Inspection on 17/07/07 for Carrick House Nursing Home

This inspection was carried out on 17th July 2007.

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

Carrick House Nursing Home 15/08/08

Carrick House Nursing Home 30/11/06

Carrick House Nursing Home 13/01/06

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 Mr Ram Sooriah Key Unannounced Inspection 17th July 2007 09:00 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 DS0000022921.V341686.R02.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. DS0000022921.V341686.R02.S.doc Version 5.2 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 chnh@mahomes.co.uk 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 DS0000022921.V341686.R02.S.doc Version 5.2 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 30th November 2006 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 nine years ago. The home is registered for 24 residents requiring nursing care. It is a large detached building, with some extensions, which is situated in a residential area of Kenton. Accommodation is provided on the ground and first floors. Residents occupy a mixture of single (eighteen) 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. The home is managed by Zhera Nazerali and her deputy and they are closely supported by the operations director, Zena Chan. Fees charged by the home range from £735 to £900 depending on the needs of residents. The statement of terms and conditions of the home, available to all residents, has details of what is covered by the fees. There were 19 residents in the home at the time of the inspection. DS0000022921.V341686.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection started on Tuesday 17th July 2007 at about 10:00 and finished at about 18:45. During the course of the inspection I spoke to 6 residents, 3 members of staff, the operations manager and the registered manager of the home. I also looked at a sample of records, toured some of the premises and observed care practices. The home has been chosen as one of the preferred placement home by the local PCT for people requiring end of life care as a result of terminal illnesses. The inspection therefore partly focused on how well the end of life care needs of people with a terminal illness were being met in the home. Whilst the home generally cares well for this group of residents and whilst residents and relatives are happy with the standard of care provided, a few areas were identified where improvement could be made to ensure that these residents receive holistic care. These are addressed in this report. I also noted the willingness of the manager and of the organisation to improve the quality of the service that the home provides. This is positive. I would like to thank all residents who spoke to me to share their experience of living in the home, and the manager and all her staff for their support and assistance during the inspection. What the service does well: General feedback by visitors and residents about the care and support that residents receive in the home was good. One visitor commented that staff are always helpful and cheerful. Another said that ‘we cannot thank staff enough for their kindness and consideration’ and a third wrote that ‘we were made to feel welcome and the atmosphere is always warm and friendly’. The healthcare needs of residents are on the whole met to a good standard, including the management of symptoms in the end of life care of residents with a terminal illness. The home provides a homely and clean environment for residents to live in. There are no odours in the home. Equipment is provided as required to care for residents who are accommodated in the home. The home provides staff in adequate numbers and provides some training to ensure that they are able to care for the residents who are accommodated in DS0000022921.V341686.R02.S.doc Version 5.2 Page 6 the home. Induction training is also provided to new members of staff to ensure that they are competent to care for residents. The manager is familiar with issues about running the care home and ensures that the care that residents require is provided as appropriate. She is supported by the operations manager, the organisation and staff from the head office to achieve the aims and objectives of the service. What has improved since the last inspection? What they could do better: All residents and/or their representatives who are offered a contract/terms and conditions should be asked to sign these documents to confirm that they have agreed to these. Care plans must be specific and individualised to the needs of each resident. All nursing staff must be involved in drawing up and in reviewing care plans and not just the manager. DS0000022921.V341686.R02.S.doc Version 5.2 Page 7 While the home generally manages the symptoms of residents with terminal illnesses well, to ensure a holistic approach to end of life care, the care records must address the perspectives and fears of residents about end of life and the future. Consideration should be given to the recreational and social needs of residents with a terminal illness who are admitted to the home for end of life care in relation to the social and recreational needs of elderly residents requiring nursing care who are accommodated in the home. These needs may not be compatible. The home must have a separate sluice and laundry to prevent cross infection as far as possible and must have a sluicing disinfector. The manager must ensure that all members of staff have statutory training as required particularly in fire training, food hygiene and manual handling. The home must have a valid PAT certificate and a safety gas certificate covering all gas equipment in the home. The property and valuables sheets must be kept updated as and when required to ensure that an up to date record is kept about residents’ possessions and to safeguard them as much as possible from financial abuse. All health and safety issues, including health and safety checks, maintenance and safety certificates, must be attended to in a timely manner to ensure the safety of all those who have access to the premises. 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. DS0000022921.V341686.R02.S.doc Version 5.2 Page 8 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 DS0000022921.V341686.R02.S.doc Version 5.2 Page 9 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): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and/or their representatives have the opportunity to make a choice about moving into the home on the basis of information that is provided to them and after a visit to the home. The needs of all prospective residents are assessed prior to them moving into the home to ensure that the manager and her staff are able to meet the needs of the residents. EVIDENCE: Copies of the service users’ guide were seen in the bedrooms of residents. A copy of the last inspection report was also available in the reception area of the home. A copy of the SUG forwarded to the inspector showed that it has been updated to contain information about the range of fees charged by the home. The service users’ guide also contained a copy of the terms and conditions, which are offered to all residents. It was noted that they do not always sign to DS0000022921.V341686.R02.S.doc Version 5.2 Page 10 show that they have received and agreed the contract/statement of terms and conditions. It is recommended that is carried out. The manager and the operations manager stated that all new residents to the home have a preadmission assessment of their needs. Four care plans were inspected and they all contained a copy of the preadmission assessment of the needs of the residents. A copy of the needs’ assessment of the relevant placing authorities and/or a discharge summary from the last place of stay of the residents were always available in the care records of individual residents. The home currently admits residents from hospitals or hospices. Some of them are unable to visit the home and therefore the relatives/friends of the residents are encouraged to visit the home prior to prospective residents deciding if they want to move into the home. The findings during the course of the inspection showed that the manager and staff in the home are familiar with the needs of residents. It was noted that a range of training has been provided to staff particularly in clinical areas related to end of life care to ensure that they were familiar with meeting the needs of the residents. A range of equipment was also noted in the home to assist in the delivery of care. The home accommodates residents from a number of religious, cultural and ethnic backgrounds. Staff were on the whole familiar with the needs of the residents and of the support that was required for residents in relation to this aspect of care. There was evidence that the home provided meals and opportunities for residents to practice their faith and to meet their cultural needs. DS0000022921.V341686.R02.S.doc Version 5.2 Page 11 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are not always individualised and do not address the specific needs of residents to ensure that all the needs of residents are appropriately accounted for. The healthcare needs of residents are on the whole maintained. Medicines management is of a satisfactory standard to ensure the safety of residents. The end of life care of residents are appropriately managed by staff in the home, but care records do not comprehensively address the individual perspectives of residents about end of life care particularly for those who have a terminal illness. EVIDENCE: The care records of four residents were inspected. These were in good order and kept in a cabinet in the dining area. There has been some improvement in the content of the care records to address all the needs of residents. It was noted that the assessments of the needs of residents were generally carried out comprehensively. DS0000022921.V341686.R02.S.doc Version 5.2 Page 12 As mentioned in the previous section, although issues about equality and diversity were generally addressed by staff, these were not always addressed in care records. From reading the care records of residents it was not always possible to differentiate between the various residents although they were of different religious, cultural and ethnic backgrounds. For example aspects about food preferences, religious observances and personal hygiene were not easily identified in care plans. One resident care plan said that ‘he will continue with his previous church’ but did not say what this was. The manager has recently introduced pre-printed care plans similar to care pathways. Staff must then use the prepared format to individualise each care plan according to the individual needs of each resident. While there are advantages of using this approach to care plan, there is a danger that by using this approach, care plans tend not be individualised enough. Inspection of the care plans showed that this was the case. Some of the care plans were not individualised to each resident needs and were general in nature and could apply to a number of residents of the home. It was also noted that although there was team of nurses to care for residents, the manager had the most input in care plans and risk assessments both in drawing these up and their review. Care plans should be reviewed monthly but the care records of two residents showed that these were not always reviewed monthly. Residents admitted to the home, particularly if they have end of life care needs in relation to a terminal illness have care plans, which at times must be reviewed more often as the needs of these residents can change very quickly. For example care plans about pain need to be reviewed more often and updated with the actions that are necessary to meet the needs of the residents. Records should also be kept about how well the needs of the residents are being met during evaluation of the care plans. One resident who was kept in his room because of a pressure ulcer has not had his care plan updated when the ulcer got better. The care plan for another resident who had epileptic fits said that the GP should do blood tests but did not say how often, to ensure that these were monitored and carried out. The care records for a resident who was on a blood thinning medicine did not address the fact that he has nose bleeds as a result. There has also been improvement with the involvement of residents/relatives in drawing up risk assessments. I observed how the manager was familiar with all visitors to the home. She said that she has an open door policy and keep relatives informed of the condition of residents and interventions to meet the needs of the residents. However more progress could be achieved by keeping evidence of the involvement of the residents/representatives in drawing up the care plan and in keeping them reviewed as two of the four sets of care records DS0000022921.V341686.R02.S.doc Version 5.2 Page 13 inspected did not have evidence of the involvement of residents or of their representatives. There were no residents in the home with a pressure ulcer. One resident had a pressure ulcer, which has healed. The home provides equipment for pressure relief as required. The pressure ulcer has healed but there was some lacking around reviewing and evaluation of the care plan addressing the pressure ulcer with regards to whether interventions in place to promote healing were successful. Residents’ records showed that their healthcare needs were being met. They were seen by healthcare professionals as required. Records showed that the GP, chiropodist, optician, palliative care nurse and dentist regularly visit the home to provide support and advice in delivering care to the residents. Residents had short term care plans in place and there was evidence of monitoring of some vital signs when residents were unwell. A resident who was unwell had his temperature monitored but other physiological signs, such blood pressure, pulse and respiration rate were not monitored. In principle all the vital signs should be monitored to give comprehensive insight into the condition of residents. Medicines management in the home was generally of a good standard. There were good records about receipt, administration and return of medicines. Codes were used as appropriate when medicines were not administered. The records with regards to the management of control medicines were also of a good standard. I noted that the dates of opening for a number of liquid medicines were not entered on the containers when these were opened. The dates used to be entered before but on this occasion there was a lacking with regards to this. The medications were still within the 28 days from the date when they were delivered. All residents who spoke to me said that were pleased with the care that they received and said that staff related appropriately to them. A number of residents preferred to stay in their bedrooms. It was noted that their care plans at times said that they should be given their call bells to call for help if they require that. Two residents who could well use their call bells to call for help did not have them although their care records said that they should be provided with a call bell. A number of other residents did not have call bells because they were not able to appreciate the use of the call bell, however in these cases a risk assessment must be in place. Notices to the commission as per regulation 37 suggest that the deaths of residents are appropriately managed by staff in the home. One relative said DS0000022921.V341686.R02.S.doc Version 5.2 Page 14 that ‘we were allowed to stay day and night with our relative and we were supported enormously’. The care records of some residents contained information about the end of life care of residents and the management of death. It was however noted that particularly for residents who require end of life care as a result of a terminal illness, that the care records at times lacked information about the perspectives and fears of the residents about their illness and future. The manager stated that with the introduction of the Gold Standard Framework for the management of end of life care, these issues would be more comprehensively addressed. DS0000022921.V341686.R02.S.doc Version 5.2 Page 15 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 and 15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The social and recreational needs of residents are on the whole met in the home. Nutritious and varied meals are provided to residents and their choices are respected within certain parameters. EVIDENCE: Progress has been made with regards to the assessment of the social and recreational needs of residents. The care records of residents contained a section on the assessment of their biography and social and recreational needs. Care plans were also in place addressing these needs of residents. The organisation employs an activities coordinator who spends two days in Carrick House carrying out and organising activities for residents. It was noted that the programme of activities was flexible depending on the wishes of residents. The activities on the day of the inspection consisted mostly of one to one interactions with residents. Care staff were also observed interacting with residents. There are other activities such as an entertainer who visits the home on a weekly basis and school children from a local school who also visit regularly. DS0000022921.V341686.R02.S.doc Version 5.2 Page 16 With the home moving towards the provision of end of life care for people who have terminal illnesses, there is an issue about what can be provided in the home to keep them occupied. Some of people who use the service have previously attended day centres and been engaged in social and recreational activities there. The manager said that this would also be explored as part of the implementation of the Gold Framework for End of Life Care. The manager stated that representatives from the local church visit residents to offer spiritual support and that those residents from other faiths are assisted in maintaining their faith and that the relatives and friends also supported residents with this aspect of care. I was informed that residents are able to go out in the local community with their relatives or with their friends. The home has not arranged any outings but has plans to address this issue. The activities coordinator stated that residents enjoy sitting outside in the patio area. There were chairs and tables for residents to use and a gazebo was also in place to protect residents from the sun. On the day of the inspection lunch consisted of lamb casserole, carrots, cabbage, mashed potatoes and there was tinned fruits and custard for desert. There was soup, lasagne and sandwiches for supper. Residents were on whole satisfied with the meals provided in the home. There is a full time chef and in the evening there is an assistant cook. The service users’ guide clarifies that the home does not provide pork products for meals. Residents are aware that they would not be provided with pork meat and that their relatives can bring that for them. DS0000022921.V341686.R02.S.doc Version 5.2 Page 17 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their concerns would be listened to and acted on. They can also be confident that the home will take steps to safeguard them against abuse if required. EVIDENCE: The complaints register of the home was inspected. There has not been any complaint since the last inspection, which took place in November 2006. The complaints procedure was available in the service users’ guide and offered to all residents. Complaints leaflets were also available in the foyer of the home. Residents spoken to said that they would talk to the manager if they had any concerns. The manager’s office is in the front of the home and she stated that she has an open door policy. This was indeed apparent during the inspection when a number of visitors to the home stop to talk to the manager. I was informed that new members of staff receive some training on abuse as part of their induction and that they are later sent for safeguarding adult training organised by the local Borough, when this is organised. The home has the Brent Safeguarding Adult procedures in place and in the past has made referrals to the safeguarding adult team as appropriate. There has however not been any referral to the safeguarding adult team since the last inspection. The manager and her staff were familiar with the procedure and were aware of what to do in cases of suspicions or allegations of abuse. DS0000022921.V341686.R02.S.doc Version 5.2 Page 18 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides appropriately maintained and decorated communal and personal space to residents. Other facilities need to be improved to ensure that the home is better equipped to care for residents who are accommodated in the home. EVIDENCE: The grounds in front of the home were maintained. The garden and the patio areas at the back of the home were also maintained to a good standard. There were some flowers in the garden to provide colours and to make these areas more appealing to residents and their visitors. The exterior of the home was in good condition. The home has had a plan to refurbish the kitchen for a number of years but nothing has yet happened to the kitchen. On the day of the inspection, a meeting took place with the owners of the home and the contractors about the DS0000022921.V341686.R02.S.doc Version 5.2 Page 19 kitchen and a definite date for the refurbishment of the kitchen was provided. The work is due to start in September 2007. The lounge and dining areas were in good decorative order and were appropriately furnished. Residents were encouraged to use both areas, but some at times preferred to stay in their rooms to watch TV or to rest. Residents were encouraged use the dining room for lunch but supper is provided wherever residents wanted it. Bedrooms of residents were decorated appropriately and were personalised as required. Residents commented that although some of the bedrooms were small, they were overall satisfied with them. Beddings, items of furniture and the standard of fixtures and fittings in the bedrooms were overall appropriate. The home does not yet have a separate laundry and sluice area. The laundry facilities and the sluice facilities are located in the same room. As a result linen is still being laundered in a relatively unclean area. A disinfecting sluice machine was also not in place as required in care homes providing nursing. There is therefore a higher risk of cross contamination. DS0000022921.V341686.R02.S.doc Version 5.2 Page 20 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides staff in appropriate numbers and who are sufficiently skilled to care for residents who are accommodated in the home. EVIDENCE: There are normally two trained nurses and four care workers for a morning shift. In the afternoon there are one trained nurse and four care workers. The manager normally works on a day shift. She is part of the nursing team in the morning but is supernumerary in the afternoon and is still on the premises and available if required. At night there are one trained nurse and a carer. Comments from residents and visitors to the home suggest that staff are caring and attentive to the needs of the residents. The personnel files of two members of staff were inspected. A checklist was in place to ensure that all records as required were available in the personnel files of members of staff. Inspection of the records showed that all the records were in place including references, proof of identity and CRB checks. A full work history was in place for one of the members of staff, but not for the other member of staff. There was however evidence that the gap in the employee’s work history was explored during interview and recorded. The training records of seven members of staff were also looked at. It was noted that staff received a range of training particularly about end of life care DS0000022921.V341686.R02.S.doc Version 5.2 Page 21 and some statutory training. There was some lacking with regards to fire training, manual handling training and food hygiene training. New members of staff were offered induction training as per Skills for Care, the training organisation for social care. The home has 8 carers. It was noted that none of them have an NVQ qualification in care. 3 are bank carers training to be nurses, 1 is also a bank carer doing an access course to nursing and one is a former enrolled nurse. There was also evidence during the inspection to show that care is delivered by a high number of trained nurses. For example when there is a shortage of care staff, nursing staff are used to cover the shortage. On the day of the inspection there were three trained nurses in the home and three carers, when there are normally two trained nurses and four carers. The home has also been assessed as a suitable placement area for student nurses. DS0000022921.V341686.R02.S.doc Version 5.2 Page 22 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 and 38 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager runs the home in an open and inclusive manner to ensure that the needs of residents are met as required. The personal money of residents is in the whole managed appropriately to protect residents from financial abuse, but property and valuables records were not updated as required. The home has a quality management system, which is used to monitor the quality of the service that it provides. A few issues were identified in relation to health and safety, which could be putting the safety of people who use the service at risk. EVIDENCE: The manager and her deputy have been in post since the inception of the commission. The manager has competed the registered manager’s award and DS0000022921.V341686.R02.S.doc Version 5.2 Page 23 there was evidence that she continues to keep herself up to date with a range of training. The manager and her deputy work closely with other members of staff and lead by example. The manager also has an open door policy and feedback from residents and visitors to the home, suggests that she is approachable and that she engages with them as required. Minutes of residents’ and relatives’ meetings were available for inspection, which demonstrated that the manager provides residents and relatives with the opportunity to give constructive feedback about the home. The home keeps the personal money of two residents. Statements regarding the expenditures made for residents and the balance of money held on their behalf were forwarded to the inspector. These showed that the money of residents was appropriately managed. The manager stated that she does not keep any money for the residents and that she requests money from the head office when expenditures for residents are required. She clarified that copies of receipts were kept as evidence of the residents’ expenditures. The valuables and property of residents are recorded on admission to the home and when new items are brought in for residents. The valuables form for one resident said that he did not have any valuables, but he was noted to have valuables on him. The home has carried out audits as per its quality assurance procedure. The quality management system used in the home is the Blue Cross Mark of Excellence Quality System, developed by the Registered Care Homes Association. Findings of the audits were addressed in an action plan, which was incorporated into the development plan for the home. Satisfaction questionnaires are sent three monthly and those returned are analysed and the results are summarised in the form of a table. A report is however not produced to give details of the areas where the home does very well and areas where improvement could be made. It is recommended that this is addressed. It was noted that the results of the last satisfaction survey in the home showed that in relation to other areas, activities, food and catering, and laundry scored less favourably than the other areas. Monthly monitoring visits by the provider as per regulation 26 are also regularly carried out and copies of the reports are sent to the Commission. The home has the Investors in People accreditation. Health and safety records held in the home were inspected. There was evidence that the fire detection system and the fire fighting equipment were maintained. The LOLER certificates for the hoists and the lifts were in place as required. It was noted that the Portable Appliances Test (PAT) certificate was not up to date. DS0000022921.V341686.R02.S.doc Version 5.2 Page 24 An electrical wiring certificate was seen in place. The gas safety certificate while addressing the hot water boilers, did not address the gas hob in the kitchen. As mentioned in the section under Environment, the home has plans to totally refurbish the kitchen. The manager said that the equipment in the kitchen would then be replaced. Records kept about the fridge and freezer temperatures showed that the fridge temperature of one of the fridges was running at 11 (instead of being less than 8 degrees) degrees centigrade and that one of the freezer was running at –15 (instead of being less than –18 degrees centigrade) degrees centigrade. I was informed that the fridge was not being used to store perishable items for a long time and the same was for the freezer. These appliances will also be replaced when the kitchen is refurbished. The home had an up to date health and safety risk assessment and a fire risk assessment. A fire emergency plan was also in place. There were records of weekly fire tests and water temperature checks but records about monthly fire tests were not in place. The last emergency light test took place in April and so was the last wheelchair test. As noted in standard 30, not all members of staff were up to date with all statutory training including fire training, food training and manual handling DS0000022921.V341686.R02.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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 DS0000022921.V341686.R02.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 OP7 Regulation 15(1,2) Requirement To provide a guarantee that the needs of residents will be met, the registered person must ensure that the care plans clearly identify the actions to take to meet the identified needs of residents. These must as far as possible contain information about the cultural, religious and ethnic aspects of the needs of the residents (Previous requirement-timescale 30/06/06 and 31/01/07 partly met). Timescale for action 30/09/07 2 OP7 15(1,2) 3 OP8 12(1) Care plans must be reviewed and 30/09/07 updated (if required) at least monthly or more often according to the needs of the residents. Evaluation of the care plans must include information about how well the needs of residents are being met. When monitoring the condition of 31/08/07 residents, all the physiological signs of residents must be monitored to give an accurate picture of the condition of the resident, and not just the temperature. DS0000022921.V341686.R02.S.doc Version 5.2 Page 27 4 OP9 13(2) 5 OP10 12(4) 6 OP11 12(3) 7 OP19 23(2)(b) The date of opening of liquid medicines must be clearly recorded on the container, as indicated to ensure that these are not administered after their expiry date. To promote the rights and dignity of residents, they must be offered a call bell unless risk assessments are in place addressing the reason(s) why a call bell cannot be offered to a resident. To ensure that the end of life care needs of all residents are being met, care plans must address the residents’ as well as the close family’s perspectives and fears for the future, as much as possible. To ensure a high quality environment for the preparation of meals the registered person must ensure that the kitchen is refurbished as soon as possible. (Previous requirementtimescales of 31/3/05, 01/04/06 and 30/06/07 not met) 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 requirementtimescales of 31/3/05, 01/04/06 and 30/06/07 not met) The home must have 50 of its carers trained to at least NVQ level 2 in care to ensure that the carers are competent to care for the residents. To ensure that staff are fully trained, all of them must be up to date with regards to statutory training such as fire training, DS0000022921.V341686.R02.S.doc 31/08/07 31/08/07 30/09/07 31/12/07 8 OP26 13(3) 30/06/08 9 OP28 18(1)(c) 30/06/08 10 OP30 18(1)(c) 31/12/07 Version 5.2 Page 28 11 OP35 17(1) 12 OP38 13(4) food hygiene training and manual handling training. The valuables and property form 30/09/07 of residents must be kept up to date as far as possible to ensure close monitoring of their personal effects. To ensure the safety of 30/09/07 residents, staff and visitors the registered person must ensure that there are regular emergency lights and wheelchair checks in the home (Repeated requirement-timescale 15/01/07 not met). An up to date Portable Electrical Appliances Test certificate must be available for inspection to ensure the safety of all electrical appliances in the home To ensure the safety of gas appliances all equipment using gas must have a gas safety certificate. 30/09/07 13 OP38 13(4) 14 OP38 13(4) 30/09/07 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 OP2 OP7 Good Practice Recommendations The manager should ensure that residents and or their representatives sign the contract/statement of terms and condition to evidence that they have agreed to these. That the registered person makes a record when residents/representatives have agreed to the plans of care to meet the identified needs of the residents but have not signed the care plans and risk assessments or when it has not been possible to consult with the residents /representatives. To ensure that all the needs of residents are fully addressed the manager should review the social and DS0000022921.V341686.R02.S.doc Version 5.2 Page 29 3 OP12 4 OP33 recreational needs of those residents with end stage illnesses and who are admitted to the home for end of life care. A report summarising the findings of the satisfaction survey should be produced detailing the areas where the home performed very well and the areas where improvement might be required for the home to fully benefit from the survey. DS0000022921.V341686.R02.S.doc Version 5.2 Page 30 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 DS0000022921.V341686.R02.S.doc Version 5.2 Page 31 - 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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