number of bedrooms on each floor, which were chosen at random. All bedrooms had a bed, a builtin wardrobe and a further wardrobe, a chest of drawers and a table and chair. All bedrooms have en-suite facilities and an additional sink unit housed behind cupboard doors. The floor of one en-suite bathroom located on the top floor had been left with standing water and presented a slip hazard. Although a squeegee was present, the floor remained very wet. This was brought to the attention of a member of staff who was accompanying both inspectors during the tour of the premises in the morning. It was noted that one of the bedroom doors (fire doors) was wedged open in the evening. The responsible person must ensure that all fire doors are kept closed unless a suitable fire-compliant door restraint (such as an automatic magnetic release system) is installed and in use. There are 6 communal bathrooms, one with a Parker bath on the first floor. In the evening, the door to the boiler room was left unlocked and the second door, leading directly into the boiler room had been removed from its hinges, Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 22 which meant that the boiler room was accessible to service users. The responsible person must ensure that appropriate security arrangements are in place to secure the boiler room when not in use. A room in which cleaning materials were stored was also kept unlocked and a number of substances hazardous to health such as bleach and other toxic chemicals were freely accessible to service users. The responsible person must ensure that all cleaning materials are kept locked away when not in use to comply with the Control of Substances Hazardous to Health (COSHH) Regulations. In the evening, the inspector found a metal handrail left in the corridor near the boiler room, posing a potential trip hazard. This was brought to the attention of a member of staff on duty and the handrail was subsequently removed. There was evidence of overhaul of the home’s fire detection system on the top floor on the day of this inspection visit. Bare cables were apparent adjacent to every smoke detector. Staff were unable to give assurance that the fire detection system was appropriately functioning. In addition the inspectors noted two food trolleys blocking the fire exit by the bottom of the stairwell opposite the kitchen. This was brought to the attention of a member of staff who said that this occurs frequently. This practice is unacceptable. The responsible person must ensure that the home undertakes a consultation with the fire authority to discuss satisfactory fire safety arrangements and that adequate precautions against the risk of fire are maintained at all times. The home had an adequate provision of aids and adaptations in place to assist those with physical disabilities. The home has a lift, grab rails in corridors and communal areas. There is a nurse call alarm system with activation points in all rooms. To test the response of staff working during the evening shift, the inspectors activated a nurse call alarm in one of the toilets on the top floor (dementia unit) at 19:09. The alarm was eventually cancelled by a member of staff at 19:21. In the meantime the member of staff was unable to identify which room had been activated and he was unable to open the door with a simple privacy lock. This shows that staff response to emergency situations was unacceptably slow and required review. The responsible person must review arrangements in relation to activation of the nurse call system to ensure that service users are protected by a timely and appropriate staff response. The premises were clean and hygienic at the time of this inspection, with the exception of the kitchen premises, which required deep cleaning. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 23 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The organisation has failed to ensure that recruitment and selection of staff is improved and as a result an enforcement notice has been served. The home’s staffing levels and numbers of hours worked by care staff required review. Some additional and/or refresher training is also required for care staff. EVIDENCE: Duty rosters were being maintained in the home and were available for inspection. The inspectors noted that several staff had been working excessive hours of up to 68 hours per week. It is recommended that hours worked by staff be reviewed to ensure that health, safety and quality of care delivery is not compromised. Staff spoken with during the course of this inspection felt that the needs of service users had increased resulting in increased workloads. The home had previously had a large ratio of staff to service users, however the findings from this inspection visit suggest that the current staffing levels may need to be reviewed in order to ensure that appropriate care is provided to service users at all times. The responsible person must review the current staffing levels to ensure that they are sufficient in numbers as are appropriate for the health and safety of service users. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 24 At the time of this inspection a number of staff had either achieved or were working towards their National Vocational Qualifications in Care. Staff recruitment and gathering of all required documentation in respect of staff employed in the home is carried out by the Chief Executive and the Human Resources Department based in the Organisation’s head office and is not directly a responsibility of the registered manager. As part of the inspection, the inspectors viewed 8 personnel files of staff. Documents demonstrated that some staff were allowed to start working in the home before all information required by law, such as Criminal Records Bureau Disclosures and/or references was obtained by the Organisation. In addition, the inspectors viewed the Organisation’s Recruitment Policy and Procedures and although it outlined the selection and interviewing procedure, evidence of staff spoken with indicated that it was not being followed. Staff interviewed during the inspection visit confirmed that they were interviewed and following the interview they were asked to complete an employment application form. One member of staff confirmed that they had been promoted to a senior position without a further interview having taken place. The inspectors were also concerned that the home had used two “volunteers” to assist in the kitchen during busy periods, neither of whom had Criminal Records Bureau Checks. This practice is unacceptable and must stop immediately. Following ongoing concerns in relation to the organisation’s recruitment and selection practices, the Commission has issued an enforcement notice to ensure that the requirement is met without further delay. Although staff training was not fully assessed during this inspection, based on discussions with staff working in the home, review of documentation as well as direct and indirect observation, the inspectors noted some staff required refresher training in moving and handling, the safe administration of medicines, and health and safety. In addition, staff were unable to provide consistent information about the home’s induction training. The responsible person must ensure that all staff receive foundation training to National Training Organisation specification within the first six weeks of appointment to their posts, including training on the principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. Beis Pinchos Nursing Home DS0000007351.V335522.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. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are required to ensure that the home is managed in a satisfactory manner. Storage of confidential information in the home required improvement. EVIDENCE: The registered manager was not preset at the time of this inspection; therefore standard 31 was not assessed on this occasion. Appropriate quality assurance systems were in place. The Chief Executive visited the home nearly every day. Monthly unannounced visits were taking place in line with Regulation 26 of the Care Homes Regulations. Following each visit, the responsible person produces a thorough report, a copy of which is available in the home. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 26 The home was appropriately insured for its purpose. The home’s business and financial plans were not checked during this inspection visit. As previously mentioned, the home must maintain records and receipts of possessions handed over by service users and/or their relatives for safekeeping. Additionally, the responsible person must ensure that the following records are maintained in the home and kept under review: - Service users’ care plans; this includes a photograph of each service user, - Records of fridge/freezer temperatures, - Records of cooked food temperatures, - Records of complaints, including evidence that each complaint has been dealt with, - Information in respect of each member of staff employed in the home, as listed in Schedule 2 of the Care Homes Regulations. - Any other documents listed in Schedule 4 of the Care Homes Regulations. Staff supervision and appraisal files were not viewed during this inspection, however it was noted that the yearly appraisal documents, which belonged to 3 members of staff were left on the desk in the manager’s office and could be read by anyone using the room. The keyworker monthly report form had individual information on one side and a list of every service user accommodated in the home on the reverse of the document. The responsible person must ensure that confidentiality is maintained in the home at all times, this includes safe storage of confidential information, such as staff appraisal and supervision notes. A random sample of the home’s health and safety records was checked during this inspection visit. The Landlords Gas Safety Certificate was issued on 05/11/06 and was satisfactory. The home’s electrical wiring certificate was issued on 26/04/06 and was valid for 3 years. Fire safety records showed that the home’s fire alarm was last serviced on 02/11/06. The home received a visit from the London Fire and Emergency Planning Authority in February 2007, which was satisfactory, however as described in previous parts of this report, the fire detection system on the top floor of the building did not appear fully operational at the time of this visit. Record of fire drills was kept. According to the record, the last fire drill was carried out on 12/01/07. The inspectors noted that all but one drill took place between 9 am and 11 am. It is recommended that the time of the fire drill is altered on regular basis, so that staff working different shifts are given opportunity to participate in the fire evacuation procedure. Health and safety risk assessments were reviewed on a monthly basis. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 27 Throughout the day, the inspectors observed several unsafe practices in relation to health and safety, which required improvement. For further details, please refer to the “Environment” section of this report. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 28 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 2 x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 3 2 2 x 3 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 3 2 x 2 1 Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 7, 9, 19 Requirement Timescale for action 18/05/07 2. OP1 4 3. OP3 14(1) 4. OP7 15(2)(b) The organisation must ensure that all information listed in Schedule 2 of the Care Homes Regulations is maintained and that staff are only employed once all the necessary checks have been carried out. (Previous timescales of 01/03/06 and 01/03/07 were not met.) The responsible person must 01/06/07 ensure that the home’s statement of purpose is reviewed to include any changes of staff working in the home and their qualifications and all information listed in Schedule 1 of the Care Homes Regulations. It is required that the 01/06/07 responsible person ensures that service users are only admitted to the home once all relevant pre-admission documentation has been obtained. The responsible person must 01/06/07 ensure that service users’ care plans are reviewed on a monthly basis or more frequently if necessary. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 30 5. 6. OP7 OP8 17(1)(a) Sch 3.2 13(5) 7. OP9 13(2) 8. 9. OP15 OP15 23(2)(d) 16(2)(g) 10. 11. OP15 OP14 16(2)(i) 17(2) Sch 4. 9 12. OP16 22(3) 13. OP18 13(6) It is required that each service user’s care plan includes his/her photograph. The responsible person must ensure that all staff receive manual handling training and that staff are aware of the safe moving and handling practices. The responsible person shall make satisfactory arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The responsible person must ensure that kitchen areas are kept clean at all times. The responsible person must ensure that record of fridge/freezer temperatures is maintained. The responsible person ensures that record of temperatures of cooked food is maintained. The responsible person must ensure that record is maintained of all money and other valuables deposited by a service user for safekeeping or received on the service user’s behalf, which shall state the date on which the money or valuables were deposited or received, the date on which any money or valuables were returned to a service user or used, at the request of the service user, on his behalf and, where applicable, the purpose for which the money or valuables were used; and shall include the written acknowledgement of the return of the money or valuables. The responsible person must ensure that any complaint made under the complaints procedure is fully investigated. The responsible person must DS0000007351.V335522.R01.S.doc 01/06/07 15/07/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 15/06/07 Page 31 Beis Pinchos Nursing Home Version 5.2 14. OP18 37 15. OP19 23(2)(a) 16. OP19 23(4) 17. OP22 23(2)(n) 18. OP19 23(4) 19. OP19 13(4) 20. OP19 23(2) ensure that the home’s Whistleblowing Policy is reviewed/improved to include information and contact details of the local office of the Commission for Social Care Inspection. The responsible person must ensure that the Commission is informed without delay of any event listed in Regulation 37 of the Care Homes Regulations. It is required that the home’s safety arrangements are reviewed where appropriate to ensure that those service users with dementia are allowed to move around areas designated for their use, unless they are supervised by members of staff in line with their care plan arrangements. The responsible person must ensure that all fire doors are kept closed, unless magnetic door closures are installed and in use. The responsible person must review arrangements in relation to staff responding to nurse call to ensure that any situations when an alarm facility is activated. The responsible person must ensure that the home undertakes a consultation with the fire authority to discuss satisfactory fire safety arrangements and that adequate precautions against the risk of fire are maintained at all times. The responsible person must ensure that all cleaning materials are kept locked away when not in use to comply with the Control of Substances Hazardous to Health (COSHH) Regulations. The responsible person that DS0000007351.V335522.R01.S.doc 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 15/05/07 15/05/07 Page 32 Beis Pinchos Nursing Home Version 5.2 21. OP19 23(2)(d) 22. OP27 18(1)(a) 23. OP30 18(1)(c) 24. OP30 18(1)(c)(i ) 25. OP37 17(1)(b) appropriate security arrangements are in place to ensure that the boiler room is kept locked when not in use. The responsible person must ensure that carpet located outside the medication room is replaced. The responsible person must review the current staffing levels to ensure that they are sufficient in numbers as are appropriate for the health and safety of service users. The responsible person must ensure that all staff receive foundation training to National Training Organisation specification within the first six weeks of appointments to their posts, including training on the principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. The responsible person must ensure that care staff receive all necessary training (including refresher training where needed) appropriate to the work they are to perform. This includes training in safe moving and handling techniques, administration of medicines, and health and safety. The responsible person must ensure that confidentiality is maintained in the home at all times, this includes safe storage of confidential information, such as staff appraisal and supervision notes. 01/07/07 15/06/07 01/07/07 15/07/07 01/06/07 Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP13 OP27 OP38 Good Practice Recommendations Visiting arrangements should be reviewed to ensure that small children are supervised in the home. It is recommended that hours worked by staff be reviewed to ensure that staff are not working excessive hours. It is recommended that time of the fire drill be altered on regular basis, so that staff working different shifts are given opportunity to participate in the fire evacuation procedure. Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beis Pinchos Nursing Home DS0000007351.V335522.R01.S.doc Version 5.2 Page 35 - 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. 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