Inspection on 14/06/06 for Church View Nursing Home

This inspection was carried out on 14th June 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

Church View Nursing Home 29/09/09

Church View Nursing Home 15/04/09

Church View Nursing Home 01/04/09

Church View Nursing Home 15/10/08

Church View Nursing Home 15/08/07

Church View Nursing Home 30/01/06

Church View Nursing Home 01/11/05

Church View Nursing Home 09/02/05

Church View Nursing Home 06/04/04

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

CARE HOMES FOR OLDER PEOPLE Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA Lead Inspector Steve Cousins Key Unannounced Inspection 09:30 14 – 16th June 2006 th 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 Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church View Nursing Home Address Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA 01793 820761 01793 820180 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) Hallmark Healthcare (Swindon) Ltd Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (3), Terminally ill (3), of places Terminally ill over 65 years of age (3) Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 3 service users with a terminal illness may be accommodated at any one time The staffing levels set out in the Notice of Decision dated 1 December 2003 must be met at all times 30th January 2006 Date of last inspection Brief Description of the Service: Church View is a purpose built care home providing nursing care and accommodation for up to forty-three residents. The home is part of the Hallmark Healthcare Group. The registered manager post is currently vacant. The home is located within a residential development in Stratton St Margaret, situated on the outskirts of Swindon, and is within walking distance of a local shop. Accommodation comprises of 29 single rooms and 7 double rooms, located over two floors with all having en suite facilities. Residents also have access to a lounge and dining area on each floor and a ground floor conservatory, which leads out to an enclosed garden, and patio area. As the home provides nursing care, registered nurses are on duty at all times, supported by care assistants, domestic, laundry, catering, maintenance and administration staff. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the 14th, 15th and 16th of June 2006 in order to inspect all of the key minimum standards relating to care homes for elderly people. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives and staff, and visiting frail residents. A number of records were inspected, including care plans, medication records and staff records. Comment cards were sent to GP’s. Comment cards were also received from residents and relatives following the inspection. The Commissions pharmacy inspector looked at the arrangements regarding medications. The findings of the visit to the home were discussed with Mrs Beresford, the acting manager, and Mr Lewis, the regional manager for Hallmark Health Care at the end of the third day of the inspection. The findings from the comment cards received from residents and relatives following the inspection have not been discussed but are incorporated in this report. What the service does well: What has improved since the last inspection? There were nine statutory requirements set at the previous inspection of which eight were found to be met during this visit. New residents now have care plans in place soon after their admission and the quality of care planning has improved, although in some cases there was a need to ensure that assessments are completed regularly and cover all aspects Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 6 of a residents needs. Staff are now more diligent in ensuring frail residents are receiving enough to eat and drink. There has been an improvement in complaint handling but further is needed with regard to recording complaints and ensuring they are dealt with promptly. Representatives of the owners, Hallmark Healthcare, are now visiting the home more often. There are more adjustable height beds in the home, which has improved residents’ comfort and lessened the risk of manual handling injuries to staff, however more are required. The kitchen is cleaner and minor repairs have been undertaken. 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. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: A review of residents care plans indicated that pre admission assessments had been carried out by the acting manager who is a registered nurse with the involvement of the resident. Where appropriate, supporting information from social services care managers and relatives was available. Information used from pre admission assessment contributed to the development of residents care plans. Two new residents spoken with confirmed that the acting manager had visited them for assessment purposes prior to admission. An intermediate care facility is not provided therefore Standard 6 does not apply to this home. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 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 and 10 The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. Care plans are in place and there is a genuine commitment to ensure that health care needs are met, however evidence suggests some improvement is required in these areas. Omissions in the records for medication show that the home’s procedures are not being followed correctly and lack of guidance for ‘as required’ medication may lead to incorrect use. Residents appear to be treated respectfully and their right to privacy is upheld. EVIDENCE: The inspector chose seven residents to case track, four females and three males all between the ages of 70 to 90. They were a mixture of active and very frail residents, and one whose first language was not English. Two of the residents were new to the home. A review of the residents care plans indicated an overall improvement with regard to reviewing and assessment and the majority of those seen appeared to be an accurate reflection of assessed needs, however the inspector did find some examples where care planning and assessment procedure required Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 10 improvement. In one case a resident who had been assessed as at risk from developing pressure damage did not have a related care plan, however pressure relief equipment had been provided and was in use. In another case the residents’ initial admission assessments were incomplete and a nutritional assessment review had been overlooked. Care plans that reflected residents’ wishes regarding end of life decisions were not in place for those residents who were very frail and dying. A requirement of the previous inspection was that care plans should be completed as soon as possible after admission. The care plans of newly admitted residents indicated that this problem had been addressed although one had not had a nutritional assessment undertaken. Observation of staff practice and a review of residents’ intake charts indicated that, in all but one case, frail residents nutritional and hydration needs were being met. In the case in question, the resident often refused food and drink and had a period of sustained weight loss; this issue was discussed with the nurse in charge and a review with the General Practitioner (GP) was planned. Residents’ comments to the inspector and a review of residents’ daily records indicated that they had access to their GP and that staff acted promptly to meet residents medical needs. GP’s visits and findings were recorded in care plans. Records indicated that other health care professionals had seen residents’ as required, such as the tissue viability nurse, dietician and ophthalmologist. Seven comment cards were received from residents following the inspection, four indicated they ‘always’ receive the medical support they need, one indicate ‘usually’ and one ‘sometimes’ with the added comment “not always”. As this resident had not entered their name on the comment card, the inspector was unable to obtain further information. Comment cards were received from three GP’s who visit the home and who indicated that they were generally satisfied with the overall care provided, the only concerns stated by one being communication with staff and some ‘basic nursing skills’, however both these areas were said to be ‘improving’. The inspector visited the residents who were being case tracked and found that interventions were in place to meet their assessed needs, such as pressure relief equipment, fluid intake charts, continence aids and manual handling equipment. Their personal hygiene needs were being met and residents appeared clean and comfortable. Those who were able to communicate indicated satisfaction with the care given. Comments included “the staff look after me, they are very good” and “They are very kind”. Other residents in the home who were spoken to by the inspector were happy with the support given by the staff, one saying “They are used to me now, they put up with my moans, they are very good”. To aid communication with the resident who understood little English, a list of words in her own language had been produced. The resident indicated satisfaction with the home to the inspector. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 11 Three of the residents who returned comment cards replied ‘always’ to the question ‘Do you receive the care and support you need’ and four replied ‘usually’. This may be a reflection of the comments received from residents and relatives regarding staff availability, which are contained in the Staffing section of this report. The Commissions pharmacy inspector reviewed the homes arrangements regarding medication. Medicines are stored securely and records of receipts and disposals maintained. Evidence of checks on new residents’ medication was available. Protocols were available for tube feeding and evidence of multidisciplinary support was seen. There were gaps in the recording on the medication administration records, two were particularly noted as the gaps continued for three to five days. There was no evidence of these medicines being given or the reason for their omission. Two medicines were noted without labelled doses. Eye drops had been opened but not dated, so the expiry date of these drops was unclear. The use of medicines prescribed ‘as required’ was not supported by care plans. One was offered regularly even though this was apparently not the intention of the prescriber. The inspectors observations and the residents’ comments indicated that they were being treated respectfully and staff endeavoured to respect their dignity and privacy. Personal care was carried out behind closed doors and staff knocked before entering residents rooms. GP’s confirmed that they were able to see their patients in private. One resident said, “I don’t usually join in things and like to stay in my room and the staff respect that”. Ten comment cards received from relatives indicated that six were satisfied with the overall care provided and three were mostly satisfied, one did not comment. Seven whose relatives were unable to make decisions, felt that they were not always consulted about their care nor kept informed of important matters. Three relatives spoken to during the inspection were happy about the care given, one stated “It’s good, they look after Mum well” and another “They do all they can, I’m very happy with the care”. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 12 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): 12.13 14 and 15 The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. Social activity is provided but is somewhat inconsistent and does not always meet residents’ individual needs. Residents are able to maintain contact with family and friends and there is a commitment to help them exercise control and choice over their lives, but this is not always achieved. The home provides the residents with nutritious meals in a suitable environment. EVIDENCE: There is an activity coordinator employed who works between 11.30am and 4.30pm, Monday to Friday. Two volunteers support her in her role for two days a week. Unfortunately there had been limited activity in the home over the three-week period leading up to the inspection due to the activity coordinator’s absence and this was reflected in the residents’ comments during this inspection. An activity record is kept which indicated a range of external and in-house, mainly group activity. Two residents felt that some of the activities were not suited to them. Of the seven comment cards received from residents, four indicated that there were ‘sometimes’ activities they could take part in. One stated ‘not often’ and another ‘rarely’. Care plans indicated that social needs were not always assessed in order to try and ascertain personal Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 13 preferences regarding social activity. Religious services are held in the home and a mobile shop is available. It was stated that there are no restrictions on visiting unless at the residents request. Visitors were in the home throughout the inspection and residents confirmed that they had contact with friends and relatives. Visitors could be received in residents’ rooms or in the communal areas. Residents’ comments indicated that links with the local community were mainly via occasional external activities or trips out with relatives. The ten comment cards received from relatives indicated that they felt welcome in the home and they were able to visit in private. Residents comments during the inspection indicated that they had some control over how they lived their lives, however this was sometimes affected by the availability of staff, particularly when getting up or gong to bed or trips out of the home. One resident said “I like to get out but there’s not always someone to take me.” Four comment cards received from residents indicated that staff listen and act on what they say, however three did not think this was always the case, one stating ‘It sometimes takes a long time to achieve results and I have to ask more than once’. Residents are able to bring in personal items and furniture if required. Details of advocacy services are on display and residents are able to voice their opinions during meetings, although these are infrequent. Comments from residents were generally positive about the food available in the home. The meals provided at lunchtime over the three days of the inspection appeared well cooked and nutritious and were served hot. A choice of meal is offered and one resident confirmed this by saying “the chef will cook what I ask for if it’s not on the menu”. Another stated on a comment card ‘Do generally enjoy the meals but would appreciate a bit more variety’. A copy of the general managers monthly report indicated that the menu was due to be reviewed by the acting manager and cook. Hot and cold drinks were available throughout the day. Residents were observed eating in their own rooms or in the dining rooms if preferred and staff were observed assisting some residents to eat sensitively and giving them sufficient time, however two comment cards received from relatives stated that the staff sometimes did not sit the resident up in bed when assisting them to eat. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 14 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): 16 and 18. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. There has been some improvement in complaint handling however not all complaints were recorded or dealt with promptly and not everybody was aware of the homes complaint procedure. As far as possible the residents are protected from abuse. EVIDENCE: The inspector reviewed the complaints record, which indicated that complaints received had been dealt with promptly and appropriately, which was an improvement on the previous inspection. One resident stated to the inspector that a care worker had been “a bit abrupt” and had mentioned it to the acting manager. The complaint record indicated that the matter had been recorded and followed up appropriately. The records of the residents meetings indicated some issues that may be seen as complaints that had not been recorded as such, such as a resident who was unable to flush their toilet. Although the acting manager was able to describe the action that had been taken to try and resolve this, the complainant indicated that the problem had still not been fully resolved, despite it first being raised in March. Residents spoken to felt that they would be able to complain to either the manager or a staff member if they needed to however comment cards received indicated that residents and relatives were not always aware of the homes complaints procedure. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 15 A requirement was set at the last inspection concerning a delay reporting of an incident that may be seen as abusive. There have been no incidents of this nature reported since the previous inspection. An adult protection procedure was in place along with a whistle blowing policy. Copies of local guidelines for reporting suspected abuse are available in each resident’s room and the staff have recently been sent a questionnaire regarding abuse reporting procedures. Training had been arranged with the Swindon Vulnerable Adults unit. There are systems in place regarding the handling of residents’ monies and recruitment procedure safeguards residents as far as possible and includes POVA and CRB checks. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. The home is safe, clean and well maintained. More adjustable beds are required and ensuring en suite toilets remain tidy would further enhance the environment for residents. EVIDENCE: A tour of the building indicated that the home was generally in a good state of repair and decoration. External areas, particularly the gardens were very well kept. A maintenance person is employed and programme of routine maintenance was in place. Some minor redecoration was required in some bedrooms and one bathroom was not in use as the chair on the bath hoist required replacement. The acting manager stated that a replacement had been ordered. More adjustable beds have been purchased throughout the home, however there are some old divan beds still in use. Mrs Beresford stated that she was Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 17 currently assessing the suitability of the divan beds in order to purchase suitable replacements. There was evidence to suggest that action had been taken to ensure that residents’ rooms and equipment meet their needs. One resident whose bed was too uncomfortable had it changed and another who was unhappy with the position of their room was moved to another. Some en suite toilets had equipment stored in them, which reduced the available space for residents. One relative commented that this was a particular problem. The home was found to be clean and free from persistent unpleasant odour and comments received from residents indicated that this was generally the case. The laundry was clean and tidy and the laundry person demonstrated an understanding of procedures for handling and laundering soiled linen and confirmed that staff adhered to these guidelines. Comments from four relatives indicated that residents clothing sometimes ‘went missing’ for periods of time and one reported finding ‘other residents wearing my mothers clothes’. Disposable gloves and aprons appeared to be used appropriately by staff and staff hand washing facilities are available. The kitchen was found to be clean but the kitchen floor remains marked in places, however the regional manager reported that this was to be replaced. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 18 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 quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. There are periods when there are delays in meeting residents’ needs and working practice needs to be reviewed. Appropriate staff training takes place and recruitment procedure supports and protects the residents. EVIDENCE: There were 38 residents in the home during the inspection. During the morning period, which is regarded as the busiest by the residents and staff, there are normally two registered nurses and six care assistants on duty, this is reduced at 2.00pm to two nurses and four care assistants until 5.30p.m when it increases to two and six until 8.30pm. At night there are two nurses and two care assistants on waking duty. Staffing rotas seen indicated an adherence to the minimum staffing notice set by the previous registration authority. The views of the residents spoken to varied on whether there are enough care staff members available throughout the day. Two felt that they did not see many staff during the afternoon and one said “It can be a bit of a rush in the morning”. Of the seven comment cards received from residents one replied ‘always’ to the question ‘are the staff available when you need them?’ Three replied ‘usually’ and three ‘sometimes’. Comments included “Generally the staff are very good but owing to commitments with other residents it can sometimes take a while for them to get to me if I need something”. As recorded in the Health and Personal Care and Daily Life and Social Activity Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 19 sections of this report some residents felt that there needs were not always being met due to staff availability. Ten comment cards were received from relatives, all of who replied ‘no’ to the question ‘in your opinion are there always sufficient staff on duty?’ Comments included ‘Staff are friendly and helpful but very busy – evening times seem to not have enough staff on duty, particularly 7 –8 pm’ and ‘shortage of staff on duty between 7.30 – 8.15 at night, --- no one checks on residents’. One relative commented that call bells could ring for ‘long periods of time’ before being answered, although the inspector did not encounter this problem during the three visits to the home. Subsequent conversations with the homes management team indicated that they felt that it was the way that care staff were currently working that may be contributing to these problems as opposed to a lack of numbers and changes to working practice were planned. Three care staff members spoken to felt that staffing levels were generally appropriate, although one felt that it was particularly busy on the first floor between 2 – 5.30pm. The cleanliness of the home and the efficiency of the kitchen, laundry and maintenance service would indicate that the number of domestic and support staff is appropriate. The recruitment records of three new staff members were reviewed and found to contain the required documentation in all but one case where photographic identification was required. Staff training records indicated that mandatory and NVQ training was undertaken and a training plan in place. There were seven care assistants with NVQ level 2 and three with NVQ level 3 out of a total of nineteen. Staff spoken to confirm that the training recorded had taken place. Induction training records for three new staff members were reviewed and appeared satisfactory. The acting manager reported that registered nurses had undertaken training in taking blood, wound care and first aid and that resuscitation training was planned. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 20 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): 31,33,35 and 38. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. The home does not currently have a manager who is registered with the Commission however a new manager has been appointed since this inspection. Systems are in place to ensure that the home is run in the residents’ best interests but communication with residents and relatives could be improved. Residents’ financial interests are safeguarded and health and safety arrangements generally protect residents and staff although some food hygiene measures require improvement. EVIDENCE: At the time of the inspection the home did not have a manager who has been registered with the Commission but recruitment has since been addressed. Maureen Beresford, a registered nurse was acting manager during the time of the inspection. A full time administrator is employed and a new regional Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 21 manager had been appointed to cover the home and had undertaken several visits to monitor the service. Current systems in place to ensure the home is run in the best interests of the residents include monthly visits and reports by the regional manager. Regular staff meetings are held and some residents and relatives meetings, although the comments received indicate that these need to be more frequent to enhance communication. The records of meetings held were seen. Formal quality assurance systems include audits of accidents, tissue viability, resident’s weight and infection control. The inspector reviewed the procedures in place to safeguard residents financial interests. Small amounts of money are held on behalf of residents. The money is secure, held individually and records and receipts are kept. Four ‘accounts’ checked were accurate. The administrator stated that staff members were not appointees for any resident’s finances or benefit payments but that a Social Services representative undertook this role for two of the residents. Health and safety policies are in place and general risk assessments have been produced however many of these required updating. Staff training includes moving and handling, fire safety, first aid, food hygiene and infection control. A tour of the building indicated that it was in good repair and maintenance records confirmed that essential equipment and services were routinely serviced. Hazardous substances were stored safely and domestic staff wore protective clothing. Radiators are covered and hot water temperatures are controlled and checked. The water supply had been checked for Legionella. Kitchen staff need to ensure that any foods with an expiry date are marked with the date they were opened and that the core temperature of cooked foods is checked and recorded at all times, as there were some gaps in records. Accidents are recorded appropriately and records indicated that they were evaluated and action was taken to reduce risk where needed. Records indicated that fire safety measures were satisfactory. Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 23 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) Requirement The registered person is required to ensure that care plans are in place for all service users assessed as being at risk of developing pressure damage. The registered person is required to ensure that, where appropriate, service users wishes concerning terminal care are discussed and recorded. The registered person is required to ensure that nutritional assessment is undertaken for all service users on admission. The registered person is required to ensure that a complete record of all medicines administered or omitted and the reason for that omission, is maintained. The registered person is required to ensure that instructions are clearly labelled on all medicines and medicine administration records. The registered person is required to ensure that all eye drops are dated on opening and discarded at the appropriate time. The registered person is required DS0000052415.V296102.R01.S.doc Timescale for action 16/06/06 2 OP7 15 (1) 12 (2,3) 01/09/06 3 OP8 14 (1,a) (2,a, b) 13(2) 16/06/06 4 OP9 16/06/06 5 OP9 13 (2) 16/06/06 6 OP9 13 (2) 16/06/06 7 OP9 13 (2) 16/07/06 Page 24 Church View Nursing Home Version 5.2 8 OP9 37 (1,e) 9 OP10 12 (4,a) 10 OP12 16 (2,m, n) 11 12 OP15 OP16 12 (1,b) 22 (4) 13 OP24 16(1,c) 14 OP24 13 (4,a) 15 OP27 18 (1,a) 16 OP29 19 (1,b, i) to ensure that clear protocols are available to all staff for the correct use of any medicines prescribed ‘as required’. The registered person is required to ensure that the Commission is notified of any event that adversely affects the wellbeing of service users. This includes the non-administration of any prescribed medicines. The registered person is required to ensure that clothes are returned promptly from the laundry to the correct resident. The registered person is required to ensure that service users have the opportunity to exercise their choice in relation to social and leisure activity. The registered person is required to ensure that service users are sat up when assisted to eat. The registered person is required to ensure that all complaints are recorded and where possible, dealt with within a maximum of 28 days. The registered provider is required to ensure that manoeuvrable, adjustable height beds are available for all residents currently assessed as requiring one. Requirement from the inspections held 1st November 2005 and January 2006, met in part. The registered person is required to ensure that en suite facilities in residents rooms are not used for storage purposes The registered person is required to review care staffing levels and working practice throughout the day to ensure that service users needs are met at all times. The registered person is required DS0000052415.V296102.R01.S.doc 16/06/06 16/06/06 01/09/06 16/06/06 16/06/06 01/09/06 01/07/06 01/09/06 01/09/06 Page 25 Church View Nursing Home Version 5.2 17 OP38 13 (4) 18 OP38 13 (3) (4,c) 19 OP38 13 (3) (4,c) to ensure that all staff records include proof of identity, including a recent photograph. The registered person is required to ensure that general environmental risk assessments and those regarding safe working practice are reviewed. The registered person is required to ensure that any foods with an expiry date are marked with the date they were opened and discarded at the appropriate time. The registered person is required to ensure that the core temperature of cooked foods is checked and recorded at all times. 01/10/06 16/06/06 16/06/06 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 Refer to Standard OP8 Good Practice Recommendations Given the comments received from some residents regarding whether they are receiving the medical support they need, it is recommended that residents’ opinion be sought via a survey. It is recommended that measures be taken to raise the awareness of residents, relatives and advocates regarding the homes complaint procedure. It is recommended that residents/relatives/advocates meetings be held more frequently in order to enhance communication and monitor the service provided. 2 3 OP16 OP33 Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Church View Nursing Home DS0000052415.V296102.R01.S.doc Version 5.2 Page 27 - 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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