Inspection on 23/06/05 for Boynes Nursing Home, The

This inspection was carried out on 23rd June 2005.

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

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

Other inspections for this house

Boynes Nursing Home, The 02/03/09

Boynes Nursing Home, The 10/12/07

Boynes Nursing Home, The 21/08/06

Boynes Nursing Home, The 27/03/06

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 The Boynes Nursing Home Upper Hook Road Upton-upon-Severn Worcestershire WR8 0SB Lead Inspector Mandy Burton Unannounced 23 June 2005 20:45 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 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. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Boynes Nursing Home Address Upper Hook Road Upton-upon-Severn Worcestershire WR8 0SB 01684 594001 01684 594812 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St Cloud Care Plc Care Home with Nursing 28 Category(ies) of DE(E) Dementia (over 65) - 3 registration, with number OP Old Age - 28 of places PD(E) Physical Disabliity (over 65) - 28 TI Terminally Ill - 3 The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14 March 2005 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 twenty eight 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 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 Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this inspection. The visit was unannounced and started at 20.45hrs and took place over a three hour period during the night shift. The main focus of this inspection was to assess progress made by the home to address requirements made at the previous inspection on 14.03.05 and to follow up a concern raised with the Commission for Social Care Inspection about staffing levels at night time. Due to the visit being conducted at night it was not possible to review all previous requirements during this visit. A partial tour of the home took place, three members of staff were spoken to and a selection of care and medication records were examined. Due to the timing of this visit it was only possible to speak with two residents on this occasion. What the service does well: What has improved since the last inspection? 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 Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 7 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 standard(s) 3 and 4 While basic pre admission assessments are completed for each resident, the lack of specific detail of individual care needs and preferences provides no assurance that care needs of residents have been identified and can be met by the home. EVIDENCE: Individual records are kept for each resident. The assessment records of three residents recently admitted to the home were inspected. A trained nurse had assessed each resident prior to their admission to the home. The assessments contained very basic information about the health care needs of each resident. Information recorded was not sufficiently detailed to form the basis of a care plan. Information in relation to personal preferences and social and emotional needs for one resident was very limited and had not been documented at all for two other residents. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 8 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 standard(s) 7, 8, 9, 10 and 11 Care planning systems are weak and fail to ensure that the health care needs of all residents are identified and appropriate care provided. Policies and procedures for the safe administration of medication are not always being followed and residents are being placed at risk as a result. EVIDENCE: Since the last inspection the home has recommenced daily progress notes for each resident. This has made a notable difference providing staff with the opportunity to document more detailed information of the health and well being of residents on a day-to-day basis. Corporate pre printed care plans are used in the home which require staff to enter the name of each resident and add or delete information as applicable according to the needs of each resident. The current format of these care plans leaves little scope for personalisation. St Cloud Care proposes to change this system in the near future. The care records of three residents were examined. Care plans seen were of poor quality and lacking in detail. Care could not be delivered safely using the information given. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 9 Specific areas of concern were: • Inadequate information with regard to residents with diabetes. The care plans for one resident with diabetes contained no information about their normal blood sugar range and conflicting information about the frequency of monitoring of blood sugar levels. • Insufficient information about the care to be provided to a resident with MRSA. • Insufficient information regarding personal care and support, with particular regard to a resident with high dependency needs being nursed in bed. Records seen showed that no fluids, oral care, pressure relief or continence care had been provided since 11.50hrs that day. (An Immediate requirement Notice was issued at the time of inspection in relation to this.) In addition to this resident’s care plans contained conflicting information about pressure relief and moving and handling. • Insufficient information in relation to moving and handling • Insufficient information regarding weight loss and intervention The records for one resident identified them at high nutritional risk but their weight had not been monitored since March 2005 • Care plans had not always been reviewed monthly and updated when the needs of residents had changed. In addition to a specific written request made by a relative in relation to one resident was not carried out. At the time of this visit it was a very warm evening and many bedrooms were hot and all residents were in their rooms at the time of arrival. Not all residents had cold drinks accessible to them and it was not clear at the time of this visit what action was being taken to ensure all residents were being suitably hydrated. (An Immediate requirement Notice was issued at the time of inspection in relation to this.) All residents are registered with a local doctor and all visits made by the doctor are recorded. Medication Administration (MAR) Records were examined. A number of concerns were noted: • Medication records for one resident seemed to indicate (there was no specific instruction on MAR chart) that a Fentanyl patch (a controlled drug) was prescribed to be applied at 16.15hrs on the day of this visit. This had not been carried out and no explanation was available to determine why the omission had been made. When a request was made to the nurse in charge to examine the controlled drug register, the nurse said they did not know where it was kept. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 10 When records were found it was noted that records relating to stock levels of the patches were incorrect and only one nurse had signed the register. Three Fentanyl patches had been delivered to the home and were signed in by only one registered nurse and the count was wrong. This error would lead to further mis counts in the future. • Antibiotics prescribed for one resident were checked and it was noted that more tablets had been dispensed than had been signed for. • The second level nurse in charge of the home at the time of this visit was observed secondary medicating. Medication for two residents was seen dispensed from blister packs into medicine pots with labelled pieces of paper (with residents name on). The nurse then took both pots with her to take to the residents concerned. • Not all written additions or amendments to MAR charts had been signed and countersigned. • A sticky label detailing the prescription for one resident had been adhered to one record. • Records for one resident showed that staff had already signed for medication due to be administered the next day. • Gaps were noted in the recording on two records. The reason for this omission had not been recorded. • A medicine dispensing pot was observed by the bedside in one bedroom. The pot contained what was thought to be a white cream/ointment. There was no information to support where the cream had come from and when, what the cream was, whom it belonged to and why it had been decanted into the container. The nurse in charge was not able to identify the contents. (An Immediate requirement Notice was issued in relation to all medication issues at the time of inspection.) It was noted that a ground floor toilet located near to the passenger lift had no privacy lock. Without a lock there is no assurance that resident’s right to privacy is being respected. In addition to this personal information regarding residents and ‘bath days’ was displayed in a communal area. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 11 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 standard(s) 15 The menu detailing the evening meals served to residents is repetitive and lacks variety. As a result, there is a potential risk that resident’s dietary needs and preferences may not be adequately met. EVIDENCE: A copy of the weekly menu was displayed in the main reception area of the home. The menu for the evening meal was noted to lack variety. Cold meals such as sandwiches and salads were served on most days with limited evidence of hot options being made available. One resident who spoke with the inspector described the evening meal as ‘boring’ and stated that they seem to receive the same thing all the time. Plastic jugs and tumblers containing orange squash were seen in the lounges, and had been available to residents accessing these areas during the day. At the time of this visit it was a very warm evening and many bedrooms were hot and all residents were in their rooms at the time of arrival. Not all residents had cold drinks accessible to them and it was not clear what action was being taken to ensure residents were being suitably hydrated during this time. (An Immediate requirement Notice was issued at the time of inspection in relation to this.) The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 12 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 standard(s) 18 Systems are in place to ensure all staff have the necessary knowledge and understanding of adult protection issues in order to ensure a safe environment for residents. EVIDENCE: Written policies and procedures are in place in order to ensure the protection of service users, which includes a whistle blowing policy. A staff education notice board was observed in the office. A variety of information and research was displayed on the board, which covered all aspects of abuse and information for staff in relation to action to be taken should a case of abuse be suspected. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 13 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 standard(s) 19, 20, 22, 25 and 26 The standard of the environment within this home is generally good and provides residents with a comfortable and homely place to live. Not all residents have access to, or are able to use the nurse call bell. Without adequate systems for ongoing supervision there is no assurance that these residents will be kept safe. Failures to identify infections and to implement adequate infection control measures are putting the health and well being of residents and staff in this home at risk. EVIDENCE: The home is generally well maintained and provides a comfortable and homely environment for residents. A partial tour of the home took place during this visit. It was a very warm and a number of electric fans were in use in an attempt to provide some cool air to residents. At the time of this visit all residents were in their bedrooms. Not all residents seen had access to their nurse call bells and there was no written evidence to support this action or to identify how the residents were to be supervised. One The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 14 resident was observed in bed and the nurse call bell was observed wrapped around a wall light fitting opposite the bed, which was out of reach of the resident. (An Immediate requirement notice was issued at the time of inspection in relation to this). Concerns were raised during this visit in relation to infection control measures. • Records seen recorded that one resident had MRSA. The nurse in charge of the night shift was unaware of this. The room of the resident concerned was observed. There were no gloves, aprons, and clinical waste facilities evident in the room for staff to use. (An Immediate requirement notice was issued at the time of inspection in relation to this). • No clinical waste facilities were available in a ground floor toilet and it was not clear how staff were dealing with the disposal of clinical waste products when accessing this area. • A tablet of soap was observed in a communal bathroom. The home has one mechanical sluice on the first floor. Laundry facilities were seen, facilities were adequate however there were concerns about safe practice (see findings in relation to standard 38). A low energy light bulb was installed in one toilet. These types of bulbs cause a delay in illumination and create a potential risk to the safety of residents and staff accessing this area. Aids and equipment are provided to residents in accordance with individual needs. Bed rails had been provided for one resident. No written consent had been obtained from the resident or their representative to agree to this type of restraint. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The low numbers of staff available to assist and support residents at night have a potential to put residents at risk. EVIDENCE: 25 residents were living in the home at the time of this inspection. At the commencement of this inspection at 20.45 hrs all staff on duty (one trained nurse and four carers) for the evening shift were observed sat outside the home in the grounds adjacent to the kitchen. All residents with one exception were in bed. Night staff commenced duties at 21.00hrs. The home was to be staffed by a second level nurse who had been recently appointed and had worked only two nights at the home and an agency carer who had worked at the home on four occasions in the past. Neither member of staff knew the residents or the home very well and were reliant on a written list to establish this information. (An Immediate requirement notice was issued at the time of this inspection) Staff on duty said that 23 of the 25 residents living in the home required 2 members of staff to attend to them. In addition to this observations made during this visit and discussions with staff indicate that the home is not adequately staffed at night to ensure the health and safety of residents and to ensure their individual needs can be met. (An Immediate requirement notice was issued at the time of this inspection). The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 16 Not all residents had access to nurse call bells, and it was unclear how they were to summon assistance or how frequently they were being checked by staff. During a walk round the home at approximately 21.30hrs a resident was heard calling out for staff to assist them to the toilet. At this point staff were already responding to calls made by other residents. Staff responded to the resident’s call but were not able to provide assistance to them as promptly as they would have wished. Previous requirements made in relation to staff records and training could not be assessed during this inspection as records were not accessible at the time of this inspection. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 Shortfalls in health and safety practices and the recording of medication administration are placing residents at risk. EVIDENCE: Since the last inspection a new matron (home manager) has been appointed for the home. An application for registration has yet to be submitted to the Commission for Social Care Inspection. The home manager was not on duty at the time of this inspection. During a walk round the home a number of concerns were raised in relation to health and safety; • Several fire doors were observed held open by a variety of items, which included furniture, chemical products and towels. (An immediate requirement notice was issued at the time of inspection in relation to this.) E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 18 The Boynes Nursing Home • • • • • • • The door from the upstairs to the laundry was open and provided residents with access to the open boiler room, an exit door and a range of chemical products which were stored in this area including an open bucket of washing powder. (An immediate requirement notice was issued at the time of inspection in relation to this.) A number of chemical products were accessible in open cupboards and on a cleaning trolley. Metal safety bars were observed fitted to the lower windows of two bedrooms. The distance between each bar was considered to be too great. (An immediate requirement notice was issued at the time of inspection in relation to this.) The carpet in one bedroom (Lincoln) was raised and presented a tripping hazard. The first floor sluice room was wedged open and external bolts were fitted to the top and bottom of the door creating a potential risk that someone could become locked in the room. A Fire evacuation /instruction notice on display on the ground floor was incomplete. The exit doors by the kitchen and in the laundry were both held open. While this action was reportedly taken to improve airflow through the home due to the excessive heat, there was a risk that someone could enter the building unnoticed. This was of particular concern given that only two staff were on duty in the home and the majority of residents required two staff to attend to them. The quality of record keeping in respect of the receipt and administration of medication was poor (see findings in relation to standard 9). The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 x 2 x x 2 1 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x 2 1 The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3, 4 Regulation 14(1) 17(1) Requirement An individual needs assessment must be documented for all residents which covers all aspects detailed in National Minimum Standard 3.3 (Previous requirement 14.03.05 not met) Any necessary aids or equipment and specialist intervention identified during the pre admission assesment is made available to the resident at the point of admission to the home in accordance with their assessed needs. (Previous requirement 14.03.05 not met) Care plans must accurately detail the specific care , including aids and equipment to be provided to meet the individual needs of residents. (Previous requirement 20.09.04 and 14.03.05 not met) Care plans must be in place for each resident where emotional and psychological needs have been identified, which accurately detail the care and support to be provided. (Previous requirement 20.09.04 Timescale for action Immediate and ongoing 2. 3,4,8 12(1) 23(2)(n) Immediate and ongoing 3. 4,7,8 15(1) Immediate and ongoing 4. 4 ,7 15(1) Immediate and ongoing. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 21 and 14.03.05 not met) 5. 7 15(2) Systems must be in place which promote resident involvement/endorsement in care planning. (Previous requirement 14.03.05 not met) Care plans for residents with diabetees must include details of their normal blood sugar ranges and accurate information regarding the frequency in which blood sugar levels are to be monitored. Information must also be detailed in respect of the action to be taken by staff if symptoms of hypoglycaemia or hyperglycaemia become apparent. Systems must be in place which ensure residents identified at high nutritonal risk are appropriately monitored and supported and specialist intervention is accessed as necessary. All residents with wounds must have an assessment of the wound regularly undertaken and a supporting care plan which specifically details how the wound is to be managed. Records must be kept which accurately evidnece the care being given to residents with high dependancy needs. Care plans must be reviewed and updated at least once a month and also when any significant changes occur. All residents must be offered and have acess to cold drinks throughout the day and nigft . All trained staff must follow the homes policies and procedures for the safe administration and receipt of medication at all times Immediate and ongoing 6. 7,8 12(1) 15(1) Immediate and ongoing 7. 8 12(1) 13(4) Immediate and ongoing. 8. 8 12(1) 15(1) Immediate and ongoing 9. 8 12(1) 15(1) 12(1) 15(1) 12(1) 13(4) 16(2) 13(2) Immediate and ongoing Immediate and ongoing Immediate and ongoing Immediate and ongoing 10. 8,7 11. 12. 8,15 9 The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 22 13. 9 13(2) 14. 9 13(2) 15. 16. 17. 9 10 15 13(2) 12(4) 16(i) 18. 22 13(4)(c ) 19. 22 13(4) 17(1) Schedule 3 20. 24 12, 13 Any written additions or amendments to the drug adminstration records must be checked, dated and countersigned by two staff. Registered nurses must sign for all medication administered and document a code for any omissions . Sticky labels must not be used on medication administration records privacy lock to be fitted to ground floor toilet The evening menu must be reviewed to ensure it contains sufficent variety of hot and cold meals which meets the dietary needs and preferences of residents. All residents who are able to use the call bell system must have full access to it at all times. Where a resident is assessed as not able to use the call bell system a written asseesment must be in place and a care plan initiated to detail how the residents safety is to be maintained. This assessment and care plan must be regularly reviewed. (Previous requirement 14.03.05 not met) Bedsides must only be fitted folowing a written assessment which should detail suitability of use and management of risks. Written consent must be always be obtained by the resident or their representative The doors of residents private accommodation must be fitted with a lock suited to the residentss capabilities and acessible to staff in emergencies. (Carried forward from 20/09/04 and 14.03.05 -This standard was Immediate and ongoing Immediate and ongoing Immediate and ongoing 1st August 2005 1st September 2005 Immediate and ongoing Immediate and ongoing. Within the homes installation programme The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 23 not inspected) 21. 24 12, 13 Residents must be provided with lockable storage space for medication, money and valuables and a key which he or she can retain (unless the reason for not doing so is explained in the care plan). (Carried forward from 20/09/04 and 14.03.05 -This standard was not inspected) The low energy light bulb in one toilet should be replaced. Staff in the home must follow safe infection control procedures in respect of MRSA. Appropriate arrangements must be made for the disposal of clinical waste products when acessing communal toilets. The home mus be adequatley staffed at night to meet the individual needs of residents. Care must be provided by staff who are suitably experienced and competent to undertake their roles and responsibilities. Criminal Record Bureau checks/POVA checks must be undertaken for all new staff prior to the commencement of duties at the home. (Carried forward from 14.03.05 -This standard was not inspected) A photograph of each member of staff must be kept in the home.(Carried forward from 14.03.05 -This standard was not inspected) All care staff must receive training on abuse .(Carried forward from 20/09/04 and 14.03.05 -This standard was not inspected) Individual records must be kept for each resident of any monies held for safe keeping.(Carried Within the homes installation programme 22. 23. 24. 25 26 26 13(4) 13(3) 13(3) Immediate Immediate Immediate and ongoing Immediate and ongoing 25. 27 12(1) 18 26. 29 19 Immediate and ongoing 27. 29, 37 19 Schedule 2 18 Immediate and ongoing 1st August 2005 28. 30 29. 35 17 Immediate and ongoing Page 24 The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 30. 37 ,10 17(1) 31. 38 23(4) 32. 38 13(4) 33. 38 13(4) 34. 35. 38 38 13(4) 13(4) 23(4) 36. 37. 38. 38 38 38 13(4) 13(4) 13(4) forward from 14.03.05 -This standard was not inspected) Personal information relating to residents must not be displayed in communal areas.(Previous requirement 14.03.05 not met) All staff must receive in house training on fire precautions at not less than three monhtly intervals.(Carried forward from 20/09/04 and 14.03.05 -This standard was not inspected) A qualified first aider must be on duty at all times and details denoted on the daily rota.(Previous requirement 20.09.04 and 14.03.05 not met) The sluice room must be kept secure when not in use. .(Previous requirement 14.03.05 not met) External bolts must be removed and replaced with a coded number door entry pad . Fire doors must not be wedged/propped open. Fire doors may only be kept open by a device has been approved by the relevant inspecting fire authority. The door form the floor to the laundry must be kept secure. All chemical products must be stored securely. Additional metal bars must be fitted to windows in two bedrooms identified during this inspection . The carpet in one bedroom(Lincoln) must be stretched The fire information/evacuation notices must detail up to date information regarding the action to be taken in the event of a fire Immediate and ongoing Immediate and ongoing 1st August 2005 Immediate and ongoing 1st September 2005 Immediate and ongoing Immediate and ongoing. Immediate and ongoing 1st August 2005 1st August 2005 Immediate 39. 40. 38 38 13(4) 23(4) The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 25 or an alarm sounding. 41. 38 13(4) The home must be kept secure at night in order to ensure the safety of residents and staff. Immediate and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 26 Good Practice Recommendations It is recommended that a mechanial sluicing facility is installed on the ground floor. The Boynes Nursing Home E52 S4097 The Boynes NH V234789 230605.doc Version 1.30 Page 26 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR7 3NW 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. 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