Inspection on 13/01/06 for Carrick House Nursing Home

This inspection was carried out on 13th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Carrick House Nursing Home 15/08/08

Carrick House Nursing Home 17/07/07

Carrick House Nursing Home 30/11/06

Carrick House Nursing Home 30/11/04

Carrick House Nursing Home 22/07/04

Carrick House Nursing Home 06/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Carrick House Nursing Home 61 Northwick Avenue Kenton Middx HA3 0AU Lead Inspector Richard Adkin Unannounced Inspection 13th January 2006 11:00 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 Carrick House Nursing Home DS0000022921.V277083.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. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carrick House Nursing Home Address 61 Northwick Avenue Kenton Middx HA3 0AU 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) 020 8907 0399 020 8907 0051 MD Homes Ms Zherabanu Nazerali Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24), Terminally ill over 65 years of age (0) of places Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 24 persons over the age of 60 may be accommodated. Date of last inspection 2nd September 2005 Brief Description of the Service: Carrick House Nursing Home is part of MD Homes, a small private company with four care homes mainly for the elderly. The home was established in 1973 and has been run by a range of providers. The current provider took over about eight years ago. The home is registered for 24 service users requiring nursing care. It is a large detached building, with some extensions, in a residential area. Accommodation is provided on the ground and first floors. Service users occupy a mixture of single (18) and double rooms (three). The home has a communal dining room, a lounge, a separate kitchen, toilets and bathrooms, and an attractive conservatory. The home is about five minutes walk from the Kenton Road where buses are available. It is also within five minutes walk from Northwick Park underground station. The home has off street parking for about six cars, but there is also parking on the roads near the home. There were 22 service users in the home at the time of the inspection. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a midweek morning. This followed a previous unannounced inspection on 2nd September 2005. The focus of the unannounced inspection were the requirements arising from the previous inspection and remaining core standards. Opportunity was afforded during the course of the inspection to speak to residents, visitors, staff and the Manager. The Inspector was also afforded the opportunity to look at policies and procedures and to look around. The Inspector would like to express his thanks to the residents, Manager, visitors and staff for their contribution to the inspection. The Operations Manager also kindly made himself available. What the service does well: What has improved since the last inspection? What they could do better: Some improvement remains needed in refurbishing the kitchen and having separate facilities for sluice and laundry to ensure sound infection control systems. Care plans need to be in place for residents when they have a short-term illness. Individual assessments remain needed for residents for their recreational and social needs. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 6 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. Carrick House Nursing Home DS0000022921.V277083.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 Carrick House Nursing Home DS0000022921.V277083.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, 6 Residents have their needs assessed and these are regularly reviewed and evaluated. EVIDENCE: A requirement that had arisen at the last inspection is that the registered person must ensure that there is a comprehensive assessment of the needs of service users, which is reviewed as and when the needs of service users change. The Inspector looked at two residents’ files. In place are forms capturing key areas of need with detailed interventions and evaluations dates. One set of documentation was not signed or dated, but was in the process of being transcribed for discussion in supervision. Also in place are the initial assessment of needs. The home does not undertake intermediate care, but does offer respite care should there be a vacant bed. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 11 Residents and family members are supported and treated with respect and sensitivity at the time of death. EVIDENCE: A large number of requirements arose at the previous inspection, concerning the health and personal care of residents. These were that the registered person must ensure that care plans are updated as and when the needs of service users change, and evidence must be kept of the involvement of service users/representatives in the review of the care plan. There was also a need for all service users to have an individual continence assessment to help manage incontinence and to promote continence. Appropriate records needed to be kept to ensure that residents are seen regularly by Opticians and Dentists. Evidence was seen of optician, chiropody and dental appointments taking place for all the residents of the home. The information is stored in the individual files and a summary is received from the allied health professionals. Work is taking place to summarise this, by the Manager, so that the information is stored and used centrally and this needs to be finalised. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 10 Care plans are updated monthly in files of residents looked at by the Inspector. Evidence was seen of relatives signing the review of the care plan. Nursing home continence assessments are now in place for residents and are on file. This covers medical history, when incontinence occurs and the degree and pattern, fluid intake, mental state, mobility and management. The Inspector discussed with the Manager how the nursing home had dealt with the death of a resident recently. The Inspector was impressed by the Manager being most sensitive and supportive of the partner of the resident who had died. Details of the death arrangements are captured in the service users assessment (admission) form. Positive comments sent by relatives concerning the final care family members received were seen by the Inspector. Though information is recorded in the daily log of each individual’s short-term health problems, the requirement remains that care plans are in place for the close management of such problems. Medicines were required to be administered to residents with an appropriate label and according to instructions on the labels. Changes to the instructions needed to be endorsed by the GP. One regular GP from a practice comes every Tuesday and on an as needs basis. He countersigns the MAR sheets. An information sheet detailing names, initials and signatures of staff giving medication preferably with dates of medication training needs to be in with the MAR sheets. Further training for palliative care needed to have been provided to both nursing and care staff. Staff are booked in at Mount Vernon for training on various aspects of palliative care on 1st February, 2nd February and 23rd February 2006. Pain charts, as used by St Lukes Hospice, are in use, which identifies the source of pain, level of intensity and interventions. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 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 the following standard(s): 12, 15 An assessment of resident’s recreational and social needs, needs to take place. Residents receive a wholesome diet in pleasant surroundings. EVIDENCE: Two requirements arose at the previous unannounced inspection around daily life and social activities. The Inspector requested that the registered person ensures that the recreational and social needs of residents are assessed comprehensively; and once these have been identified, appropriate indoor and outdoor activities must be provided by the home to meet these needs. The home has a small van that takes one wheelchair and three sitting. More activities are taking place in the home according to the Manager, but there is not much uptake to external visits by residents. The assessment of social and recreational needs still needs to be undertaken. Boys from Harrow School visit weekly. The second requirement was that menus had to be reviewed with the input of residents to ensure wide and varied choices and to include fresh ingredients in the preparation of meals as much as possible. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 12 Lunch was observed by the Inspector and the food seemed healthy and nutritious, pureed food was also provided where necessary and residents supported in eating as required. Menus are now in the process of being laminated, having been drawn up. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 13 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 Residents at the home are protected from abuse. EVIDENCE: The Whistle blowing Policy was not fully known to some staff interviewed at the last inspection. However, there is a policy in the home file and this is signed when read by staff members. The Whistle blowing policy has details of CSCI, should staff wish to bypass the line management structure and report concerns that they may have. The Brent POVA policy and guidelines is also accessible. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 14 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, 26 The home is comfortable, pleasant and hygienic. Refurbishment work needs to be completed. EVIDENCE: Two requirements from the previous inspection remain, in that the registered person must ensure that the kitchen is refurbished as soon as possible and that the home must have separate premises for the sluice and laundry to ensure good infection control systems. A sluicing disinfector is also needed. The Operations Manager and the registered home Manager both advised the Inspector that there were plans to purchase the property next door imminently and construction would commence then. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 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 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): 29, 30 Staff are competent and trained to look after residents. EVIDENCE: A requirement that arose at the previous inspection was that staff should be up to date with mandatory training; that training should be provided in clinical areas relevant to the needs of residents. Also, training was needed in food hygiene for all staff handling food. The two cooks have or are about to attend food hygiene training. Two staff went on fire training this year. Moving and handling training has taken place for seven staff this year as well. Training videos are shown on various aspects of training need at the home. The staff training records were up to date and future training was identified by the Manager with staff. Recruitment of staff is undertaken centrally. Supervision files and recruitment information are stored as two separate files for the whole staff group. Each member of staff should have their own separate file. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 37, 38 First aid training remains needed for a member of staff on each shift. The home is run in the best interests of the residents. EVIDENCE: The registered person needed to ensure that staff that are responsible for the provision of First Aid are suitably trained. A request has been made, but nothing arranged. There needs to be a trained person per shift. Resident’s files should be more systematic and divided into sections for the storage of information. A process is in place for the reviewing of policies and procedures, and these reviews are beginning to happen. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 17 Finances are administered by family members. One resident’s finances are handled via the owner through an arrangement with a solicitor. The liability insurance valid until May 2006 was displayed. On 29th September 2005, the LFEPA wrote to the nursing home regarding three areas that needed to be addressed. These are fire risk assessment, fire resistant doors and means of escape. No details of the response from the organisation were available and are needed to satisfy the Inspector, though there was evidence of a fire risk assessment being in place. The gas safety check was completed on 18/5/05. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X 3 2 Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 19 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 OP8 Regulation 15(1) Requirement In cases where service users have short-term problems such as chest infections, the registered person must ensure there are care plans in place. In cases of chest infections, there must be comprehensive monitoring of the vital signs of service users. (Previous timescale of 31/10/05 not met) Attached to the MAR sheets should be placed a sheet covering the name of the nurse giving medication, the signature and initials and dates of medication training update. The registered person must ensure that the recreational and social needs of residents are assessed comprehensively. Once identified, appropriate indoor and outdoor activities must The registered person must ensure that the kitchen is refurbished as soon as possible. (Previous timescale of 31/3/05 not met) DS0000022921.V277083.R01.S.doc Timescale for action 01/04/06 2 OP9 13(2) 01/04/06 3 OP12 16(2)(m) (n) 01/04/06 4 OP19 23(2)(b) 30/06/06 Carrick House Nursing Home Version 5.1 Page 20 5 OP26 13(3) 6 OP38 23(4) The home must have separate premises for the sluice and laundry to ensure good infection control systems. It must also have a sluicing disinfector. (Previous timescale of 31/3/05 not met) The response to the LFEPA by the registered provider regarding issues raised and the conclusion of the correspondence must be passed to CSCI. 01/04/06 01/02/06 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 3 Refer to Standard OP8 OP29 OP37 Good Practice Recommendations Dental and optical records for residents should be available centrally in summary form. Staff should have individual files that include supervision and personnel information. Resident’s files should be more clearly organised. Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 21 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 Carrick House Nursing Home DS0000022921.V277083.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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