Inspection on 12/10/06 for Buchanan Court Nursing Home

This inspection was carried out on 12th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Buchanan Court Nursing Home 01/04/09

Buchanan Court Nursing Home 25/04/08

Buchanan Court Nursing Home 13/11/07

Buchanan Court Nursing Home 04/06/07

Buchanan Court Nursing Home 09/02/06

Buchanan Court Nursing Home 28/06/05

Buchanan Court Nursing Home 18/01/05

Buchanan Court Nursing Home 28/07/04

Buchanan Court Nursing Home 02/02/04

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

CARE HOMES FOR OLDER PEOPLE Buchanan Court Nursing Home Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 12th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Buchanan Court Nursing Home DS0000022918.V315964.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. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buchanan Court Nursing Home Address Buchanan Court Care Centre Sudbury Hill Harrow Middx HA1 3AR 020 8423 3311 020 8423 2299 buchanan.court@ashbourne.co.uk 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) Ashbourne Homes Limited Miss Jane Karago Care Home 85 Category(ies) of Old age, not falling within any other category registration, with number (83), Physical disability (1) of places Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Temporary variation agreed for individual (BC) who is under the age of 65 years for the duration of her stay.Maximum of 85 persons may be accommodated Temporary variation agreed for individual (CC) who is under the age of 65 years for the duration of his stay. Maximum of 85 persons to be accommodated 9th February 2006 Date of last inspection Brief Description of the Service: Buchanan Court belonged to Ashbourne Plc, which has been taken over by Southern Cross Healthcare, a national provider of care homes mainly for the elderly. The home is purpose built to be a care home and consists of three floors. It is found in Sudbury Hill and is easily accessible by public transport as the area is well served by buses. The closest underground station is Sudbury Hill, which is about 10 minutes walk away. There is an extensive parking area in the grounds of the home and there are maintained lawn/shrubs areas in the front and at the back of the home. Buchanan Court is registered for 85 elderly service users requiring nursing care. However, only 70 beds in the home are used. It is purpose built and provides accommodation on 3 floors. The ground floor accommodates 25 service users, the first floor also has 25 beds and the second floor accommodates 20 service users. Accommodation is provided in a mixture of single and double bedrooms with en-suite facilities, although most of the double bedrooms tend to be used as single bedrooms. The home is run by Jane Karago, the general manager and her deputy, Kamala Chohun. The home charges local authorities £549-£784 for service users placed by them and charges self-funding service users £784-£800 depending on the needs of the service users. On the day of the inspection there were 60 service users in the home. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the findings of a key unannounced inspection which took place on the 12th October from 10:00 to 19:30 and on the 17th October from 10:00 to about 14:00. The findings are based on conversations with service users, visitors to the home, the manager and her staff, and some community healthcare professionals; inspection of a sample of care, health and safety, training and personnel records; observation of care practices in the home; and a partial tour of the premises. An immediate requirement was issued on the 12th October to address the poor condition of the environment and a letter was sent to the responsible individual after the inspection on the 17th October to address maintenance issues and the lack of health and safety checks in the home. A response has since been received with regard to the immediate requirement. The inspector is grateful to all service users and visitors who spoke to him during the course of the inspection and thanks the manager and all her staff for their support and cooperation during the course of the inspection. What the service does well: What has improved since the last inspection? The healthcare needs of service users were in the main being met. Pressure area care in the home has improved and documentation with regard to the management of pressure ulcers has also improved. Medicines management in the home has improved and few issues were identified while inspecting this aspect of the service. The home now has an appropriate lancing device for blood sugar testing in cases of service users who were diabetic. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users were admitted the home after a preadmission assessment to ensure that their needs could be met in the home. The home had the appropriate staffing levels and was generally able to meet the needs of the service users accommodated in the home. However as service users’ needs were not always comprehensively recorded for care plan purposes there was no guarantee that their needs would be met. EVIDENCE: The manager stated that all service users receive a copy of the service users’ guide. A random inspection of some service users files revealed that copies of the terms and conditions of the placement as agreed by the service users/representatives were available on file. There was however no evidence that service users/representatives were receiving information about the range of fees charged by the home as per Regulation (5)(1)(bb) of the Care Homes Regulations 2001 according to the source of funding and type of placement. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 9 The manager added that she was in the process of adding this information to the service users’ guide. The inspector was informed that all prospective service users have a preadmission assessment prior to being offered a place in the home. These are carried out either by the manager or by her deputy. The preadmission assessments are also carried out for short stay service users. The home has a number of short stay service users who occupy ‘step-down’ care beds to recuperate following a stay in hospital or to wait for adjustments to be made to their house prior to moving back into their own house. Records of the preadmission assessments were available for inspection and the needs assessments of the funding authorities were also available for inspection. Six care records were inspected. It was noted that the needs assessments of service users were not always comprehensively recorded once they were admitted to the home and that these assessments were not always kept under review. The home has also recently changed the format of the care records, from the format used by Asbourne Plc to the format used by the parent company- Southern Cross Healthcare. Staff therefore had to transfer all the information from the old care records to the new format and needed to get familiar with using the new format. Sections such as on the likes and dislikes of service users, sexuality and religion were not always clearly recorded. The home had some service users from ethnic minorities. While the care records mentioned some aspects of the cultural diversity of the service users such as religion, these were not explored more in detail to ensure that the needs of the service users with regard to these aspects would be met. For example the inspector noted that the care plan of a service user who was from a particular faith did not reflect the fact that the service user did not strictly practice his faith as he did not always comply with the dietary practices of that faith. While the needs of the service users were not always recorded, care staff were on the whole aware of the needs of service users and could discuss these with the inspector. The fact that the home was changing documentation could have affected the comprehensiveness of the record in the short term while staff come to grip with the new format. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans of service users did not always comprehensively address the needs of service users. There was therefore a possibility that the needs of service users would not be consistently met. These were however discussed with service users and/or their relatives. The healthcare needs of service users were on the whole met by the home. Medicines management was on the whole good with few issues identified. The records with regard to end of life care and the death of service users were not comprehensively addressed to ensure that these needs would be met when the time comes. EVIDENCE: As stated in the previous section six care records were inspected. The care records were in good condition and were kept in the clinical rooms, except on one unit when the files’ trolley was broken and the records could not be stored in the clinical room and were kept at the nurses’ station. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 11 The inspector noted that care plans were in place in cases where needs of service users have been identified. It was noted that one service user who was aggressive did not have a care plan to manage this need. One care plan on pressure sore said to take action to reduce ‘shearing and friction’ but did not say how this was going to be achieved. Two service users were diabetic but the care records were not very clear with regard to the signs and symptoms to observe in cases where service users may be having hypo or hyperglycaemic attacks and the care records did not describe the actions to take in these cases. The risk assessments and care plans on manual handling did not comprehensively address the various manual handling manoeuvres such as turning in bed, moving in bed, transfers and standing up. It was also noted that the care plan on manual handling in some instances mentioned that a standing hoist should be used for service users who could not weight bear, when a standard hoist should be used for these purposes. Out of the six care plans inspected one had not been reviewed since July. The home had a form to record care reviews which are conducted by staff with service users/representatives. A number of these were noted to have been completed suggesting that service users and/or their relatives were involved in the care planning process. All service users presented as clean and appropriately dressed with a good standard of hygiene, including oral hygiene. Feedback from relatives of service users about the standard of care that service users received was on the whole positive and they said that they would discuss their concerns with the nurse in charge or with management if they had any. The home used a pressure ulcer risk assessment tool to identify service users who were at risk of developing pressure ulcers. There was one service user with pressure sores at the time of the inspection. She had care plans in place and all records were being kept appropriately to demonstrate that the service users were being cared for appropriately. Service users at risk of pressure sores also had pressure relief equipment as dictated by their risk assessments. A number of service users who were at high risk of pressure sores did not however have adjustable beds (see section under environment). Records showed that service users were seen by a range of healthcare professionals when that was required. This included the GP, dietician, optician, dentist, tissue viability nurse and the speech therapist. Care plans have a section which deals with the death of service users. It was noted that this section was not always appropriately completed and did not always reflect the wishes and instructions of service users and of their relatives with regard to end of life care and death. Three of the six care plans inspected said ‘no comments’, two did not have that section completed and one Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 12 mentioned that the service user “did not wish to discuss”, but there was no evidence that staff have revisited the service user/relative to review this matter. Medicines on the first and the second floors were inspected. The clinical rooms were all air-conditioned and records of the temperature of the medicines fridges showed that they were all running at the required temperature. There were a few items in the clinical rooms which were stored on the floor and which could have been stored on shelves. The management of medicines in the home and the knowledge of nurses with regard to administration of medicines were generally good but there were a few issues which needed to be addressed. An eye drop did not have a date of opening. There were a few occasions when the amounts of medicines, received into the home, were not recorded and when the instructions on the application on creams/ointments were not very clear. The home used an appropriate lancing device for blood sugar testing but the home did not have a calibrating solution for the glucometers. (see “Blood Glucose Meters”. Advice for Healthcare Professionals. (2005). MHRA. Pg2 and 4, www.mhra.gov.uk ) Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While the home provided activities to service users and promoted the involvement of service users in the community, records about this aspect of care were not always adequate to evidence that the activities which were provided met the individual needs of the service users. Meals were provided to service users according to their tastes and choices in a congenial setting. EVIDENCE: The home had a programme of weekly activities and a yearly programme for outside entertainers. These were available on each floor. The home also employed an activities coordinator. On one of the days of the inspection there was reminiscence, which service users clearly enjoyed. The activities coordinator also visited service users on a one to one basis and engaged with them and their relatives. Feedback about the input of the activities coordinator was very good. The care records contained sections to be completed about the social and recreational needs and the ‘life history’ of service users. These sections were Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 14 not always completed comprehensively and care plans were not in place to address the individual needs of service users. As a result although the home provided activities which were appreciated by service users, it was not always clear if these were according to the individual needs and tastes of the service users. There were regular visits by representatives from various churches including the Church of England, the Roman Catholic Church and Pentecostal church. The visits were planned and notices were present on boards to inform service users/representatives about these visits. The home has a bus, which is normally driven by the handyman to take service users out. In the absence of a handyman in the home, there have not been many outings. The manager stated that there has been a visit to a local school in the bus which was driven by someone from one of the other homes belonging to the organisation. The home had a permanent chef and kitchen assistants. There was a four weekly menu and there was evidence that staff ask service users about their choices which were recorded on menu choices sheets. The home normally provides three meals a day, including a cooked breakfast. The inspector observed lunch and supper being served in the home. A copy of the menu for the day was available on each table in the dining rooms, which were prepared appropriately for service users to have their meals. On the first day of the inspection lunch consisted of minestrone soup, roast chicken and gravy, carrot, cabbage, potatoes, Cornish pasties as the second choice, and lemon meringue for desert. The chef also prepared individual meals such as omelettes, salads and fish for other residents. Supper consisted of lentil soup, corned beef hash, omelette and salad and rice pudding. The inspector concluded that a range of meals was provided to service users to suit their needs. The kitchen was very clean and tidy. All records were kept and available for inspection, including a record of all food cooked in the home. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes complaints and allegations of abuse seriously and deals with these appropriately. EVIDENCE: The home has had two complaints since the last inspection. One was still ongoing and the other was about a care aspect. The investigation which was carried out showed that the complaint was substantiated. The way that the home has handled these complaints suggests that the home takes all complaints seriously and will ensure that these are appropriately investigated. The complaint procedure was available in the service users’ guide and in the foyer of the home. Visitors who were spoken to by the inspector said that they would approach the manager or other senior staff if they wanted to make a complaint and they had the confidence that their concerns would be taken seriously and dealt with appropriately. There has not been any allegation of abuse since the last inspection. Previous allegations of abuse have been dealt with within the Safeguarding Adults policy of the Local Authority. The manager stated that most members of staff have had training on abuse as part of the ‘Residents’ Welfare’ training. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment has started to look dated and past its useful life. There was no assurance that the home would address this issue which has been repeated in past inspections, as the home did not have a comprehensive redecoration and refurbishment plan. EVIDENCE: The grounds around the home and the car park areas were well maintained. The bushes and shrubs were kept trimmed and the manager had made some attempts at planting flowers in front of the home to brighten this area. This was commendable. The home has not had a permanent handyman for a long time and a number of issues, which needed to be addressed in the home, had not been addressed. As a result the home was starting to look dated and the standard of decoration was starting to look poor. The home did not have a redecoration plan and a Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 17 plan to replace the fixtures and fittings such as chairs, other items of furniture, curtains, light fittings and the covers of the call bells. A comprehensive redecoration plan has been requested as part of the requirements in the reports following the inspections on the 9th February 2006 and on the 18th May 2006. This has not been provided. As a result there was no assurance that the redecoration would be addressed within an appropriate timescale to ensure that service users were able to benefit from a quality environment. The home has a communal bath on each floor. The bedrooms are en-suites and most of them have a bath and a few have showers. The baths in the ensuites are not easily accessible to service users with poor mobility as they are situated against the wall, does not allow access to a hoist and staff are unable to attend to service users on either side of the bed. Both staff and service users stated that they do not use the en-suites baths because of the risk that this may pose to service users with poor mobility. As a result very few ensuites are used in the home and most residents have their bath in the communal bath. There is however only one such bath on each floor. The inspector has requested a review of the bathing facilities in the home, but this has not yet been produced. The inspector noted that a number of bedrooms were in a poor decorative state. Some of the issues were: the wallpaper looked dated, the paint work looked old, there were holes in the wall where the plaster has been damaged by knocks and the bedrooms were not personalised. Some of the bedrooms looked like they have not been redecorated since the home was commissioned. Some of the flooring in the en-suites looked old and stained. Part of the ceiling in one of the bathrooms was black with damp. It was also noted that the extractor fans in a number of en-suites were not working. The fire door (giving on the outside) in one bedroom did not close properly. There was a draught in the room and the visitors of the service user, who was accommodated in the room, have taped the door to prevent the draught, The covers on a number of call bell sockets have come off and a number of call bells were not working as recorded in the maintenance book. The curtains in one bedroom needed to be overhauled since July 2006. A pelmet to the curtains in another room was required for more than a year. Nearly all the wooden window sills outside the windows needed painting to ensure an aesthetic look and the protection of the wood. The carpet in one of the lounges was becoming unstuck near the windows and needed to be stuck to the floor as this could be a tripping hazard. A broken recliner chair was still in the lounge and needed to be disposed of. The cushions on some chairs in the bedrooms of service users did not fit the chair frames properly. This could cause poor posture of a service user as the cushion slides on the frame. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 18 At least three service users who were confined to their beds because of their frailty, did not have an adjustable bed. They were being cared for over a 24hour period on divan beds. As a result they could not always be seated for their meals and repositioned that easily in bed, causing discomfort to them and posing a health and safety hazard to members of staff. The mattress replacement systems in place on these divans for the pressure relief of the service users were also spilling on the sides and at the bottom of the divan beds raising questions about the effectiveness of these items of equipment. This issue for the three service users was addressed following the serving of the immediate requirement, but the home must review its strategy with regard to providing adjustable beds for service users. The home was issued with an immediate requirement requesting the home to provide the Commission with a written plan for the redecoration of the bedrooms of service users and of the home, and for the replacement of fixtures and fittings with appropriate timescales, by the 23rd October 2006. This has still not been produced on the 13th November 2006, although the responsible individual has stated that the maintenance manager was preparing such a plan for the home. The home was in the main clean with no odours. The carpet was in the main clean. A new housekeeper has been appointed by the home. The inspector noted that some bed frames needed to be dusted. There were a few service users in the home with a particular infection. It was noted that there was no alcoholic handrub in place which has been recommended as a quick way for hands decontamination. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff were sufficiently experienced and trained. They were provided in appropriate number to meet the needs of service users. The recruitment procedures were not carried out as thoroughly as they should have been to ensure the safety of service users. EVIDENCE: There have not been any changes in the staffing levels in the home since the last inspection. During the day there were one trained nurse and three carers for the second floor (20 service users maximum), one trained nurse and four carers for the ground and first floors each. At night there were one trained nurse and one carer for the ground floor and one trained nurse and three carers for the first and the second floors. Comments from service users and visitors showed that staff in the home were able to care for the service users and that they were kind and showed respect to service users. The home employs about 30 carers. Out of these only 9 carers were trained to at least NVQ level 2 in care. 1 carer had nearly completed NVQ 2 in care and 13 had started on the course. It therefore did not yet have 50 of its care staff with NVQ level 2 in care and it is unlikely that it would meet this requirement by the end of December 2006. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 20 The inspector looked at the personnel files of 4 members of staff chosen at random. He noted that two of them, including one who started work in March of this year, had one written and one verbal reference each. One member of staff did not have a full work history recorded in the application form and there was no evidence that this was explored during the interview. The home has an up to date training plan with individual training profiles. There was evidence that most staff had received statutory training and that training has been provided in clinical areas to improve the knowledge of nurses and carers. There was also evidence that new members of staff had received induction prior to starting work in the home. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager is trained, experienced and is now registered. She is aware of her responsibilities with regard to running the home. The home has a quality management system, but the impact of this on the service with regard to continuous improvement was not very clear. The management of the personal money of service users was in the main good. Serious issues were identified with regard to maintenance and health and safety which could compromise the health and safety of service users, staff and visitors to the home. EVIDENCE: The manager has been in post for about two years. She has since been registered and she has also completed the Registered Manager’s Award. She Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 22 has kept herself updated as she has attended some training. There was evidence that she involved her staff in the running of the home. Minutes of a number of meetings were available for inspection. These included minutes of night staff meetings, kitchen staff meetings, domestic staff meetings, care staff meetings and trained nurses meetings. In these meetings she discussed issues relevant to each group of staff to raise the awareness of staff in relation to these issues and for these to be addressed. The manager is aware of her legal responsibilities but in line with the issues noted below with regard to health and safety, it is not very clear if the manager has been able to discharge her responsibilities fully. There were records that supervision was taking place in the home. There has been progress since the last inspection and efforts have clearly been made to ensure that all members of staff received supervision regularly. However the manager acknowledged that not all members of staff were receiving supervision every two months or at least six times a year. The home has a quality management system which has been devised by Southern Cross Healthcare. A copy was available for inspection. According to the system, monthly audits are conducted by the manager according to a designed format and every second month the operational manager conducts a validation audit. Copies of audits carried out by the manager were available for inspection. These were completed when the manager looked at various aspects of the service such as care plans, catering and the personal care of service users and checked whether the company procedures were being implemented and whether records were completed appropriately. Corrective actions were identified in cases where non-compliances were identified. The manager stated that a customer satisfaction survey had also been conducted in July/August of this year. A report detailing the findings of the survey was however not yet available. Despite the above, the findings of this inspection noted under ‘environment’ and below, raise questions about how the quality management system was being implemented and about its contribution in securing continuous improvement. The management of the personal monies of service users was inspected. This task has been delegated to the administrator. Random checks were made by the inspector by checking the balance of money and the expenditures that have been made on behalf of service users. The inspector concluded that the personal money of service users was being managed to a good standard. All transactions were recorded and receipts were kept for all expenditures. It was Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 23 however noted that the home still had money for about 40 service users who were no longer in the home, albeit not large sums of money. The inspector looked at the management of health and safety in the home. A significant number of issues were noted which could be putting service users, members of staff and visitors to the home at risk. Records showed that the home was not carrying out weekly fire detector tests. The last weekly test was carried out on the 28th July 2006. There were also no records of regular in house emergency light testing. It was also noted that a number of bedrooms doors do not close fully to fit the frame. As these are fire doors, they must fully close to prevent the spread of smoke in the event that there is a fire. The hot and cold water temperature was not regularly monitored and there was no chlorination certificate available for inspection in the home to show that the water system has been treated for Legionella. The call bell system looked in poor condition. The covers of a number of the call points were coming off, a number of them were not working and there were no records of regular in house call bell system checks. The last check was carried out in July 2006. There were no regular wheelchair checks. The last wheelchair check was carried in June 2006. The home had a portable appliances test certificate and the electrical wiring certificate was dated 17th July 2006. The later rated the electrical wiring system in the home as unsatisfactory as there were 48 issues of ‘code 1’ (most urgent issues) to be addressed. There was no evidence that these were being addressed. The gas safety certificate for the gas boilers (hot water and central heating) were not available for inspection. Up to date LOLER certificates for the hoists were not available for inspection. Members of staff informed the inspector that the standing hoist on the ground floor was unsafe. As this had not been recently checked, the inspector was unable to comment on the safety of this hoist. The inspector that a new hoist had only one sling and therefore staff could not fully make good use of the hoist. This could pose a problem particularly in cases where there were dangers with regard to cross infection. Staff on the ground and the first floors mentioned that they were sharing a hoist. As a result of the above a review must be conducted with regard to the manual handling equipment in the home including the number of hoists and slings in the home. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 24 The home had an up to date fire risk assessment and emergency fire plan, but the health and safety risk assessment had not been updated since August 2005. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 2 X X 1 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 1 Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5(1)(b) Requirement Timescale for action 31/12/06 2 3 OP3 OP7 14(1,2) 15(1) The service users’ guide must contain information about the range of fees charged by the home in respect to various types of placement and funding. The needs’ assessment of service 31/12/06 users must be carried out comprehensively. There must be a care plan in 31/12/06 place when a new need has been identified or when a particular intervention is needed from care staff with regard to meeting a service users need (Previous Requirement-Timescale 30/4/5 and 31/07/06 not met). Care plans must be reviewed at least monthly or more often if the needs of service users change. The care plan and risk assessment on manual handling must clearly describe the actions to take to carry out the various manual handling manoeuvres. The right hoists must always be used for service users according to their individual assessment DS0000022918.V315964.R01.S.doc 4 OP7 15(2)(b) 31/12/06 5 OP7 13(5) 31/12/06 Buchanan Court Nursing Home Version 5.2 Page 27 6 OP7 12(1) 7 OP9 13(2,4) 8 9 OP9 OP9 13(2,4) 13(2,4) 10 OP11 15 11 OP12 16(2) (m,n) which have been made by a competent person. The care plans of service users who have diabetes must be clear about the signs and symptoms to observe in cases of hypo and hyperglycaemia and must describe the actions to take in these cases. That the amounts of all medicines received into the home are clearly recorded. Creams and lotions must have clear instructions with regard to the application of these medicines. All eye drops must have a date of opening. Calibration solutions must be available and must be used at the intervals recommended by the manufacturers to calibrate glucometers to ensure that these always give the right readings about blood sugar levels (repeated requirement-previous timescale 15/07/06 not met) The instructions and wishes of service users and of their relatives with regard to end of life care and death must be addressed in the care records while taking into consideration the cultural and the religious backgrounds of the service users. That the social and recreational needs of service users are continuously kept under review and updated as and when new information is received and that the registered person develops care plans to address the social and recreational needs of service users based on their individual needs assessments. (Previous Requirement-Timescale 30/4/5 and of 31/07/06 partly met DS0000022918.V315964.R01.S.doc 31/12/06 31/12/06 31/12/06 31/12/06 31/12/06 31/12/06 Buchanan Court Nursing Home Version 5.2 Page 28 during this inspection). 12 OP19 23(1)(2) (b) The registered person must provide the commission with a comprehensive plan with timescales addressing the redecoration of the bedrooms and of the home, and the replacement of fixtures and fittings. (An immediate requirement was issued on the 12th October with a timescale of the 23rd OctoberThis was not met.) The fire doors which give on the outside from the bedrooms of service users must be repaired to ensure that there is no draft in these rooms. The call bell system must be reviewed and all call points must be in good working order. All curtains and pelmets must be in good condition. All carpet must be appropriately fixed to the floor. The provision of armchairs in the home must be reviewed particularly in the bedrooms of service users. The registered person must review the bathing facilities available in the home. (Previous requirement-timescale 31/05/06 not met). A copy must be sent to the Commission. The bedrooms of service users must be fit for purpose. They must be decorated to high standard and must be personalised according to the wishes and choices of the service users The registered person must provide adjustable beds to all service users with nursing needs and to those who require pressure relief equipment DS0000022918.V315964.R01.S.doc 23/10/06 13 OP19 23(2)(b) 31/12/06 14 15 16 17 OP19 OP19 OP19 OP19 23(2)(c) 16(2)(c) 23(2)(b) 16(2)(c) 31/12/06 31/12/06 31/12/06 31/12/06 18 OP21 23(2)(j) 31/12/06 19 OP24 23(2)(b) 31/01/07 20 OP24 23(2)(n) 31/12/06 Buchanan Court Nursing Home Version 5.2 Page 29 21 22 OP26 OP26 23(2)(d) 13(3) 23 OP28 18(1)(c) (Previous requirement- timescale of 31/12/5 and 31/07/06 not met). The registered person must 30/11/06 ensure that the bed frames are kept free from dust. That alcoholic handrub is made 30/11/06 available in the home as a quick and effective mean for hand decontamination in cases where service users may have particular infection. The registered person must 31/08/07 ensure that 50 of care staff are trained to at least NVQ level 2 as soon as possible (Previous requirement- timescale of 31/12/5 not met. Timescale of 31/12/06 unlikely to be met). The registered person must ensure that all the records as per schedule 2 of the Care Homes regulations 2001 are available for inspection. The work history of all applicants must be fully explored during interviews if gaps are noted in the application forms. The impact of the quality management system on the quality of the service must be reviewed to ensure that its use is leading to continuous improvement. The home must reimburse the money of service users who are no longer in the home as soon as possible. The registered person must ensure that all members of staff receive supervision at least every two months or six times every year. Fire doors must close properly and fully to ensure that there are no gaps between the doors and the frames (Repeated DS0000022918.V315964.R01.S.doc 24 OP29 19 31/12/06 25 OP33 24 31/01/07 26 OP35 17(2),20 31/01/07 27 OP36 18(2) 31/01/07 28 OP38 23(4) 31/12/06 Buchanan Court Nursing Home Version 5.2 Page 30 29 OP38 13(4) 30 31 32 OP38 OP38 OP38 13(4) 13(4) 13(4,5) 33 OP38 13(4) 34 OP38 13(4) 35 36 OP38 OP38 13(4) 13(4) requirement-timescale 30/06/06 not met) The home must have a satisfactory electrical wiring certificate as soon as possible and issues/problems identified during the inspection of the electrical wiring system must be addressed. All hoists must have up to date LOLER certificate There must be regular in-house fire detectors and emergency lights tests. There must be a review of manual handling equipment in the home, including the number of hoists and slings. The temperature of hot and cold water must be monitored and there must be a Chlorination certificate available for inspection. All wheelchairs in the home must be regularly checked for safety and records must be kept to this effect. A gas safety certificate must be available for inspection. The health and safety risk assessment must be reviewed at least yearly. 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 31/12/06 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 OP7 OP9 Good Practice Recommendations All care records should be kept securely as far as possible. Medicines items and other items should not be stored on the floor of the clinical rooms and should instead be stored on shelves. DS0000022918.V315964.R01.S.doc Version 5.2 Page 31 Buchanan Court Nursing Home 3 OP24 The registered person should provide locks for the bedrooms of service users. Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Buchanan Court Nursing Home DS0000022918.V315964.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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