Inspection on 09/02/06 for Buchanan Court Nursing Home

This inspection was carried out on 9th February 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 12/10/06

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 Unannounced Inspection 9th February 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.V283535.R01.S.doc Version 5.1 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.V283535.R01.S.doc Version 5.1 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.V283535.R01.S.doc Version 5.1 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 28th June 2005 Date of last inspection Brief Description of the Service: Buchanan Court belongs 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 found in Sudbury Hill. It 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. 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. The home is run by Jane Karago, the general manager and her deputy, Kamala Chohun. On the day of the inspection there were 63 service users in the home. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was the second inspection for the period 20052006. It started at about 10:15 and lasted until about 19:30. During the course of the inspection, the inspector was able to talk to some service users, the manager and some members of her staff. He was also able to observe care practices, to tour some of the premises, to look at a sample of records and to check for compliance with previous inspections. Comments cards about the quality of the service that the home provides were received by the Commission. The inspector would like to thank all those who have returned the comments cards and he has used these where possible in this report. There were 10 comments cards from relatives/visitors to the home and 7 from service users. They were all pleased with the care that service users receive in the home, except for one service user. The comments cards showed that respondents were in the main pleased with all areas addressed in the comment cards such as food, laundry, respect of privacy, awareness of the complaint procedure and numbers of staff on duty. No serious weaknesses were identified from the comments cards. One issue that was noted was that 2 (20 ) of the relatives/visitors comment cards stated that they were not always kept informed of important changes in the condition of service users. The inspector would like to thank the service users, visitors to the home, Jane Karago, Kamala Chauhan and all the staff in the home for their kind support and cooperation during the inspection. What the service does well: What has improved since the last inspection? The comprehensiveness of care records including the assessment of the needs of service users has improved. There has been improvement in the recording of the care of pressure sores and wounds. The home has prepared a comprehensive training and development plan and the records kept with regard to training were good. They showed that a range Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 6 of training has been provided to staff to ensure that they are skilled and competent to care for the service users. The manager is now registered and the home has a stable management structure. There is also good line management support. There was a calm and pleasant atmosphere in the home, which was most likely due to the positive attitudes of members of staff. 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. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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.V283535.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Service users have a comprehensive assessment of their needs and the home is generally suited to meet the needs of the service users. EVIDENCE: The care records for four service users were inspected. The inspector noted that new service users to the home have had preadmission assessments. These are normally carried out by the manager or by the deputy manager. The manager stated that where possible the needs assessments of the funding authorities are requested. She added that all service users have preadmission assessments including service users who are admitted for short stays and respite care. The home has a number of beds for short stay mostly for service users who do not need acute treatment in hospital but who are not yet ready to go to their home. The assessment of the needs of service users once admitted to the home were generally well completed and described the needs of the service users in some detail. The home is generally able to meet the needs of service users. At the time of the inspection staffing levels in the home were appropriate and staff were skilled enough to ensure that the needs of the service users can be met. There Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 9 was evidence that service users were seen by a number of healthcare professionals as and when that was necessary. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 There has been progress in the quality of the care records, but a few areas were identified which require improvement. The healthcare needs of service users are being met in the home, but records kept by the home did not always reflect that. A number of issues with medicines management were identified which could put service users at risk. EVIDENCE: Care records were in good order and kept safely and securely in filing cabinets or on trolleys, which can be wheeled in the clinical rooms to be kept locked. The inspector noted that in most cases care plans were in place to meet the identified needs of service users. In a few cases however, a care plan was not in place particularly when service users had short-term problems. Care plans were reviewed at least monthly. There was a range of risk assessments, which were also reviewed monthly. The care plans in some cases were agreed with service users or their representatives. A service user who spoke to the inspector stated that she had not been consulted about her care plan even though she felt capable of doing so. 2 of the 10 comments cards from relatives/visitors stated that they are not always informed of important matters affecting the service user. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 11 The home has a pressure sore risk assessment, which is used for all the service users in the home. Once service users were identified at risk, care plans were in place and pressure relief equipment was also put in place. One service user with a pressure sore had a care plan in place, photographs and progress reviews of the sore. This was good practice. The inspector however noted that a number of the pressure equipment in use in the home was not set to the pressure corresponding to the weight of the service users and that the pressure relief equipment in two of the bedrooms sampled at random had red lights on, indicating some kind of problem with the equipment. It is therefore required that the registered person put in place a system of regular checking of the pressure relief equipment in the home to ensure that these are set and working at the optimal level according to the needs of the service users. The care plan of one of the four service users whose care plan was sampled was not clear to the pressure relief equipment in place. The care plan mentioned a particular type of equipment but another type of equipment was in place. The home has a comprehensive format for the continence assessment of service users. The inspector noted that this was not always completed fully to identify the type of incontinence that the service user had and to identify what needed to be in place to resolve the problem, promote continence or manage the incontinence. Care plans contained statements such as ‘toilet regularly’ but clarified the type of incontinence aids in use to manage the incontinence. The inspector acknowledges some progress in this area but further improvement is required. As a result the registered person must ensure that the continence assessment of service users are completed comprehensively The management of medicines on the first and on the ground floor was inspected. The clinical rooms were in the main tidy and clean. They all had air conditioning to maintain a constant temperature in these rooms. The inspector noted that fridge’s temperature on the 1st Floor has been showing temperatures of about 8.1 degrees centigrade. The home uses a number of codes in the Medicines Administration Records Sheets (MARS). These are used to describe the reasons when service users have not had/taken their medicines. The inspector observed that in a few cases the codes used were not clarified to describe the reasons for the medicines not to be administered. The inspector noted that variable doses were prescribed with regard to some medicines. In a few instances the MARS did not clarify the indications when to give a higher or a lower dose and the MARS were not always clear with regard to the doses (e.g. whether 1 or 2 tablets), which have been administered. A service user was on a medicine, which has been apparently stopped by the GP. There was no indication on the MARS to show that the medicine has been stopped and as to why the medicine was not being given and the spaces for signing were left blank. In other cases medicines, which have been stopped were carried over to the MARS from previous MARS, without a note to say that the medicines have been discontinued. As a result there is a danger that a new member of staff may administer such a medicine if there is no clear indication/instruction on the Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 12 MARS. A service user was prescribed a particular antibiotic made of two main components, but only one component of the antibiotic was entered on the MARS. One service user was having her medicines (tablets) crushed while the medicines were available in liquid format. A risk assessment was also not available for inspection. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 While there has been some improvement in the assessment of the social and recreational needs of service users, care plans were not always in place to meet the identified needs of service users. Without this there is no guarantee that these needs would be met. Appropriate meals are provided to service users according to their individual wishes and choices. EVIDENCE: The care plans contain a section on the assessment of the ‘social and spiritual activities’ of service users. There was also a section on the Life history of service users. Some service users/relatives have provided information on these sections on admission to the home but a few have not. As a result these areas were at times, left uncompleted. These sections can also be filled as and when staff receive information on service users. For example, one member of staff described how one particular service user likes music and which type of music she likes, but this information was not transferred to the care records. Staff must consider the assessments of the social and recreational activities of service users as ‘living documents’ and must ensure that these are updated as and when staff receive new information about the needs of service users, including the social and recreational needs. It is also required that a care plan be drawn up with regard to addressing the social and recreational needs of service users. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 14 The home now employs an activities coordinator. Service users and visitors were pleased with regard to arrangements that have been made for the provision of activities in the home. A few members of staff were observed sitting with service users and interacting with them. It is positive that the home is making progress in this area by making the provision of leisure and social activities an integral part of the delivery of care and not just an ‘add-on’. The comments cards from service users and relatives/visitors were all complementary about the range of activities provided in the home. The inspector observed lunch being served. There was roast pork with apple sauce, cauliflower, sprouts and boiled potatoes as the main meal, and cream sponge for desert. The second choice was mince, but other choices were also available, as the inspector noted that a few service users were offered omelettes or fish. The content of the suppers also looked appropriate and the inspector was informed that service users who want a snack in the evenings are offered one. Service users have their meals in the dining rooms, which are kept tidy and appropriately prepared, unless they prefer to have their meals in their bedrooms. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home deals with allegations and suspicions of abuse in an appropriate manner. EVIDENCE: Training records showed that the home has provided training on abuse to most members of staff. Allegations of abuse have in the past been appropriately dealt with by the home. Staff were also clear that they would approach the person in charge in cases where abuse is suspected. The inspector spoke to a number of adaptation students in the home. They were not very clear about the whistle blowing policy and about the procedure to follow in cases of allegations and suspicions of abuse. It is recommended that these areas be covered as part of the induction of all staff in the home. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24 and 26 The standard of the redecoration and fixtures and fittings in some areas of the home were starting to look dated. The provision of bathing facilities in the home seemed to be lacking. EVIDENCE: The grounds of the home were maintained and in keeping with the time of the year. The exterior of the home was also in a reasonable state. The interior of the home was clean and in generally good condition. There was evidence that some areas of the home have been repainted. The carpet in few bedrooms has also been replaced. However some aspects of the building and the fittings and fixtures were starting to look dated and as a result the home would benefit from a comprehensive redecoration and refurbishment plan. The home has en-suite bathrooms, which in most bedrooms consisted of a bath, toilet and wash hand basin. There are a few bedrooms with showers in the en-suites. In addition there is one communal bath on each floor. The bathtubs in the en-suite are however situated against the wall and therefore Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 17 staff cannot help service users on either side of the bath. The bathtubs do not allow access for the legs of the hoists to fit underneath them and therefore service users cannot be transferred to the bath by the use of mobile hoists. As a result the use of the en-suite is very limited and most service users have to rely on the communal bathrooms for their baths. During the inspection the inspector noted that the hoist to the ground floor bath was broken and he was informed that this has been broken for a number of months and that service users have been unable to use that bath. The manager stated that staff could take the service users to the first floor for their baths, which means that there would be one bath for about 35-40 service users and that service users would be going up and down in the lifts for their baths. An immediate requirement was imposed on the home to address this issue and an action plan has been provided within the time scale. It is however required that the registered person review the bathing facilities in the home as a result of the above. While looking at the care records of a service user and while talking to staff, the inspector noted that a service user who needed a sling hoist was being transferred by a standing hoist. The use of a piece of equipment for which the service user has not been assessed for, could be putting the service user at risk. An immediate requirement was imposed on the home to ensure that the right equipment is used for the transfer of service users. An action plan was provided by the home about how the home plans to meet the needs of the service users who require a sling hoist on the ground floor. The communal areas were clean, bright and appropriately furnished. Furniture was of a domestic nature and mostly appropriate for the needs of the service users. Although the chairs have been replaced in the communal areas, there were still some chairs in the bedrooms of service users where the cushions did not fit the frame properly and which could slide from underneath service users. The bedrooms of service users were in the main clean and free from odours. The inspector noted that few service users who required nursing care were being cared for on divan beds and that a few pressure relief equipment were placed on divan beds. The divan beds did not hold the pressure overlays appropriately in place, and in some cases the pressure mattresses spilled over the side of the divan. About 2-3 bedrooms have been repainted on the second floor, but at least two service users’ bedrooms have not been redecorated ever since the service users moved in these rooms about five years ago. One of the service users stated that his bedroom needed to be redecorated and the relatives of the other service user also confirmed that the bedroom has not been redecorated since the admission of the service user, a few years ago. Some bedrooms mostly on the second floor did not have pictures or items of decorations and therefore did not looked very personalised. The décor and the state of the fixtures and fittings in some bedrooms were probably from the inception of the home and needed to be addressed. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 18 The bedrooms do not yet have locks as per standard 24.5 The inspector observed that there were a few areas on the second floor where the carpet was stained and he was informed that the home has tried hard to remove these stains. The areas where the carpet was not very clean/dirty included an area in the dining room on the second floor and some bedrooms of service users, also mostly on the second floor. In one of the bedrooms there has been a spillage behind the bed of a service user, which had not been cleaned. A mattress overlay was also noted under a divan bed. It was the same overlay, which was noted in the corner of the same bedroom during the last inspection Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The home provides staff in sufficient numbers. A range of training is provided for staff, but less that 50 of staff are trained to NVQ level 2. EVIDENCE: There were 3 carers and 1 trained nurse on the second floor and 4 carers and 1 trained nurse on the first floor and the ground floor, each. At night there is a trained nurse and 3 carers for the 1st and second floor, which accommodate 45 service users when the units are full; and a trained nurse and a carer for the ground floor. A few members of staff have been in the home for a number of years and were recognised by the inspector. Staff, who were spoken to by the inspector, were familiar with the needs of the service users. 16 comments cards from service users and from relatives/visitors were complementary about staff in the home, and one was not so complementary. They were also happy about the numbers of staff on duty. One comment card mentioned that staffing at night was lacking. The home has about 27 carers. 6 of them were already trained to NVQ level 2 and 11 were training for this qualification. As a result the home does not yet have 50 of the care staff trained to NVQ level 2. The personnel files of four members of staff were inspected. These contained application forms, references, a copy of the passport, photos of the members of staff, evidence that the members of staff can work in the UK (for those who require this), and evidence of CRB checks. A comprehensive training plan has been prepared by the deputy manager, which consisted of a training programme based on the individual training Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 20 profiles of each member of staff. These were up to date and showed that a range of training was being arranged for staff in the home. On the day of the inspection, a training session was arranged for staff on mentorship. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 The home is managed in an inclusive and open manner. A few health and safety issues were identified which could service users at risk. EVIDENCE: The manager has been registered with the Commission. She has now been in post for more than a year and is familiar with the issues in the home and the care of service users. She knew the service users well and kept a visible presence on all the floors. Staff and service users stated that they would approach the manager if they have issues to discuss with her. There was evidence that there has been a range of meetings such as health and safety, residents and relatives, care staff and ancillary staff meetings. The home has a quality assurance procedure. There was a system of audits with regard to care plans, medicines, food and health and safety. The inspector was informed of the interests of the management of the home in achieving Investors In People accreditation, to demonstrate the quality of the service Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 22 that the home provides. The local CSCI office regularly receives reports following monthly visits of the home by the Provider. The inspector was unable to inspect the personal monies of service users, as the administrator was not in. However in the past the home kept good records about the personal monies of service users. The home had most safety certificates in place and there was evidence that equipment was being appropriately maintained or put out of action if unsafe. The inspector was however unable to see a clear up to date electrical wiring certificate in place. The home also had up to date health and safety risk assessment and a fire risk assessment. The Environmental Health Officer for the Borough had visited the home in August 2005 and there were a number of recommendations that the home has addressed or was addressing. During an inspection of the kitchenette on the ground floor, the inspector noted that the fridge’s temperature has been around 9-10 degrees centigrade for most of the 9 days in February. This should have been below 8 degrees centigrade and ideally between 1-5 degrees centigrade. The inspector noted that a number of bedrooms’ doors did not close fully into the frame when closed and that a few of them were propped opened by small sandbags. Fire doors must close properly and fully to ensure that there are no gaps between the door and the frame and must ideally be kept open by an automatic closure device and not by sandbags. Another issue, which does not seem to have been addressed appropriately and which can put service users at serious risk is the fact that the domestic room on the second floor was left open on the day of the inspection. This room has a chute for throwing rubbish and other items to the ground floor. This can pose an unacceptable risk to service users who are disorientated and who may enter these rooms if these are not kept locked: they may fall down that chute. Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 2 X 2 2 X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 24 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 OP7 Regulation 17(1(a), Sch3 Requirement There must be a care plan in 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 not met). The care plan must be drawn with the service user/representative, agreed and signed by the service user whenever possible and /or representative (if any). A note must be made if this is not possible (Previous requirement-Timescale 30/4/5 not met). The continence assessment of service users must be completed comprehensively to identify the type of incontinence in order to put in place an appropriate care plan to address the promotion of continence. The timing of the toileting of service users must be made clear in the care plan of service users (Previous requirement- timescale 30/9/5 not fully met). DS0000022918.V283535.R01.S.doc Timescale for action 30/04/06 2 OP7 15(2)(c) 31/05/06 3 OP8 15(1) 31/05/06 Buchanan Court Nursing Home Version 5.1 Page 25 4 OP9 13(2,4) 5 OP12 16(2) (m,n) The registered person must 30/04/06 ensure that the following issues are addressed, with regard to the management of medicines in the home: • That the codes used to describe the reasons when service users have not had/taken their medicines are clarified • That in cases of variable doses of medicines, the indications when to give a higher or a lower dose are clarified and the actual amount administered are clarified • That there are clear records in cases when medicines have been stopped and that either the medicines are discontinued by the GP or that a clear code is used if the stoppage is only for a short time. • That when the home staff have to write the names of medicines in the MARS, particularly when antibiotics have been prescribed that these are clearly written to prevent confusion with other medicines. • That appropriate risk assessments are in place when medicines are administered in an altered state and that attempts are first made to identify appropriate liquid/soluble formats of the medicines. That the social and recreational 30/04/06 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 DS0000022918.V283535.R01.S.doc Version 5.1 Page 26 Buchanan Court Nursing Home 6 OP24OP19 23(1)(a) 7 8 OP21 OP22 23(2)(j) 13(5) 9 OP24 23(2)(n) 10 OP26 23(2)(d) 11 OP28 18(1)(c) 12 OP38 13(4) and recreational needs of service users based on their individual needs assessments. (Previous Requirement-Timescale 30/4/5 not fully met. The registered person must have a clear plan to address the redecoration of the home and the replacement of fixtures and fittings in the home, to ensure that the home provide a high standard of accommodation for service users. The registered person must review the bathing facilities available in the home. The registered person must ensure that service users are always transferred in a safe manner, by the provision of the appropriate equipment or otherwise. The registered person must provide adjustable beds to all service users with nursing needs and to those who require pressure relief equipment (Previous requirementtimescale of 31/12/5 not met). The registered person must ensure that all areas of the home including bedrooms (en-suite, carpets, furniture etc.) are clean and tidy at all times (Previous requirement- timescale of 30/9/5 almost met). The registered person must 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). The registered person must ensure that the door to the domestic room is kept locked at all times (Previous Requirement- Timescale DS0000022918.V283535.R01.S.doc 31/05/06 31/05/06 30/04/06 31/07/06 30/04/06 31/12/06 30/04/06 Buchanan Court Nursing Home Version 5.1 Page 27 13 OP38 23(4) 14 OP38 13(4) 30/4/5 not met). Fire doors must close properly 30/06/06 and fully to ensure that there are no gaps between the doors and the frames and must be kept open by an automatic closure device and not by sandbags, if these have to be kept open. The home must have an up to 31/05/06 date electrical wiring certificate. A copy must be forwarded to the local CSCI office within the timescale. 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 OP38OP9 Good Practice Recommendations The registered person should monitor the medicines’ fridge temperature on the first floor and the fridge temperature in the kitchenette of the ground floor and take steps to ensure that the temperature is always below 8 degrees centigrade and ideally between 1-5 degrees centigrade. It is recommended that ‘whistle blowing’ and ‘Protection of Vulnerable Adults’ issues are covered as part of the induction of all staff in the home, including adaptation students. The registered person should ensure that all bedrooms of service users are personalised to a high level. The registered person should provide locks for the bedrooms of service users. 2 OP18 3 4 OP24 OP24 Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Buchanan Court Nursing Home DS0000022918.V283535.R01.S.doc Version 5.1 Page 29 - 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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