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Inspection on 15/08/07 for Church View Nursing Home

Also see our care home review for Church View Nursing Home for more information

This inspection was carried out on 15th August 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a commitment from staff to ensure that people who live in the home have their health needs met and to ensure that proper equipment is provided to meet their needs. People also have the opportunity to have a say about how the home is run through residents meetings and they are able to maintain contact with family and friends. Staff recruitment procedures are rigorous and there is a commitment to ensure staff receive training, with a high level of care assistants with a National Vocational Qualification (NVQ) in care. Complaints are dealt with promptly and the management of health and safety is good.

What has improved since the last inspection?

There were nineteen statutory requirements set at the last key inspection in June 2006 and the home has met sixteen of these. There have been improvements in some aspects of care planning and assessment procedures and medication procedures have also improved. Following a review, there have been some changes to care staff numbers and shift patterns in an effort to ensure peoples` needs are being met, however further review is required as comments received from people (and staff) indicate that some problems remain. The laundry service is better and there have been improvements in food safety in the kitchen. Some more height adjustable, profiling beds have been purchased.

What the care home could do better:

There needs to be further improvement in care planning and assessment procedures to ensure that the needs of the people living at Church View are fully known, and this should include their social needs. Some findings indicated that there was a degree of institutionalised care practice, with particular regard to getting people up in the morning. Nurses need to be more vigilant when reviewing people who have diabetes and those who are at risk from dehydration. Medications should not be left unattended at any time. Some improvements are required to the decoration of people`s rooms and some bedroom furniture requires cleaning or replacement. There needs to be a more pro-active response to general maintenance and repairs in the home. A home manager needs to be appointed and registered with the Commission.

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 09:00 15 – 16th August 2007 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.V339693.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.V339693.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 churchview@hallmarkhealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 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.V339693.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 14th June 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 twenty-nine single rooms and seven 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 and are supported by care assistants. Domestic, laundry, catering, maintenance and administration staff are also available. Current fees range from £450 to £660 per week. Church View Nursing Home DS0000052415.V339693.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 15th and 16th of August 2007 in order to inspect all of the key minimum standards relating to care homes for elderly people. A total of 15.25 hours were spent at the home. The findings from this inspection are based on a tour of the premises, speaking to people who live in the home, their relatives and staff members, and visiting frail residents. A number of records were inspected, including care plans, medication records and staff records. The inspector reviewed the care of five people in detail, both male and female, who had varying physical, social and mental health needs. Some were new to the home and others had been at Church View for some time. The care of other residents was reviewed in less detail. Consideration was given to issues of ethnicity and diversity. Comment cards were received from people who use the service and their relatives prior to the inspection. Their views were used to inform the inspection process and some are incorporated into this report. However it appeared that many of the comment card had been completed by some staff members in order to air grievances they had about the home and these issues were discussed with the home manager and regional manager. Other information was obtained from The Annual Quality Assurance Assessment, which had been completed by the manager and sent to the Commission prior to the inspection. The findings of the visit to the home were discussed with Mrs Willett, the home manager, and Mrs Wanklyn, the regional manager for Hallmark Health Care at the end of the second day of the inspection. 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. Since this inspection the Commission has been informed that home manager has left and a new manager is to be appointed. What the service does well: There is a commitment from staff to ensure that people who live in the home have their health needs met and to ensure that proper equipment is provided to meet their needs. People also have the opportunity to have a say about how the home is run through residents meetings and they are able to maintain contact with family and friends. Staff recruitment procedures are rigorous and there is a commitment to ensure staff receive training, with a high level of care assistants with a National Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 6 Vocational Qualification (NVQ) in care. Complaints are dealt with promptly and the management of health and safety is good. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Church View Nursing Home DS0000052415.V339693.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.V339693.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Pre admission assessments are undertaken although some improvement is necessary to ensure that the needs of people whose first language is not English are fully assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A review of peoples care plans indicated that pre admission assessments had been carried out by the home manager who is a registered nurse with, where able, the involvement of the person being admitted to the home. Where appropriate, supporting information from social services care managers and relatives was available. Information used from pre admission assessment contributed to the development of peoples care plans. One person spoken with confirmed that the home’s manager had visited them for assessment purposes prior to admission. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 9 In the case of one person who was admitted to the home, who did not speak English, it was evident that more information could have been obtained from an interpreter prior to admission, to ensure that the person’s needs and wishes were being met and the care plan in place was an accurate reflection of their needs. An intermediate care facility is not provided therefore Standard 6 does not apply to this home. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Care plans are in place but these need to improve to fully reflect people’s needs. The home goes some way to meeting people’s health needs, however monitoring of those who are at risk from dehydration and of those who have diabetes, requires improvement. People’s privacy and dignity appears to be respected however some comments indicate that they are not always treated respectfully. Medication procedures generally protect the people living in the home, but nurses need to ensure that medicines are not left unattended at any time. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A care planning system is in place and staff reported that a new system was being introduced during the time of the inspection. Care plans reviewed were generally an accurate reflection of needs and were based on appropriate assessment but not all plans had been reviewed monthly, a particular problem Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 11 from May of this year. There were other areas relating to care plans that required further development. One person who had a urinary catheter in place did not have a care plan to direct care or allow for evaluation. Not all people using the service, or their representatives, had signed agreement to their plans and not all assessments had been signed and dated by the person compiling them. Plans were not always in place that related to end of life decisions for those people who were admitted for continuing care. The inspector visited the people whose care was being reviewed and found that interventions were in place to meet their assessed needs, such as pressure relief equipment, continence aids and manual handling equipment. However, records indicated that where a person’s fluid intake and output was being recorded, records were not completed accurately as some charts had few entries. This also indicates that nurses were not adequately or regularly reviewing these charts to ensure that people were receiving adequate hydration, which could have an impact on their health. In another case, the recording of a diabetic person’s blood sugar level was not consistent and indicated again that review of their condition required improvement. Records indicated that staff are prompt in referring people to their general practitioner (GP) when required and to other health care professionals, such as the continence advisor and hospital consultants. Two people who live at Church View told the inspector that they were able to see their GP when they wanted to. One relative felt that the home ‘Delivers good care’ but another stated that ‘I think the shortages of staff means that for care, one size fits all’. There was some evidence to suggest that peoples’ privacy and dignity was respected, but some comments received indicated that this was not always the case. It was observed that personal care was being given behind closed doors and staff knocked on doors before entering a room. People seemed to be having their personal hygiene needs met and those who were unable to dress themselves were dressed in clothing that maintained their dignity. One person who lived in the home told the inspector when asked if they were treated with respect “ It’s generally very, very good” and another said ‘staff don’t have a lot of time but they are good”, however they also added “they sometimes get annoyed if I ring”. A person also stated that “80 of the staff are good, 20 bad, their attitude isn’t right, they are not very willing”. The arrangements regarding medication administration were reviewed and found to be generally satisfactory, however in one instance some medication was left unattended on a medicine trolley in the nursing office on the first floor. Medicines are stored and recorded appropriately and a policy is available. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 12 There was minimal use of night sedation. No residents currently self medicate, however a procedure is in place should anyone wish to do so. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Activities are provided, but the service needs to be reviewed to ensure that the home is able to meet people’s social needs. People are able to maintain contact with family and friends but some report limited access to the local community. People were not always able to exercise choice and control over their lives in the home and improvements could be made to the meals provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities organiser is employed. Activities arranged are advertised within the home. The list for August was reviewed and included, bingo, trips to the park, music for health and a visit from a clothing supplier. One to one activity was also listed and a church service was held in the home. A newsletter printed in August recorded that three residents enjoyed a trip to the local pub and that the maintenance person had completed a sensory garden, which was ‘well received by residents’ One relative commented ‘we were led to believe from the home’s leaflet that there would be a wide range of activities and outings for residents able to Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 14 participate. There have been gaps in the provision of activities when a post holder has not been in place’. Another person commented that they felt that one activity person was not enough to meet the social needs of the people living at the home. Two people felt that they would like more opportunity to have trips out of the home and one relative commented ‘a lot of people would benefit from outings’ and suggested that a minibus for the home would help. People appear to be supported in maintaining links with families and friends, there were no restrictions on visiting and visitors were seen in the home throughout the two days of the inspection. The inspector’s observations allied to some comments received indicated that not all people were able to have a degree of choice and control over their life. The inspector visited the home at 08:00 am on the second day of the inspection and found that a total of eight out of sixteen people were out of bed on the ground floor. Six were in the sitting room, two of who were asleep. Two people were able to verify that they were happy to be up and that this was normal for them. Others were unable to state whether it was their choice to be up. One stated that they “had no choice”. Another person told the inspector “They (the staff) like their routine, I get up about eight but could do with a lie in sometimes’. One staff member told the inspector that staff sometimes “start washes about six’. The nurse on duty stated that the staff did not start to get people until 07:00 a.m., however given the support they require and the level of staffing at that time of the morning, this would indicate that either their hygiene needs are not being met, or they are got up earlier than 07:00 am. This was discussed with the manager and regional manager. Another example of a degree of institutionalised care was in regard to a ‘toileting record’ which the manager stated was kept in order to record who had assisted residents to the toilet and what time. It was apparent from the comments of some staff members however that people were regularly ‘toileted’ following the mid-day meal. However one said that this would not happen if the resident did not wish it. The toileting record was discontinued during the inspection. Details of advocacy services are on display and people are able to voice their opinions during regular meetings, which are recorded. Comments received were mixed about the meals available in the home. Some people spoken to were happy with the food, one saying “the meals are good’ and another “It’s lovely”. One person however felt that the food “leaves a lot to be desired” and felt that there was some inconsistency with the quality. One person stated on a comment card ‘It would be good if less stodge was provided. Meals could be more imaginative’. It was also noted that those who Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 15 required a pureed diet did not receive a choice of meal. This was discussed with the cook and the regional manager. The meals provided at lunchtime over the two days of the inspection appeared well cooked and nutritious and were served hot and a choice was offered to those who did not receive a pureed diet. People were observed eating in their own rooms or in the dining rooms if preferred and staff were observed assisting some to eat sensitively and giving them sufficient time. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 16 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 Complaints are taken seriously and investigated. As far as possible, people in the home are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has received five complaints relating to the home since the previous inspection, three of which were anonymous. The registered provider of the service, Hallmark Healthcare, investigated three of the complaints and produced a written report to the Commission. The complaints were dealt with promptly and satisfactorily. Random inspections by the Commission were held to investigate the other two complaints. The first of these took place on the 4th August 2006 and related to the care of a person admitted for a respite stay in the home. This inspection resulted in four statutory requirements being issued in relation to care planning, assessing tissue viability, ensuring peoples nutritional and hydration needs are met and medication administration. The second random inspection was held on the 20th October 2006 in response to an anonymous complaint relating to care practice and routines, and staffing levels. There were no statutory requirements issued as a result of the inspection. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 17 People spoken to during this inspection felt that they could approach the manager or the staff if they had any problems. One person said, “I usually go to Michelle (manager) and she will do something about it”. One relative recounted two concerns that he had relayed to the manager, which she had “quickly sorted”. 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 person’s room and the staff spoken with indicated an awareness of abuse reporting procedures and had received training. There are systems in place regarding the handling of residents’ monies and recruitment procedure includes Protection of Vulnerable Adults (POVA) list and Criminal Records Bureau (CRB) checks. Church View Nursing Home DS0000052415.V339693.R01.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): 19,23 and 26. There needs to be a more pro-active response to general maintenance and repairs in the home and the condition of some furniture. The suitability and condition of older divan beds needs to be reviewed. The home is clean, but levels need to be maintained by employing enough domestic staff. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building indicated that there had been some deterioration in the environment and in the level of routine maintenance since the previous inspection mainly in relation to people’s rooms and the en-suite facilities. Many chairs in rooms were stained, as were some carpets and en-suite floors. Continence pads and washbowls were being stored on toilet floors. Many bedrooms required redecoration. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 19 Other issues included some extractor fans not working in toilets and sluices, two radiators not securely fixed to walls and fire door closures not repaired. Three staff commented on delays in repairing equipment. Communal areas of the home appeared better decorated and maintained and external areas, particularly the gardens were well kept. The inspector discussed the more urgent issues with the regional manager for immediate action and provided her with a list of environmental defects on the day following the inspection. Many old divan beds are still in use. These are not easily moved nor height adjustable. The home should assess the condition and suitability of the divan beds and take into account safe working practice for staff and purchase suitable replacements. This has been an ongoing statutory requirement, which has not been fully met since the inspection held in November 2005 and action should now be taken to avoid enforcement action by the Commission. Levels of cleanliness in the home were generally satisfactory, but appeared better in the communal areas that some bedrooms. The manager reported a shortage of cleaning staff and there was no cleaner on duty on the first day of the inspection. It was stated that two staff had been recruited and were awaiting CRB clearance. The kitchen was found to be clean and food hygiene procedures in place. The laundry was clean and satisfactory systems in place in relation to handling and washing of soiled laundry. Church View Nursing Home DS0000052415.V339693.R01.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): 27,28,29 and 30 There needs to be a review of current staff levels and their practice to ensure that peoples needs are fully met. The arrangements for staff training and recruitment are satisfactory and there is a high number of care staff who have obtained NVQ. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were thirty-nine residents in the home during the inspection. During the day, there are normally two registered nurses and five to six care assistants on duty, there is also an extra person to help support at breakfast time. At night there is one nurse and three care assistants on waking duty. The findings detailed in the Health and Personal Care section of this report, along with comments received throughout the inspection, would indicate that a review of staff numbers and practice is required. This was also a requirement at the previous inspection and although it is acknowledged that some changes have been made with regard to shift patterns and numbers of staff on shifts, further action is required. One person stated on a comment card, ‘Sometimes there is a long wait when the call bell is rung before somebody comes’ and another ‘I think the shortage Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 21 of staff means that for care – one size fits all’. One person told the inspector “I sometimes have to wait to go to bed or get up. Some staff can be a bit abrupt, I think it’s down to numbers and inexperience.” Another said “Staff don’t have the time, but they are good’. Staff spoken to felt that some of the problem was a result of staff sickness, one saying “It (staffing) could be improved and is affected by people not coming in”. Another felt that “There are some problems with staffing levels, particularly at weekends” another said, “It’s OK until somebody goes off”. One care assistant reported having to undertake some domestic duties due to the absence of cleaning staff. The manager confirmed that there were periods when the home had been short staffed due to the level of staff sickness. The arrangements for staff training were reviewed. Training records are kept. The manger reported that there were currently 76 of care assistants who had obtained a NVQ in care and that a further four were currently undertaking one. Mandatory training included food hygiene, moving and handling, fire safety, health and safety and abuse awareness. New staff undertake induction training. The arrangements for staff recruitment were reviewed and the records of three recently recruited staff were seen. Required documents were held on file and appropriate checks undertaken. References were in place from previous employers, although in one instance were a person had worked in another care home, further effort could have been made to obtain a reference from that employer and this was discussed with the manager for action. Church View Nursing Home DS0000052415.V339693.R01.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. The home does not currently have a manager and one needs to be appointed and registered with the Commission. Systems are in place to ensure that the home is run in the residents’ best interests and their financial interests are safeguarded. Health and safety arrangements generally protect people living and working in the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager in post during this inspection has since left her position. The home has not had a registered manager for over two years and the company Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 23 must recruit and appoint a suitable person as soon as possible and apply for their registration with the Commission. Current systems in place to ensure the home is run in the best interests of the people living there include monthly residents and relatives meetings, and monthly staff meetings. The records of meetings held were seen. Formal quality assurance systems include audits of accidents, tissue viability, infection control and medication checks. The inspector reviewed the procedures in place to safeguard peoples financial interests. Small amounts of money are held on behalf of residents. The money is secure, held individually and records and receipts are kept. Three ‘accounts’ checked were accurate. The administrator confirmed that staff members were not appointees for any persons’ finances or benefit payments but that a Social Services representative undertook this role for two people living in the home. Health and safety policies are in place and general risk assessments have been produced. Staff training includes moving and handling, fire safety, first aid, food hygiene and infection control. 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. Window restrictors are fitted and there is controlled entry into the building. 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. The home has a health and safety committee and records showed that three meetings had been held so far in 2007. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 24 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 3 17 X 18 3 2 X X X 2 X X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 (1,a,c) Requirement The registered person is required to ensure that wherever possible peoples needs are fully assessed before they are admitted to the home. The registered person is required to ensure that where required, people’s wishes concerning end of life care are discussed and recorded. (Unmet requirement from inspection held 14/6/06) The registered person is required to ensure that service users care plans are reviewed at least once a month and updated to reflect changing needs. The registered person is required to ensure that those service users’, who have urinary catheters, have a care plan in place that directs their care. The registered person is required to ensure that where a service user is assessed at risk from inadequate hydration, their fluid input and output is accurately monitored and reviewed. The registered person is required DS0000052415.V339693.R01.S.doc Timescale for action 01/10/07 2 OP7 15 (1) 12 (2,3) 01/11/07 3 OP7 15 (2,b,c) 01/10/07 4 OP7 15 (1) 01/10/07 5 OP8 12 (1,b) 16/08/07 6 OP8 12 (1,b) 16/08/07 Page 26 Church View Nursing Home Version 5.2 7 OP9 13 (2) 8 OP12 16 (2) 9 OP14 12 (2) 10 OP15 16 (2,i) 11 OP19 23 (2,b) 12 OP24 16 (1,c) 13 OP27 18 (1,a) 14 OP31 8 (1,a,b) to ensure that where a service user is diabetic, their condition is adequately monitored and reviewed. The registered person is required to ensure that medicines are stored safely at all times and not left unattended. The registered person is required to consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities, if that is their wish. The registered person is required to ensure that, as far as practicable, service users are enabled to make decisions with respect to the care they receive. The registered person is required to ensure that service users who require a pureed diet are offered a choice of meal. The registered person is required to ensure that the environmental defects (a list of which was provided) are corrected. The registered provider is required to ensure that manoeuvrable, adjustable height beds are available to all people currently assessed as requiring one. (Requirement met in part from inspections held 1/11/05 and 14/6/06) The registered person is required to review care staffing levels and working practice throughout the day to ensure that peoples needs are met at all times. (Requirement met in part from inspection held 14/6/06) The registered person is required to appoint a manager and apply for their registration with the Commission. DS0000052415.V339693.R01.S.doc 16/08/07 01/11/07 16/08/07 16/08/07 01/11/07 01/12/07 01/11/07 01/12/07 Church View Nursing Home Version 5.2 Page 27 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 OP7 OP7 OP15 Good Practice Recommendations It is recommended that, where possible, care plans be signed and agreed with the service user, or their representative. It is recommended that staff who assess service users for care planning purposes, sign records as having done so. It is recommended that a review be held of the meals available in the home. Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Church View Nursing Home DS0000052415.V339693.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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