Inspection on 21/08/06 for Boynes Nursing Home, The

This inspection was carried out on 21st August 2006.

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

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

Other inspections for this house

Boynes Nursing Home, The 02/03/09

Boynes Nursing Home, The 10/12/07

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 Sandra J Bromige Unannounced Inspection 13:40 21 & 22 August 2006 st nd 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.V308061.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.V308061.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 594855 St Cloud Care Plc Care Home 28 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (28), Terminally ill (3) Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate one named service user under 65 years with a learning disability. 27th March 2006 Date of last inspection 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 twentyeight people aged 65 years and over. As part of the registration the home can accommodate three people with a terminal illness and three people with a dementia related illness. The terminal illness category no longer exists for any care home with nursing and will be removed from the registration as it is recognised that end of life care may be required by all residents at some stage who are living in the home. The home has a total of 22 single bedrooms, 14 of which have en-suite facilities, and 3 shared bedrooms. First floor bedrooms can be accessed by a passenger lift. The home has planning permission to increase the size of the home from 28 to 41 beds. The intention is to provide 2 self-contained units; one for 20 frail elderly and one for 21 residents with dementia care needs. The building work is due to commence in September 2006. The increase in numbers will be subject to a major variation application to the Commission for registration, which will be considered upon receipt and completion of the building work. The current range of fees is £458 – 620 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.V308061.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 2 days by 1 Inspector and lasted for the duration of 14.5 hrs. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission including the monthly visit reports from the Provider and/or a representative of the organisation, any concerns, complaints or allegations, written feedback from residents & relatives and a visit to the home which includes case tracking a number of residents care. There have been 3 complaints about this service since the last inspection in March 2006. The complaints have related to poor care plans, attitude of staff, facilities provided by the home, the care needs of an identified resident, and the staffing levels at night time. One of the complaints was referred to the Provider for investigation & response to the complainant, one was referred to the Primary Care Trust and one was looked into by the Commission. The complaint forwarded to the Primary Care Trust related to the care of an identified resident and concerns that the resident’s care needs were not being met by the home. This was already being addressed at the time that the complaint was received and the resident has now been moved to another service. The home have been very co-operative and proactive in assisting the Commission with information and in investigating and responding to complaints received. No adult protection issues have arisen about this service. The home has planning permission to increase the size of the home from 28 to 41 beds. The intention is to provide 2 self-contained units; one for 20 frail elderly and one for 21 residents with dementia care needs. The building work is due to commence in September 2006. The increase in numbers will be subject to a major variation application to the Commission for registration, which will be considered upon receipt and completion of the building work. There are some environmental issues that are outstanding, and others have been identified during this key inspection. Hopefully, these will be addressed as part of the home’s planned extension. What the service does well: The home provides information about the service offered to prospective residents in the format of a Statement of Purpose & Service User guide. A Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 6 copy of the last inspection report is also publicly available within the home for residents, staff & visitors to the home. All residents are assessed prior to admission by one of the trained staff in the home. The assessment is carried out at the resident’s current place of residence, it is thorough and informative and enables the home to make an informed decision as to whether they have the skills & facilities to meet the resident’s care needs. The assessment is checked upon admission to identify any changes in the resident’s care needs and is used to formulate a care plan for that resident. The trained staff seek advice and guidance from healthcare professionals within the community when the need is identified. This advice and any changes prescribed is then implemented by the home. Specialist healthcare professionals have also assisted the home with specific care for a resident with insulin dependent diabetes and also given support with the format for wound documentation. The home has a good system in use for the ordering, receipt, administration & disposal of medication. Residents are respected by staff and their privacy & dignity is respected. Residents are well dressed and their clothes are nicely laundered. Staff were seen to address residents in a caring and friendly manner. A relative spoken with was very complimentary about the care received by his late wife at the home and another resident said the staff are ‘nice & kind, the matron & nursing staff are attentive’. Residents are encouraged to remain independent and to make choice about their personal welfare. Residents are offered a choice of a well balanced & varied diet. They are able to eat in one of the dining rooms or in the privacy of their bedroom. A Diversional Therapist is employed by the home to provide a programme of recreational therapy for the residents. Visitors are made welcome in the home and are able to visit at any time. Meetings are held twice a year for residents & relatives to attend so that the home can keep them informed of progress & changes. The home has a complaint procedure and residents and relatives are encouraged to raise any concerns that may arise. The home is in a rural setting with views across to the Malvern Hills. It is set in its own extensive grounds and offers a homely and comfortable environment. The home has been converted to care for residents with physical disabilities and provides a range of aids & adaptations for this purpose. The home is clean and there are no bad smells. Good systems and procedures are in place for the prevention of cross infection. What has improved since the last inspection? Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 7 The quality of the care plans has improved since the last inspection. The format has been revised. Care plans are being reviewed on a regular basis and there is evidence of good management of residents with diabetes. A named nurse and key worker system has been introduced for each resident. Risk assessments are in use for bedrails. A format is now in use to identify, record & formulate a care plan for the social care needs of residents. The décor in the home has been improved with a number of bedrooms being redecorated, new carpets to the corridors, repainting of the lounge/dining areas and new pictures in the home. A quality assurance and monitoring system has been devised and has just been implemented. This will enable the home through audits & questionnaires to monitor the quality of the entire service offered by the home. Staffing levels & practices have been reviewed since that last inspection and additional staff have been provided to assist the night staff from 7.00am until the day staff come on duty. A training programme has been revised and implemented focusing initially on the core training that staff are required to receive. A system for supervision of care staff has been implemented and annual appraisal of all staff has commenced. The Provider has appointed a manager and an application has been received by the Commission for consideration. What they could do better: Changes have been made to the Care Home Regulations this year relating to giving residents more financial information regarding the payment of the nursing contribution. These are now in effect and the home now needs to review their current contract to incorporate the changes. Care plans need further improvement. Residents involvement with the care planning process needs to be promoted and documented. Care plans need to be reviewed with accuracy. Resident consent must be obtained prior to the use of bedrails. Any handwritten changes to the Medication Administration Records must be checked, dated and countersigned by 2 registered nurses. The medication policy must be reviewed as it is out of date and does not support the current practice in the home. The home should refer to the guidance written by the Royal Pharmaceutical Society of Great Britain on the administration of medicines in care homes and a copy should be available in the home. The Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 8 home must review the arrangements for storing prescribed creams & ointments in residents’ rooms. Medical equipment prescribed by the General Practitioner must not be use for other residents in the home. The temperature of the room where the medication is stored should be monitored to ensure that it does not exceed the 25°C. Insulin pens should be labelled with the resident’s name. The provision & deployment of staff to supervise & provided the level of assistance to residents in the dining room must be reviewed. For residents who eat their meals in their bedrooms, the dessert course should not be served to residents at the same time. Care staff should only assist one resident to eat at a time. They should sit beside the resident in a discreet manner so that it becomes a social occasion and not a task. A budgeted sum of money should be allocated by the Provider for social & recreational activities provided by the home. A record must be kept in the home of all complaints/concerns made to include the details of the investigation, outcome and any action required. A review of the condition of the premises & equipment must be carried out. A copy of any action plan must be sent to the Commission. Staff must be able to access both sides of the bed at all times for residents who require assistance with moving and handling. A review must be carried out by the home of the suitability of the beds currently provided for residents needing nursing care. The doors to residents bedrooms must be fitted with a lock suited to each resident’s capabilities and must be accessible to staff in emergencies. Lockable storage must be provided in resident’s bedrooms. The numbers and deployment of care & ancillary staff in the home each day must be reviewed. An application must be submitted to the Criminal Records Bureau for an Enhanced Criminal Records Bureau check for both employees from overseas. Staff must not commence employment in the home until the home has received a satisfactory POVAfirst check in addition to all other information required through regulation. The home must ensure that references received are authentic and that they seek verification for the reason they ceased to work in a care position. Two written references relating to the person’s last period of employment must be obtained prior to employment at the home. Gaps in employment history should be explored prior to employment. An appropriately qualified first aider must be on duty at all times. All staff must receive fire training at regular intervals. Risk assessments must be done for all tasks which involve moving & handling of residents and loads. Cleaning products must not be accessible to residents & must be securely stored at all Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 9 times. All wheelchairs must be fitted with two footrests and must be used all times when transporting residents. The home should review the use of bolts on the outside of toilet, bathroom & sluice doors as someone could get locked in the room. 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. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 10 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.V308061.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home which will meet their care needs. Residents individual needs are assessed prior to them moving into the home in order to establish the home’s ability to meet those needs and appropriate care to be provided. The homes contract and Service User guide tells residents about the service they will receive. The contract needs to be reviewed to ensure that it is in line with current and newly implemented regulations. EVIDENCE: The home has a Statement of Purpose and Service User guide which is available to prospective residents in the home. A copy of the last inspection report is also available in the front hall of the home. A resident spoken with said that their daughter & son had visited the home on their behalf and had been given enough information about the home. A letter had been sent to another new resident with their contract enclosing a copy of the ‘Home Information Sheet’. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 12 Contracts had been issued to the two recently admitted residents case tracked during this visit. A copy of the homes current contract was provided by the manager (designate). The contract needs to be reviewed, as the current notice period of 2 weeks for any increase in fees is not in line with the regulations. The Service User guide gives information to residents about the payment of any ‘free nursing care’ payments by the Primary Care Trust and how these are managed generally by the home. Due to the changes to the Care Home Regulations with effect from 1st September 2006 this information needs to be more specific and provided to all existing and new residents on an individual basis. The first 4 weeks of admission is a trial period for the benefit of the resident and the home. Case tracking confirmed good practice. A registered nurse from the home had visited a prospective resident prior to admission and completed a thorough assessment of the resident’s care needs. This was checked on the day of admission to the home to see if any care needs had changed since the assessment. This is good practice. A detailed pre-admission assessment was seen in another residents care records and was also checked for any changes at the point of admission. This information provided basic information for staff from the point of admission and was used to form the basis of the care plan for this resident. The home does not contract to provide intermediate care. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have improved but they require further improvement to ensure that the health, personal & social care needs of all the residents are identified and a clear action plan is in place to ensure that the resident receives a consistency of care at all times. Medication is generally well managed, although the medication policy does not support the current practice & procedures for the management of medication, which has the potential to place residents at risk. The principle of respect, privacy & dignity are put into practice. EVIDENCE: Residents care plans showed signs of improvement. This was confirmed in written feedback from a visiting healthcare professional to the home. The format of the care plans gives the problem identified, the aim/objective and the action to be taken by the staff to achieve the objective. The care plan for a resident with diabetes gave specific information about their targeted blood sugar levels, the frequency of checking these blood sugar levels and action to be taken if they were found to be too high or low. The home seeks written advice from the specialist diabetes nurse relating to individual residents. Risk assessments are in place including the use of bedrails where required. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 14 Care plans need further development as areas are lacking in detail, some areas contain conflicting information and some are not being reviewed accurately. One care plan was for the ‘prevention of pressure sores’ and a point of action was to ‘apply appropriate barrier creams’. The type and frequency of applying this creams was not prescribed in the care plan and does not provide sufficient information to ensure that the resident receives regular and consistent care. The ‘eating & drinking’ care plan & Malnutrition Universal Screening Tool (MUST) assessment for the same resident indicated the use of ‘prescribed supplements’ and the care plan refers to the use of ‘fortisip’, a high energy drink. The pre-admission assessment for this resident lists ‘fortisip’ as being prescribed to be given to this resident, although it was not listed on the resident’s Medication Administration Records. Daily records had entries relating to problems with the resident’s eyes and mouth and what treatment the Doctor & Dentist had prescribed, although there was no care plan for either of these acute problems. There was no care plan for the management of the resident’s Parkinson’s disease or Osteoporosis. The care records for another resident stated that they had ‘MRSA around the catheter site’, but two entries of evaluation for May & June 2006 stated ‘MRSA free’, ‘remains MRSA free’. Another care plan prescribes specific care due to MRSA being present. This care plan had not been update regarding the current status of the MRSA infection. The mobility care plan refers to the MRSA and contained conflicting prescribed actions as it stated the resident is able to ‘sit out for short periods’ and ‘unable to sit out in a chair because of fainting attacks’. This shows that the care plans are not being updated/reviewed accurately. A care plan for the prevention of pressure sores states an action ‘nursed on a pressure relieving mattress’, but it does not prescribed the type of mattress. The evaluation shows the use of a specific type of cream for the skin, but it is not prescribed as part of the action plan in the care plan. The daily records for the 15.08.06 state ‘commenced on food chart as appetite decreased’. There was no reference to this action being prescribed in the nutritional care plan or in the evaluation of the care plan. The daily records for the 12.08.06 stated ‘area under the chin is very sore – cavilon applied’, there was no care plan for this problem. The daily records for the 25.07.06 showed a visit by the General Practitioner where medication had been prescribed for ‘low mood’. There was no care plan relating to this problem. The care records for another resident stated that the resident had a medical history of cataracts on the eyes. There was no care plan for this identified problem and the daily record contained an entry dated 09.09.06 which stated ‘OPD ophthalmology - laser treatment to left eye’. Risk assessments for moving & handling, nutrition, falls, continence, skin assessment & the use of bedrails were included in the care records seen. Some of these documents were clear and well completed, and some had been Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 15 inaccurately completed and contained conflicting information. The Malnutrition Universal Screening Tool (MUST) assessment for an identified resident stated that the score was ‘2 high risk’, but the total score had been stated as being ‘0’. An identified skin assessment stated the score was ‘14’, but when adding up each section marked the score came to ‘19’ and the gender of the resident had not been included in the assessment. The falls risk assessment for an identified resident stated ‘no need for cotsides’, although there was a bedrail risk assessment in place dated 15.06.06. Bedrail risk assessments were seen for two residents, although there was no evidence seen of any consent from the resident and/or their representative to the use of the bedrails. Falls for an identified resident were being recorded in the care plan and accident records completed. Social care plan formats are now in use. They are held in a separate file and are being completed by the Diversional Therapist for the home. The social care plans are not being fully completed and there is no evidence to show that the trained nurses are evaluating these care plans as part of the monthly review of the individual residents care. A social care plan for a resident with sight problems identified the need for the provision of ‘audio story tapes’ and a CD or tape player, although there was an entry which stated ‘no tape player or CD provided’. The resident told the Inspector that they ‘preferred to read – but was unable to because of their eyes’. This is an example that the home are not fully meeting this resident’s social care needs. Written feedback from 8 residents when asked do they receive the care and support they need responded; 3 said ‘always’, 4 said ‘usually’ and 1 said ‘sometimes’. One resident commented that sometimes ‘small things are overlooked e.g. the TV control or water just are out of reach’. All residents seen during the inspection had access to a drink within reach, but not all residents had access to a call bell. During supper the dining room was left unattended by staff and none of the residents had access to a call bell, one resident was sitting alone in the lounge and did not have access to a call bell and a resident in their bedroom called the Inspector into the room as they required assistance and did not have access to the call bell. The 2 individuals asking for assistance with no access to a call bell were brought to the attention of the nurse in charge of the shift. A resident said that their care needs had ‘never been discussed’. There was no documentary evidence in the care plans to show that they had been discussed with the resident and/or their representative. The minutes of a residents meeting held in July 2006 and attended by residents and relatives informed them about the introduction of a named nurse and key worker for each resident. Written feedback from 4 relatives confirmed that they are all kept informed of important matters affecting their relative. Written comments from relatives include ‘they are most caring & patient’, ‘some nurses are very very good and cannot do enough for my relative. Others could not careless’. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 16 The Medication Administration Records for these 3 residents showed that the home use pre-printed Medication Administration Records which are part of a Monitored Dosage System provided by a national pharmacy group. There were 2 handwritten entries on one Medication Administration Record where there were no signatures of the person writing or checking the entry on the chart. One medicine had been out of stock since the 7th August 2006 due to a manufacturing fault of this medicine, another entry showed that stock of Zopiclone 7.5mg was ‘not available’ for 3 consecutive dates in August 2006. This indicates poor stock control. New and repeat prescribed medicines are obtained through a national pharmacy using a Monitored Dosage System and short courses of medication such as antibiotics are dispensed by the local surgery. A copy of the home medication policy was requested which was dated June 2004. This has been passed to the pharmacy inspector for comment and correspondence has been sent to the home outside of this report as the policy has shortfalls and is in need of review. A copy of the guidance for care homes produced by the Royal Pharmaceutical Society of Great Britain was not available in the home. The manager (designate) was advised to obtain a copy and make it available to all trained staff. A file of Patient Information Leaflets are held in the home for medication in use and a medicine reference book dated March 2006 was in use. This is good practice. There is a list of ‘Homely Remedies’ signed & reviewed by the General Practitioner in June 2006 with the Medication Administration Records. Lists of staff signatures (including agency staff) are also held in this file to enable staff to be identified from their signatures on the Medication Administration Records. An insulin pen is in use and this needs to be labelled with the resident’s name. Single use needles that have been prescribed for another resident were being used with this insulin pen. This was brought to the attention of the manager (designate) who stated that she would obtain a prescription for this resident from the General Practitioner. There are clear records of medication being ordered, received, administered and disposed of by the home. Medicines waiting to be destroyed are being securely stored and a contract is in place with a specialist company. No controlled drugs were in use at the time of the inspection. The temperature of the medicine fridge is checked and recorded each day showing that medicines are being stored within the appropriate temperature range. The temperature of the room where the external & internal medicines are being stored is not being checked each day. Prescribed ointments which are being kept in residents bedrooms are not being securely stored. Residents privacy & dignity was observed as being respected by staff. Staff were mostly seen to knock on doors before entering the room, although the Inspector did observe a carer walk into a resident’s room without knocking. Staff were observed addressing residents in an appropriate manner and being gentle and encouraging when giving care. A male resident spoken with said that the staff ‘always knock the door’ and that he did not mind receiving care from the female care staff. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 17 Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents social and recreational activities meet their expectations and they are able to keep in contact with family and friends. A well-balanced, varied menu choice is available which caters for the needs of the current residents. The standard of supervision & assistance of residents during mealtimes is not satisfactory. EVIDENCE: The home employs a Diversional Therapist for 22 hrs each week. These hours are usually worked on a Monday, Wednesday & Friday with some flexibility as activities may be planned to take place on other days. It is the role of the Diversional Therapist to organise the social side of the nursing home. Residents are consulted about the type of activities required. When on duty she visits the residents individually in the morning and will ask them for ideas and a general consensus on activities. A programme of activities is put up on the notice board each week. On the first day of the inspection a group of residents were playing cards during the afternoon and afterwards two residents were taken outside to enjoy the sunshine. In May the home organised a visit to the Black Country Museum. The home does not own a vehicle for transporting residents; it is hired when needed at no cost to the residents. There is no allocated budget for activities the money is raised Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 19 through raffles or is ‘donated’ to the ‘residents fund’. The ‘residents fund’ is managed by the administrative staff for the home. Care staff support the Diversional Therapist to carry out her role. Recreational activities taking place in the home include games, musical entertainment, reading, talks, manicures, fetes and coffee mornings. Outside the home residents are able to go shopping in town or when trips are arranged to various places of interest. Written feedback from 8 residents state that 7 residents are of the opinion that there are ‘usually’ activities arranged by the home that they could take part in, 1 resident said only ‘sometimes’. A comment was received that it would be better if more time were available to visit residents who are frail and need to spend most of their time in bed. Residents spoken with said there were ‘enough activities’. One resident enjoyed listening to the radio in their room and also enjoyed going out in the garden and out occasionally with a friend. The visitors’ book indicates that the home is well visited at various times of the day and evening. Written feedback from 4 relatives all confirm that they can visit the resident in private and are welcome in the home at any time. A recent meeting has been held with residents and relatives to keep them informed of any planned changes including the proposed extension with minutes posted on the notice board for those who could not attend. Preinspection information completed by the manager (designate) confirmed that at present one resident handles their own financial affairs. The homes Service User guide confirms that residents are encouraged to bring into the home small pieces of furniture, ornaments, pictures etc. A 4-week menu is provided and it is on display in the home. Residents have breakfast brought to their room and are able to have a continental or cooked breakfast of choice. Lunch & supper is served in the dining room or the privacy of their bedroom. A second small dining room is available in the home where residents can eat. The menu shows a choice of 2 main courses at lunchtime, and for supper soup with a variety of sandwiches 3 times each week and a lighter hot or cold snack 4 evenings each week. The menu states that soup, fresh fruit, cheese & biscuits and ice cream are always available on request. Supper was observed on the first day of the inspection and 8 residents were using the dining room. The tables were nicely laid and a choice of water or lemon squash was available and offered to residents. The meal was served to the residents in the dining room and at the same time staff were observed taking meals to residents in their bedrooms. Residents using the dining room were served one course at a time, although residents eating in their rooms were served both courses at the same time. Residents in the dining room were offered a second helping of supper and offered bread & butter to go with the meal. Staff were observed offering assistance to residents with their meal and giving them encouragement to eat. The dining room was left unattended by a member of staff at times when residents were still eating and some were needing assistance to eat. A carer was observed crouched down by the side of Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 20 a resident assisting them to eat and at the same time was also observing and offering verbal encouragement to other residents and going to assist another residents to eat on the same table. This is not good practice. A carer was observed to take a resident out of the dining room and said to another resident ‘I will be back to help you in a minute’. 2 residents were observed assisting a confused resident who was sitting between them as there was not a carer available and they did not have any access to a call bell. Lunch was observed on the second day of the inspection and residents were offered a choice of roast chicken or faggots and a desert of stewed apple & cream. Ice cream and yoghurt were also available. A carer was observed sitting next to a resident assisting them to eat. When finished feeding this resident, the carer went to assist another resident to eat. Whist carrying out this task the carer was approached by a colleague and they had a conversation over the resident in a foreign language. This is poor practice. Care staff were observed taking lunch to residents in their rooms. The main course was covered but the pudding was uncovered and taken at the same time as the main course. 7 residents have given written feedback about the meals in the home. 2 residents said that they ‘always’ like the food, 2 said ‘sometimes’, 2 said ‘usually’ and 1 resident said ‘never’. Residents spoken with were asked if they liked the food and did they get a choice of meals and responses received were the meals are ‘quite good, not aware of a choice’, ‘ I prefer not to mention’, ‘its what I expect’ and the choice is ‘ok’. No comments were received from any relatives regarding the food in the home. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are aware of the homes complaints procedure and feel able to use it. The homes current practice does not fully protected residents from abuse. EVIDENCE: The home has a complaints procedure that is included in the homes Service User guide and is also sent out with the contract to each resident. The homes complaint records were seen. No complaints had been recorded as being received since the last inspection. The home has received a complaint since the last inspection that was received by the Commission and passed to the Provider for investigation and response. This was not available in the homes complaints records. Two complaints received by the home during the Autumn of 2005 were recorded, although there was no evidence to show that either had been investigated & that a response had been sent to the complainant. 6 residents provided written feedback saying that they know how to make a complaint. Written feedback from 4 relatives indicates that 2 are aware of the homes complaints procedure and 2 were not aware of the homes complaint procedure. None of these relatives had ever had cause to make a complaint to the home. The minutes of a recent residents & relatives meeting shows that complaints were discussed and they were reminded that the complaints procedure is available in the hall of the home and people were urged by the home to raise any concerns that may arise. Protection of Vulnerable Adults training is provided by the manager (designate). Not all staff have received this training, although all staff spoken Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 22 with were aware of the action they would take if they suspected abuse. A Protection of Vulnerable Adults training session is programmed to take place in October 2006. The Inspector was invited into the home by a carer without requesting to see their identification. The Inspector was not known by the home. Two overseas staff had commenced work in the home prior to an application to the Criminal Records Bureau for an enhanced disclosure check and receipt of at least a POVAfirst check. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been changes to the décor of the home since the last inspection which creates a more homely and pleasant environment for the people living there. The layout of the room and the types of beds provided for residents who require assistance with moving and handling are not suitable and has the potential to put residents and staff at risk. There is insufficient storage space provided for equipment. The home is clean and systems are in place for the prevention of cross infection. EVIDENCE: The home is a country house that had been converted to accommodate up to 28 residents. It is situated in a rural area and is set in its own extensive grounds that are mostly laid to lawn. The grounds are well maintained and accessible to residents with physical disabilities. Building work is due to start in September 2006 to increase the size of the home to offer 41 places within 2 units; one for frail elderly and 1 for residents with dementia care needs. This Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 24 will be subject to the home obtaining registration with the Commission upon completion. The pre-inspection information completed by the manager (designate) states that 9 bedrooms have been redecorated since the last inspection, the walls have been painted in the kitchen & lounge/dining areas, carpets have been replaced in the day room & corridors and new pictures have been purchased. The Inspector looked at parts of the premises. Residents’ bedrooms seen were of various shapes and sizes. They were generally well presented and had been personalised by the resident, some much more than others. One bedroom contained a badly stained carpet. Not all of the bedrooms seen had a door lock and a lockable facility for valuables or to secure prescribed medication. Some of the bedrooms did not have room either side of the bed to enable staff to carry out the care to the resident. (Refer to management section). One resident spoken to described their room as ‘a bit small’. 15 single rooms are en suite. 3 bathrooms were seen, although it was evident from observation and discussion with staff that only 2 bathrooms were in use as one was being used as an equipment store. Separate toilet facilities were situated on both floors. One was out of use as it was being used to store equipment, and the toilet situated in the hairdressing room was not accessible as the access was blocked by 7 walking frames. One bathroom seen did not have a privacy lock on the door. A toilet had a light bulb with no lampshade and toilets were seen to have bolts on the outside of the door. 2 sluices were seen; one was a manual sluice and the other contained a sluice disinfector machine. Handrails were provided in the corridors. Aids were provided for residents with physical disabilities such as bath, portable & standing hoists. Staff confirmed that they had sufficient equipment available for moving and handling residents. A lift provided access to both floors. A ceiling panel is missing in the lift and one of the other panels is broken. Areas of the home are in need of redecoration & repair such as water damaged wood in a bathroom & sluice which also poses a risk with regard to the management of cross infection, the floor covering coming away from the steps behind a sluice door, wallpaper missing in the corner of the dining room. Some equipment is in need of repair/replacement such as the clinical waste bin in the sluice as the impervious coating is coming off and the underside of a bath hoist is badly stained and the impervious coating is coming off the metal tubes. This is also an issue with regard to infection control. The outside of the building was receiving maintenance at the time of the inspection as the stonework around the front window was being repainted. Some of the paintwork to the window frames is in need of refurbishment as the paint is flaking leaving exposed wood. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 25 The laundry is situated in the basement of the building and is only accessible via a set of steep and narrow stairs. Laundry has to be carried up and down the stairs by the staff. (Refer to management section). The laundry is an adequate size for the numbers of residents and contains 1 commercial washer with sluice facilities, 1 domestic washer and 1 tumble dryer. The floor is washable. Hand washing facilities are available for staff throughout the home and plenty of stocks of gloves and aprons were available for staff to use to prevent cross infection. The home was clean and there were no bad smells noted. Written feedback from 7 residents state that the home is usually clean and fresh. One resident stated ‘There has been an improvement in the hygiene in recent months’. The pre-inspection information provided by the manager (designate) states that the Fire Officer last visited the home in March 2002 and the Environmental Health Officer visited the home in April 2006. The information provided did not indicate if any requirements or recommendations had been made during these visits. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are insufficient staff on duty at all times to meet the physical & social care needs of the residents. The homes induction training programme needs reviewing as it is not in line with all elements of the Common Induction Standards for social care workers. The homes recruitment procedures are not robust and do not offer protection for the people living in the home. EVIDENCE: On the first day of the inspection there were 22 residents with 1 registered nurse & 4 care staff on the late shift and 1 registered nurse & 1 carer during the night. On the second day of the inspection there were 23 residents with 1 registered nurse & 4 care staff in the morning. 2 care staff had come on early at 07.00 am to assist the night staff and an agency carer arrived part way through the morning as a carer had called in sick. In the afternoon there was 1 registered nurse & 4 care staff and 1 registered nurse & 2 carers during the night. The manager (designate) works 3 shifts each week as the nurse in charge including some weekends. 2 days each week her time is supernumery. Rotas provided indicate that these are the normal staffing levels for the home. The manager (designate) stated that they had carried out a staffing review and following the review have 2 care staff who come on duty each morning at 07.00am to assist the night staff. The home also has a staffing procedure for nights, if they are 22 residents or below they only have 2 night staff on duty. Pre-inspection information provided by the manager (designate) states that Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 27 they have 22 residents who require help with toileting and 18 residents who require 2 or more staff to undertake care during the day and 19 at night. Written feedback from 7 residents indicates that staff are ‘usually’ available when needed and 1 resident said only ‘sometimes in there own time’. Written feedback from 4 relatives states that they are of the opinion that there are sufficient staff on duty. Complaints have recently been received by the Commission relating to only having 2 staff on at night and concern was expressed to the Inspector during the inspection. This inspection has highlighted concern regarding the supervision & support of residents during mealtimes. The home employs a Diversional Therapist who works 3 days each week. There is no one employed for the remaining days of the week to provide social & recreational activities for the residents. Written information has been received that it would be better if more time were available to visit residents who are frail and need to spend most of the time in bed. The home employs a laundry assistant who works 9-2 pm Monday to Friday. They do not employ a laundry assistant at weekends. The manager (designate) stated that the care staff launder the bedding & towels at weekends, no personal laundry is done at weekends. The rotas show that no additional care staff are employed at a weekend compared to the weekdays to carry out the extra duties. The home employs 3 domestic staff and rotas show that they all work 9-2 pm Monday to Friday, 2 on a Monday & Friday & 1 on a Tuesday, Wednesday & Thursday. No cleaning staff are employed at the weekend. Two cooks are employed and a relief and agency chef assists them when required. A maintenance person is employed for 18 hrs each week. The home employs 6 staff that have NVQ 3 & 1 carer who has NVQ 2. Two further care staff are trained nurses overseas. The manager (designate) stated that staff are encouraged to commence NVQ training after their induction is completed. The home has 2 internal assessors for NVQ one of which is the manager (designate). The induction for staff is carried out by the manager (designate). She stated that it takes 6-8 weeks to complete which includes a questionnaire. The current induction programme used is not fully in line with the ‘Skills for Care’ Common Induction Standards. The manager (designate) was not aware of TOPSS now know as ‘Skills for Care’ and was advised to look at their website. Evidence was seen that a recently employed carer had received induction and had been assigned a mentor for the duration of her induction. 3 staff employment records were seen during this visit. One application form showed gaps in employment with no evidence that these had been explored prior to appointment. No referees were listed on this application form. One file contained one reference and a note saying ‘reference rec’d but mislaid/misfiled. To obtain a copy’. The second file contained 2 testimonial type references ‘To whom it may concern’. The third file contained two ‘opinions’ that had been written at the request of the applicant and not Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 28 requested by the home. There was no information to show that the authenticity of the information had been checked and that the home had sought verification of the reason that they ceased to work in their previous position. Criminal Records Bureau checks had not been carried out for two staff employed from overseas. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A system is now in place to enable the home to audit the quality of the service provided for the people living in the home. A supervision programme is now in place to ensure that care staff have the knowledge and skills needed and put them into practice whilst caring for the residents. Risk assessments & further staff training needs to be carried out to ensure that the health & safety of the residents and staff are promoted and protected. EVIDENCE: There is now a manager (designate) in post and an application has been received by the Commission for consideration. A quality monitoring system was developed by the home in June 2006. Each month of the year a specific action is audited. The process started in August 2006 with an audit of staff files & staff risk assessments. In addition to the Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 30 audits, questionnaires are used for staff, environment & care and residents meetings will be held twice a year. The Inspector was unable to access records of residents monies held by the home for incidentals as the administrator was not on duty and the manager (designate) and the general manager did not have access to these accounts. The manager (designate) has implemented supervision for care staff that is in line with the National Minimum Standards for Older People. Appraisals have also been started. The manager (designate) stated that since she joined the home one of the areas that she is focussing on is training. It is evident from training records and discussion with staff that some staff have received moving & handling training. A further session is programmed for September 2006. Health & safety training is programmed to take place the week of the inspection. All staff have not received fire training. Infection control training is also planned for September 2006. 9 care staff have undertaken First Aid for Carers training. This training is not sufficient to be the designated first aider on duty in the home. Staff were observed transporting residents in wheelchairs with only one footrest in use. On one occasion the footrest in use appeared to be fixed to the wrong wheelchair as the wheelchair frame was black and the footrest was red. Some of the beds in the home are pushed up against the wall of the bedroom and do not enable staff to get either side of the bed with equipment for moving & handling. A number of staff have expressed concern that they have to pull the bed away from the wall with the resident in it in order to carry out some of the care. Risk assessments for this task were requested but they were not in place. The manager (designate) stated that she has raised with the general manager the need for ‘nursing beds’ as she is aware that staff are having to pull out the divan beds to give care to the residents. The only access to the laundry is via a set of steep, narrow stairs. Staff are having to carry laundry up and down the stairs. There is a handrail in place but staff are not always able to use it if they are carrying a basket of washing back upstairs. A risk assessment for this task was requested but it was not in place. Some cleaning chemicals were noted as being left accessible to residents. Safety data sheets are available for the chemicals in use in the home. Weekly & monthly fire equipment checks are recorded. The gas has recently been serviced but the certificate was not available at the time of the inspection. Portable electrical appliances had been checked in June 2006. A risk assessment for the control of Legionella is in place and random tests of water Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 31 temperatures are recorded. The pre-inspection information completed by the manager (designate) confirms that all equipment & services in the home have been checked within the required timescales. Accidents are being recorded appropriately. Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 32 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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 2 2 X 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 2 X X 3 X 2 Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 33 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 Standard OP2 Regulation 5A Requirement Timescale for action 31/10/06 2 OP8 15(1) The homes contract must be reviewed regarding the notice period for any fee changes and to give existing & new residents specific information relating to their ‘free nursing care‘ payments. Care plans must accurately detail 31/10/06 the specific care, including aids and equipment, to be provided to meet the individual needs of residents. Previous requirements of 20/09/04, 14/03/05, 23/06/05 & 27/03/06 not met. Resident involvement within the care planning process must be promoted and documented. Previous requirements of 14/03/05, 23/06/05 and 27/03/06 not met. Residents identified as being at high nutritional risk must be monitored and supported, with specialist intervention accessed as necessary. This must be DS0000004097.V308061.R01.S.doc 3 OP7 15(2) 31/10/06 4 OP8 12(1), 13(4) 30/09/06 Boynes Nursing Home, The Version 5.2 Page 34 documented. Previous requirement of 23/06/05 and 27/03/06 not met. 5 OP8 12(1), 15(1) Care records must accurately evidence and demonstrate the care being given to all residents. Brought forward amended. Previous requirement of 23/06/05 & 27/03/06 not met. 31/10/06 6 OP7 12(1), 15(1) 7 OP9 13(2) Care plans must be reviewed and 31/10/06 accurately updated at least once a month (more frequently when any significant changes occur). Brought forward amended. Any written additions or 30/09/06 amendments to the MAR charts must be checked, dated and counter-signed by two registered nurses. Previous requirement of 23/06/05 and 27/03/06 not met. The medication policy must be reviewed. Review arrangements for managing creams, ointments and other external medicines to make sure these are safe. Prescribed medical equipment such as insulin pen needles must only be used for the resident they are prescribed for. The supervision & level of assistance of residents in the dining at mealtimes must be reviewed. A record must be kept of all complaints made to include the details if the investigation, outcome and any action taken. A review of the condition of the premises & equipment must be carried out. A copy of any action DS0000004097.V308061.R01.S.doc 8 9 OP9 OP9 13(2) 13 31/10/06 30/09/06 10 OP9 13 30/09/06 11 OP15 12 31/10/06 12 OP16 17 30/09/06 13 OP19 13, 23 30/11/06 Boynes Nursing Home, The Version 5.2 Page 35 14 OP22 23 15 OP22 13(4), 17(1), Schedule 3 plan must be sent to the Commission. Storage must be provided for equipment not in use that is not part of the communal facilities for the residents. Bed side-rails must only be fitted following a written assessment, which must detail the suitability of use and the management of risks. Written consent must always be obtained by the resident or their representative. Previous requirement of 23/06/5 and 27/03/06 partly met. 31/03/07 30/09/06 16 OP23 17 OP24 18 OP24 19 20 21 OP24 OP27 OP29 12, 13, 23 Staff must be able to access both sides of the bed at all times for residents who require assistance with moving and handling. 12, 13 The doors of residents’ bedrooms must be fitted with a lock suited to each resident’s capabilities, and must be accessible to staff in emergencies. Previous requirements of 20/09/04, 14/03/05, 23/06/05 not met. Brought forward 13, 16 A review must be carried out regarding the suitability of the beds provided for residents requiring nursing care. 12, 13, 23 Lockable storage space must be provided for residents for medication, money & valuables. 18 The numbers & deployment of care & ancillary staff in the home each day must be reviewed. 19 An application must be submitted to the Criminal Records Bureau for an Enhanced Criminal Records Bureau check for both employees from overseas. An immediate requirement was made. DS0000004097.V308061.R01.S.doc 30/11/06 31/03/07 31/10/06 30/11/06 30/11/06 23/08/06 Boynes Nursing Home, The Version 5.2 Page 36 22 OP29 19 Staff must not commence employment in the home until the home has received a satisfactory POVAfirst check in addition to all other information required through regulation. The registered person must make sure that references received are authentic and that they have obtained written verification as to the reason why the applicant ceased to work in that position. Two written references, including a reference relating to the person’s last period of employment must be obtained prior to employment at the home. An appropriately qualified first aider must be on duty at all times. All staff must receive fire training at regular intervals. Risk assessments must be carried out for all tasks which involve moving & handling of residents & loads. (e.g. moving beds with residents in them & carrying laundry up and down stairs.) Cleaning products must not be accessible to residents & must be securely stored at all times. An immediate requirement was made. All wheelchairs must be fitted with two footrests and must be used at all times when transporting residents. 20/09/06 23 OP29 19 30/09/06 24 OP29 19 30/09/06 25 26 27 OP38 OP38 OP38 13 23 13 30/11/06 30/11/06 30/09/06 28 OP38 13 22/08/06 29 OP38 13 30/09/06 Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations The home should obtain a copy of the guidance for care homes written by the Royal Pharmaceutical Society of Great Britain. The temperature of the room where medication is stored should be checked and recorded each day to ensure that the temperature does not exceed 25°C. Action should be taken if this temperature is exceeded. Insulin pens should be labelled with the resident’s name. A budgeted sum of money should be allocated by the Provider for social & recreational activities provided by the home. For residents who are served meals in their bedrooms, the dessert course should not be served to residents at the same time. Care staff should only assist one resident to eat at a time. They should sit beside the resident in a discreet manner so that it becomes a social occasion and not a task. Gaps in employment history should be explored prior to employment. The home should review the use of bolts on the outside of toilet, bathroom & sluice doors as someone could get locked in the room. 3 4 5 6 7 8 OP9 OP12 OP15 OP15 OP29 OP19 Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Boynes Nursing Home, The DS0000004097.V308061.R01.S.doc Version 5.2 Page 39 - 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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