Inspection on 10/12/07 for Boynes Nursing Home, The

This inspection was carried out on 10th December 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 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

Boynes Nursing Home, The 02/03/09

Boynes Nursing Home, The 21/08/06

Boynes Nursing Home, The 27/03/06

Boynes Nursing Home, The 23/06/05

Boynes Nursing Home, The 14/03/05

Boynes Nursing Home, The 20/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Boynes Nursing Home, The Upper Hook Road Upton-upon-severn Worcestershire WR8 0SB Lead Inspector Jane Morgan Key Unannounced Inspection 10th December 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Boynes Nursing Home, The DS0000004097.V356253.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. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boynes Nursing Home, The Address Upper Hook Road Upton-upon-severn Worcestershire WR8 0SB 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) 01684 594001 01684 594812 matron.theboynes@stcloudcare.co.uk St Cloud Care Plc Mrs Gaik Cheng (Pearl) Winchester Care Home 38 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (38), of places Physical disability over 65 years of age (38) Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2006 Brief Description of the Service: The Boynes Nursing Home is a country house in a rural setting, with views of the Malvern Hills and surrounding countryside. The home is part of St Cloud Care Plc and is registered to provide nursing care for a maximum of thirtyeight people with needs arising from the ageing process, and older people with physical disability. The home may also accommodate three people with needs arising from a dementia illness. The home has planning permission to increase the size of the home to 41 beds. The first phase of the extension to the home has been completed and has been registered by the Commission. A second phase is continuing. Once complete the home plans to provide two separate units, one for the care of frail older people, and one for the care of people with dementia. The current range of fees is £600 - 720 per week. The fees do not include the following: - hairdressing, newspapers & magazines, private physiotherapy & chiropody, medical requisites (other than those prescribed), personal nursing care for appointments off the premises, toiletries and any luxury or personal items. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information in this report has come from the visit to the home, the annual quality assurance assessment (AQAA) provided by the home, surveys completed by residents, relatives, visiting health professionals and staff employed at the home. The Commission has a record of events at the home since the last inspection. This was also looked at. The care provided to three residents was looked at thoroughly. Practice at the home was observed. Residents, relatives and staff were talked to. The registered manager left her post at the home in the week before the inspection. A manager designate had been in post for a week and the operations manager for two months. What the service does well: What has improved since the last inspection? People who struggle to eat very well are being checked and offered more specialist help. People needing a little bit of help to eat at mealtimes are receiving better help. If bedrails are needed for the safety of people living at the home consent from relatives has been obtained and the rails are checked for safety each month. A record of complaints is being kept in the home. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 6 The way in which checks are made on people applying for jobs at the home has been improved. No cleaning products were left where people living at the home might find them and wheelchairs had two footrests attached to them. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 7 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 Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual needs of people who may come to live at the home are assessed before they move into the home in order to establish the home’s ability to meet those needs. EVIDENCE: The files containing records for three people living at the home were looked at. A registered nurse from the home had visited people who may come to live at the home prior to admission and completed a thorough assessment of care needs. This had been checked on the day of admission to see whether any of the identified needs had changed. Three people living at the home returned surveys. Two said that they received enough information before moving in and one said that they did not. Two Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 9 stated that they had a contract for the service to be provided by the home, and one stated that they did not. A requirement was made in the report following the inspection of August 2006 for the contract to be reviewed. The newly appointed operations manager stated that it would shortly be reviewed and that people admitted to the home were told verbally that 28 days notice of fee increases would be given. Information about fee levels was provided by the manager designate as the service users’ guide in the entrance hall needed to be updated. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were difficult to follow, not always sufficiently detailed and not always up-to-date. Risk assessments need improvement. Residents have access to health care services and medication is generally managed satisfactorily. There was positive feedback about the approach of staff but evidence of poor practice relating to respect for privacy and dignity was seen EVIDENCE: The care plans for three people living at the home were looked at. They covered physical needs and the care to be provided to meet these. However, oral hygiene was not covered. Areas of mental wellbeing were covered, for example, help with depression and agitation. Some of the care plans were not up-to-date, for example, there was a care plan for the use of a catheter by one person. This had been removed in Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 11 November. It was noted at the bottom of the plan that an incontinence pad was now worn, with no further information. It was noted in a care plan that a person living at the home could be physically abusive and that a chart to monitor this should be filled in. The care plan did not contain sufficient guidance for staff about the approach to be taken. It was of concern that a care plan included instructions to staff not to force a person living at the home to eat and that staff were not allowed to restrain the person against their wishes. Instructions for staff should be focussed on positive approaches to managing needs. Care plans did not include social needs. There was no evidence of involvement in the devising of care plans by people living at the home or their relatives and friends. The newly appointed operations manager provided two examples of completed care plans in the new format. These had been written for use in staff training. These included additional information, for example, personal fire evacuation plans, oral hygiene, social information, social activities and a life history. The comment card returned by a GP stated that they were satisfied with the care provided to people living at the home. Two of the people living at the home who returned surveys said that they always received the care and support they needed, one said that they usually did. A relative commented, “they deal with him very well as he gradually gets worse.” Another relative said, “they give my mother professional nursing care and lots of TLC”. Equipment for the promotion of tissue viability and the prevention and treatment of pressure sores is available. There was evidence in records that people living at the home saw a GP and other health professionals when needed. For example, a dietician was visiting one of the people living at the home. The dietician stated that the home seeks advice and acts upon it. “The care home will always contact the department if there are any concerns regarding the patient’s nutritional status and are continually assessing the situation and always make contact when there are uncertainties.” A speech and language therapist was visiting two of the people who live at the home. She said that staff followed her advice, patients were spoken to appropriately and that changes to posture and oral comfort were made on her advice. Risk assessments for moving and handling, nutrition, falls, continence, and the use of bedrails were seen in the care records looked at. Some of the information in the risk assessments was contradictory. For example, a moving Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 12 and handling assessment included that a person living at the home needed the help of one person to wash, later it was recorded that the help of two people was needed. An assessment for the use of bedrails included “not for bedrails at present”, “to monitor” and “considered unsafe without bedrails”. Consent had been obtained from relatives for the use of bedrails. There were clear records of medication being ordered, received, administered and disposed of by the home. The home has obtained a copy of the guidance for care homes written by the Royal Pharmaceutical Society of Great Britain. Since the last inspection the home’s medication policy has been reviewed. Insulin pens are now labelled with the name of the person using them. A bottle of diazepam dated 12/10/06 was found in the medicines trolley. The MAR indicated that the person for whom it had been prescribed was no longer taking this medication. This was removed by the manager designate for disposal. Medication records sometimes included the code N for not required when medication was prescribed to be taken when required, and at other times a gap was left. The manager designate said that she intended to address this with staff so that no gaps were left. Written amendments to the medication administration records (MAR) were signed by one nurse, rather than the recommended two. People living at the home said that staff listened to them and acted on what they said. The dietician visiting the home stated that the people living at the home were spoken to appropriately. Comments from a health professional included that they were concerned about the level of working knowledge of the care of people with dementia, how to approach someone who is confused. We saw staff attempting to administer medication at the table at lunchtime and the person living at the home resisting and crying. Staff spoke gently and encouragingly to the person concerned but this public attempt led to comments about the behaviour of the person from other residents present. Another member of staff was observed to be patiently encouraging a person who was confused to sit at the table to eat. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 13 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. People living at the home have opportunities to join in social and recreational activities and they are able to keep in contact with family and friends. The home needs to improve residents’ ability to make choices in some situations. A well-balanced, varied diet is offered but the presentation of food needs some improvement. EVIDENCE: The home has employed an activities co-ordinator (diversional therapist) for 22 hours each week. The manager designate said that the home was advertising an additional 18-hour post. A schedule of December entertainment had been drawn up. This included visits by choirs and organ playing. Two of the people living at the home commented that there were “usually” activities that they could take part in. Two relatives returned surveys. One commented that the home “always” helped their relative to keep in touch and the other said that this “usually” Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 14 happened. A relative spoken to during the inspection said that he visited every day and felt able to come at any time. The visitors’ book indicated that the home is visited at various times of the day and evening. The operations director stated that training would be provided for staff on residents’ rights to autonomy and choice. She said that she would like the home to become more person-centred with fewer routines. Concerns had arisen recently about the denial of choice to a resident in relation to the taking of medication and the way in which this took place. This will be referred to more fully in the section on complaints and protection. A four-week menu is provided. Residents eat breakfast in their room and many eat all meals in their room as they are very frail. We ate lunch with the residents. Staff were offering assistance where required. For some of the residents the main course was served in a pudding bowl. The manager designate said that this would be addressed and plate guards used. She acknowledged that the main course and pudding were still being served to some residents at the same time and that this was not good practice. Two people living at the home commented in the surveys on the food. One said that they “always” liked the food and the other said “usually”. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People know how to complain. Complaints are investigated and action taken. The home’s practice is in relation to the protection of vulnerable adults needs to improve. EVIDENCE: The home’s complaints’ file held records of two complaints. One of these had been made to the Commission and returned to the provider for investigation. Both had been investigated and action taken to try to prevent recurrence. As a result of one of the complaints staff had been disciplined. The complaint sent initially to the Commission raised issues about the style of management of the home and communication with relatives. Two residents returning surveys said that they did not know how to make a complaint, one said that they did. Both the relatives responding to the survey said that they knew how to make a complaint and that the home has responded appropriately when any concerns have been raised. The operations manager said that the protection of vulnerable adults policy and procedure had been re-written. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 16 A protection of vulnerable adults referral had been made in November 2007 relating to the forcible administration of medication. This had been recorded by staff but not picked up by the previous manager. A visiting health professional had reported the incidents to the Commission. As a result of the referral the home has agreed to assess the competencies of the nurses working at the home. The operations manager stated that the nurses and senior care workers would shortly receive training in the care of people with diabetes. Protection of vulnerable adults training would also be provided in order to reinforce expectations of all staff. The operations manager also said that Mental Capacity Act issues would be included in the new care plans. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 is in the middle of a major programme of extension and refurbishment. The environment is therefore not as homely and pleasant as would be expected. Measures are in place for the control of infection but the control of malodour needs to improve. EVIDENCE: The home is a country house in extensive attractive grounds. A major extension and refurbishment of the home is underway. This has been planned in two phases. The plan is for a variation to the registration of The Boynes to provide 20 places for frail older people and 21 places for people with dementia. Care will eventually be provided in two separate units with a secure garden for people with dementia. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 18 Registration for ten further bedrooms has already been agreed. These are being used by frail older people. Some of the people already living at the home are using the new bedrooms while the building work is completed. This has led to a period of disruption for residents and created some difficulties for staff trying to maintain a homely environment. As part of the refurbishment of the existing building new door furniture will be fitted, as well as free swing door closers connected to an upgraded fire alarm. The nurse call system will be replaced. As a result a full assessment of the facilities within the home has not been made during this inspection. The manager designate and the operations manager produced a file in which were recorded the results of a tour of the building with areas for improvement noted. This included who was to take action and a timescale. On entering the home at the start of the inspection a strong malodour was evident. There was also a malodour in one of the bedrooms inspected. The three residents returning surveys said that the home is “always” clean and fresh. One of the relatives commented, “room cleaning could be improved”. The laundry is in the basement and is accessed down a set of steep and narrow stairs. Laundry facilities are adequate for the current number of residents. Hand-washing facilities are available for staff throughout the home and aprons and gloves are provided for staff to prevent cross infection. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The competencies of nurses are being assessed following concerns and the home must provide dementia training in readiness for the planned specialist unit. Recruitment practice was generally satisfactory with one omission noted EVIDENCE: Staffing remains at the levels identified during the last inspection. There are a registered nurse and four care staff on duty during the day. At night with the reduced occupancy of the home (20 people), there is a nurse and one care worker on duty. The home employs a cook from 7am until 2pm and a kitchen assistant who works a split shift covering the morning and early evening. Domestic staff cover the morning hours with one domestic on duty at the weekends. The operations manager said that a case is being made to the providers of the home for a housekeeper working 35 hours a week. The manager designate said that two staff had resigned in the preceding week, a nurse who works a night shift and the handyman. The handyman post had been offered to one of the care workers in addition to part-time caring duties. The home has vacancies for three part-time care staff and one domestic worker. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 20 As mentioned above the home has recently agreed to assess the competencies of the nurses working at the home. Comments received from a visiting health care professional included: “I am concerned about the levels of knowledge (working knowledge, not just attendance at courses) surrounding dementia care- how to approach someone who is confused.” The manager designate said that the deputy and 2 or 3 of the care workers had undertaken dementia training. The home will need to ensure that all staff providing care in the planned dementia unit participate in dementia training prior to an application for registration. One of the staff files contained a personal performance improvement plan, unsigned and undated, indicating the shortfalls in practice had been identified by the previous manager. There was no record of whether any measures to address these had been put in place. Of the three people returning surveys two said that staff were “usually” available when needed and one said “always”. Two relatives commented that the staff “usually” have the right skills and experience” and one added that the “standards for new staff should be higher”. One of the staff returning the survey said that they “usually” had the right experience and knowledge to meet the different needs of the people living at the home. No staff training matrix for 2007 was available for inspection so that the training undertaken by staff could not easily be checked. The previous manager of the home returned an annual quality assurance assessment (AQAA) to the Commission on 24/07/07. This included the information that of 17 care staff 5 had NVQ level 2 or above and that 3 others were working towards NVQ level 2 or above. The operations manager stated that staff training had been planned. This included safeguarding adults, moving and handling, customer care, care planning, autonomy and choice. Of the two staff returning surveys one said that the induction covered everything they needed to know to do the job “very well”. The other member of staff answered “mostly”. Both said that they had received appropriate training. Three staff files were looked at. These included evidence of satisfactory recruitment, for example, two written references, one from the previous employer, and CRB and POVA checks. In one of the files the employment history was not full. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38. 35 could not be looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is in a period of transition with a new manager designate and a new operations manager. Planning for improvements to the management of the home has begun. A quality assurance system needs to be fully established. Constant vigilance is needed to ensure the safety of residents while the building work continues. EVIDENCE: The registered manager left shortly before the inspection took place and a new manager designate had been in post for one week. A new operations manager had been in post for two months. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 22 The operations manager said that as part of the visits required under regulation 26 she will carry out a full care plan audit. She also said that she would monitor weight loss, audit pressure area care and nutritional risk assessments. The operations manager stated that she had held four staff meetings in the last two months and that emphasis had been placed upon the provision of person-centred care. A quality assurance process had begun while the previous manager was in post. The file at the home showed that some audits had been undertaken, for example, a bed and mattress audit on 12th November, and a staff file audit in July 2007. Questionnaires had been sent out to people living at the home in June and August 2006 but none since. There had been eleven replies to a staff questionnaire sent out in October 2007. Three staff had asked that more moving and handling equipment be provided. The manager designate was asked about the management of money for people living at the home. She was unsure about how much money was held, but knew about money left for one person. The records could not be checked as the home’s administrator had left for the day. A visit by the Commission and the Health and Safety Executive (HSE) was carried out on 13th March 2007. A complaint had been made by a third party about poor health and safety management. Some of the breaches of health and safety legislation related to the building work being undertaken at the home. Breaches were addressed. The operations manager stated that all the nurses working at the home have undertaken first aid training. Fire training was planned. The manager designate said that the fire records should be in a file at the entrance to the home, but they had been moved so these were not inspected. Risk assessments for the building and grounds were reviewed in August 2007. Following the last inspection when a risk assessment for carrying laundry up and down the basement steps had been required, a note had been added to the laundry policy advising staff to carry laundry in small loads. The operations manager said that new laundry trolleys were being purchased with safety bags for soiled linen. Bags would be put straight into washing machines and could be rolled down the steps rather than carried. The windows inspected had restricted openings. Hoists had been serviced in March, April and June 2007. A gas safety inspection had taken place in November 2006. Electrical circuits had been checked in July 2007, and portable electrical equipment in February 2007. Fire fighting and detection equipment, and the call bells, in April 2007 Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 23 Some of the beds remain against walls in the bedrooms so that staff cannot easily assist people to move. As part of the refurbishment of the home nursing beds are being bought. A hoist was observed to be blocking a fire exit. A resident with dementia was struggling to open a door from the lounge into an area where refurbishment work was being undertaken. A member of staff was occasionally present in the lounge but the resident persisted in her attempts to reach an unsafe area. Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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. OP8 Standard Regulation 15(1) Requirement Care plans and risk assessments must accurately detail the specific care to be provided to meet the individual needs of people living at the home. Staff must receive training to enable them to meet the needs of people living at the home. This must include training in the care of people with dementia in readiness for the new specialist unit. The law and policies on restraint, rights to choice and protection from abuse must be reinforced for all staff. The manager designate must make an application for registration. Timescale for action 30/04/08 2. OP4 18(1)(C) 31/03/08 3. OP18 13 (6) 28/02/08 4. OP31 8, 9. 31/03/08 Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 Refer to Standard OP2 Good Practice Recommendations Amendments should be made to the contact given to people moving into the home to include up-to-date information about fees. Handwritten alterations to MARs should be signed by two nurses. A code should be entered in MARs when as required medication has not been administered. The development of a more person-centred approach to care should continue, with emphasis on autonomy, dignity, choice and independence. Main courses of meals should not be served in pudding bowls. The dessert course should not be served to people eating in their room at the same time as the main course. There should be no malodours in the home. Gaps in employment history should be explored prior to employment. The access to the laundry should be risk assessed. Fire exits should not be obstructed. Extra vigilance should be exercised to ensure that active, confused people remain safe during the alterations to the home. OP9 OP9 OP12 OP15 OP15 OP25 OP29 OP38 OP38 OP38 Boynes Nursing Home, The DS0000004097.V356253.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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