Inspection on 15/02/07 for Clavering Nursing Home

This inspection was carried out on 15th February 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clavering Nursing Home 09/07/07

Clavering Nursing Home 27/02/06

Clavering Nursing Home 06/09/05

Clavering Nursing Home 01/03/05

Clavering Nursing Home 21/09/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOMES FOR OLDER PEOPLE Clavering Nursing Home Royston Grove Hatch End Pinner Middlesex HA5 4HE Lead Inspector Ram Sooriah & Julie Schofield Key Unannounced Inspection 11:30 15 and 22nd February 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 Clavering Nursing Home DS0000057551.V330364.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. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clavering Nursing Home Address Royston Grove Hatch End Pinner Middlesex HA5 4HE 020 8421 5819 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) clavering@elitecarehomes.co.uk Clavering Care Ltd Mrs Milithra Wickramarachchi Care Home 49 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: Clavering Nursing Home is a registered care home providing nursing care and accommodation for a maximum of 49 older people aged over 65 years who have dementia or enduring mental disorder. The registered provider is Clavering Care Ltd. The Registered Manager is Mrs Milithra Wickramarachchi. The home is located in a quiet residential road in Hatch End about five minutes walk from the main Uxbridge road. It is therefore situated at some distance to local shops, pubs, transport and leisure facilities in Hatch End. There are parking areas for more that six cars in the grounds of the home as well as street parking around the home. The home has a large garden to the rear that is well maintained and accessible to service users through the building. The building consists of three floors. There is a passenger lift, which serves the first and the ground floors where service users are accommodated. The second floor/attic area is used for administration and by management. There is an office in the attic along with a training room. The home has 29 single and 10 shared bedrooms. There are about four bedrooms, which are en-suite, but there are bathroom/shower toilet facilities on each of the floors where service users are accommodated. There are two living rooms and a conservatory with a seating area on the ground floor and one living room on the first floor. The home charges £600-£850 for a bed. At the time of the inspection there were 47 service users in the home. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the findings of an unannounced inspection, which took place on two occasions. The first visit took place on Thursday the 15th February from 23:30 to 01:30 and the second visit took place on Thursday the 22nd February from 09:30 to 17:00. The inspection was carried out by Ram Sooriah and Julie Schofield, regulation inspectors. In this report the term ‘inspector’ refers to Ram Sooriah and the term ‘inspectors’ refers to Ram Sooriah and Julie Schofield. The inspectors toured some of the premises, observed care practices, talked to service users, visitors to the home and members of staff. They also sampled records, including care, medicines, health and safety, training and personnel records. The inspectors would like to thank all the service users and the visitors who spoke to them and the manager and her staff for a kind welcome to the home and support during the course of the inspection. What the service does well: Most service users in the home have high needs, including behavioural, cognitive and physical needs. The inspectors noted that the home in the main cares well for some of the most vulnerable service users in the community. This was apparent during the night visit and during the day visit, when the inspectors spent a lot of time observing service users and talking to a few of them, where possible. All service users presented as clean, appropriately dressed and cared for. A relative commented in a letter to the home about “the wonderful care you are taking of him”. Another relative wrote to the home thanking them for “the patience and care you gave to him and your kindness to me”. A third letter from a relative said that they had nothing but praise for the fantastic job the manager and her team were doing. During the inspection a relative visiting the home said that the manager “is a tower of strength and is devoted to the welfare of the residents”. The service users’ guide and the statement of purpose contain the necessary information for people to decide if they want to move into the home. All service users when admitted are provided with a contract/statement of terms and conditions. Service users’ needs are assessed by the manager or senior members of the nursing staff prior to them being offered a place in the home. The needs’ Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 6 assessments and the care plans of publicly funded service users, which have been prepared by the placements authorities, are also available to assist in the decision making process about accepting new service users. Care plans are on whole being reviewed monthly and contain a number of risk assessments to ensure the safety of service users and for those caring for them. Service users have the opportunity to be seen by the GP and have their mental health monitored by a psychiatrist. Other healthcare professionals in the community are involved in the care of service users. There is evidence that service users are offered appropriate leisure and recreational activities within their abilities. The opportunity for outings is also offered. The home has weekly menus, which are attractively prepared with various colours to draw the attention of service users to these. The dining rooms are appropriately prepared for service users to have their meals. Meals are presented in an attractive manner to stimulate the appetite of service users. The home takes complaints seriously. The manager and staff maintain good relationships with relatives/visitors to the home and ensure that they would be approached if there were issues/concerns about the care of service users. There is evidence of ongoing maintenance and investment to ensure a quality and homely environment for service users. Bedrooms of service users are personalised and decorated to a good standard. There are adequate numbers of appropriately trained staff on duty in the home. Training and support are offered to new members of staff to ensure that they are competent to meet the needs of the service users. The manager is experienced and is familiar with issues with regards to running a care home. She keeps herself updated by attending relevant training. Staff and visitors have commented that the manager is approachable and that she would listen when people want to talk to her. The home has a quality management system to ensure that a quality service is provided. Most equipment in the home are maintained and there is evidence that staff are up to date with regards to training in health and safety matters. What has improved since the last inspection? A statutory requirement was identified during the previous inspection that the complaints information leaflet needs to be displayed and needs to include reference to contacting the Commission for Social Care Inspection (CSCI), as Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 7 necessary. During this inspection it was noted that a copy of the leaflet was on display in the entrance hall and that it contained reference to and contact details for the CSCI. New carpet has been laid in the corridors and there was evidence of ongoing maintenance. What they could do better: The service users’ guide must contain information about the range of fees charged by the home to ensure that prospective service users know exactly the amount of money that it will cost to move into the home. When carrying out the preadmission assessment of the needs of service users, staff in the home must include their assessment of the mental health and dementia care needs of service users. Once admitted into the home, the assessment of needs must be carried out comprehensively. Information, which is collected, must also include cultural and ethnic aspects of the care of service users. Risk assessments must be in place in cases where there are perceived limitations to the independence and freedom of service users. The risk assessments and the care plans must be agreed with service users or with their representatives whenever possible and a record must be made when this is not possible. Service users’ condition and vital signs must be closely monitored in cases when they are not well and care plan must be in place to ensure that prompt actions, as identified in the care plan, are taken when the condition of service users deteriorates. All medicines must be signed when administered and a code must be used when the medicines have not been administered. The home must also ensure that there is an up to date medicines reference book such as a BNF to provide up to date information about medicines. Instructions for the administration of topical medicines must be clear about the location for the application of the medicines. The registered person must ensure that appropriate lancing devices for professional use are used during the testing of blood sugars for diabetic service users. As far as possible, care plans must address the future and fears for the future of service users and their wishes and instructions with regards to end of life care and death. The assessment of the social and recreational needs of service users could have been more comprehensive particularly in cases where the information could be accessed relatively easily. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 8 The feature of the doors of some bedrooms where there are two door handles (one in the normal place and one at the top of the doors) must be reviewed as these could be seen as an infringement on the freedom and independence of service users. A risk assessment must be carried out and agreed with the service user/representative, if access to the bedroom of one service user to other service users is a problem. Other control measures must be used and the two handles on the doors must only be used as a last measure while carefully weighing the benefits against the limitations to the freedom and independence of service users. The menu should be reviewed to include the choice of a second meal with a similar nutritional value to the main meal on offer. Service users must also be offered the opportunity to have a drink of water in their room by the provision of a jug of water or otherwise, while assessing the risks that this may entail. The facilities with regard to the provision of baths, toilets and disability aids should be reviewed to ensure that these meet the needs of the service users who have mobility restrictions and for their safety. While recruiting staff, emphasis must be given to ensuring that all applicants have appropriate references before they are offered employment in the home. There must be an up to date Portable appliances Test Certificate available for inspection. Risk assessments must be carried out with regards to doors on the internal set of stairs from the first floor being fully accessible to service users and the gaps between the spindles of the banisters. Access by service users to fire doors to the exterior must also be included in a risk assessment. 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. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 9 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 Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have enough information to make a decision about moving into the home. The service users’ guide is comprehensive but it does not yet contain information about the range of fees charged by the home. Service users’ needs are appropriately assessed by the manager and her senior staff before offering a place to the service users. The home is able to meet the needs of the service users, even if the level of needs tends to be high. EVIDENCE: The service users’ guide has been recently updated and copies were available in each bedroom of service users. The manager stated, that prospective service users and their representatives receive the service users’ guide to provide them with the necessary information to make a decision about moving into the home. The service users’ guide was on the whole comprehensive, but Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 11 it does not yet contain information about the range of fees charged by the home. While some service users may not always be in a position to visit the home, the relatives/friends of service users are encouraged to visit the home, to meet staff and other service users and to ask questions about the service. Copies of signed contracts were available in the files of service users who are self-funding. Those who are publicly funded also receive a contract containing the terms and conditions with exception that the section on fees are crossed out. The contracts of the home with the placement authorities of publicly funded service users were also available on file. Care plans of recently admitted service users contained pre-admission assessments of the needs of service users. These were on the whole appropriately completed by one of the senior nurses in the home or by the manager. Copies of the needs’ assessments and care plans of the placing authorities were also available on file for those service users who are publicly funded. A visitor confirmed that their relative’s needs were assessed by the manager prior to the person moving into the home. It was however noted that the preadmission assessment which has been carried out for a recently admitted service user did not have a section on the mental health and dementia care needs of the service user. The inspectors found enough evidence during the course of both unannounced visits to the home, to conclude that the needs of service users are being met in the home. On both occasions the inspectors concentrated on finding out about how service users were being cared for and observed service users for signs of wellbeing. They noted that all service users were being cared for and attended to appropriately at night and during the day. Members of staff were familiar with the needs of service users and appropriate training was provided to them to ensure that they were competent to meet the needs of the service users. The staff mix was not representative of the service users’ ethnic and cultural group in the home, but this is a situation, which occurs in most care homes in London. There was however some members of staff from ethnic minorities to work with some of the service users who were from ethnic minorities. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were not as comprehensive as they could have been and these were not always agreed with the service users or their relatives. The healthcare needs of service users were on the whole, being met in the home. The home generally has sound procedures for the management of medicines but a few areas were identified which needed addressing to ensure the safety of service users at all times. Although the care of dying service users is normally managed well, care plans of service users did not address the fears of service users for the future and the arrangements, wishes or instructions of service users with regards to end of life care and death. EVIDENCE: The care records of five service users were inspected. It was noted that once a service users was admitted to the home, an assessment of needs was completed by a nurse based on the preadmission assessment, observation of Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 13 the service user and conversation with the service users and their representatives for preparation of a care plan. The manager stated that she was in the process of reviewing the format used for the care records as some of them were lacking. It was indeed noted that the format used for the assessment of needs was not conducive to completing a comprehensive assessment of needs. There were no prompts on the format used for the assessment of needs and there was little space available in the format to document the information about the needs of service users. For example comprehensive information about aspects of communication was not available such as the level of cognition of service users and whether service users liked to socialise and talk to other people or whether they were introverts. The section on eating and drinking for one service user said that ‘she takes a normal diet’ and gave no indication what was normal and what were her likes and dislikes. There was also no information on the dentition of the service user and the dining preferences (whether they prefer to eat on their own or with other service users). It was noted that there have been attempts to address the cultural and ethnic aspects of the care of service users in the care plans. For example there was evidence that special measures were undertaken to meet the dietary needs of service users from ethnic minorities. Care records also addressed the religion of service users and had some information about their backgrounds. The care records however did not always make clear whether service users were practising their religion or not. Care plans were also drawn up to address the cultural needs of service users, but at times details were lacking with regard to how the needs of the service users would be met. For example it says to give ‘appropriate food’ to a service user from the West-Indies and the care plan on personal hygiene did not include information about specific issues such as the management of her hair and skin. So while staff were on whole sensitive about this aspect of the care of service users, care plans could be made more comprehensive to include information about how the needs of service users would be met taking the cultural and ethnic backgrounds of the service users into consideration. Care plans contained a range of risk assessments, which were on the whole reviewed monthly. There were risk assessments for pressure ulcers, falls, manual handling and other individual risk assessments such as for the use of bed rails. These were signed by nurses but it was noted that these were not always agreed with service users or with their relatives. A number of service users were not offered a call bell because these could pose a risk to them, but a risk assessment was not always in place. A number of service users were also cared for in ‘tilt-in-space chairs’. While these chairs provide increased comfort and safety for very frail service users, these can also be viewed as a form of restraint for some service users who may be likely to try and get up to walk. Therefore risk assessments, if carried out and agreed Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 14 with the service users or their representatives and other healthcare professionals, would demonstrate that the home has carried out the necessary consultation with regard to these interventions and is using these, as a last measure to ensure the safety of the service users. Feedback from relatives of service users suggests that they were involved in the care of the service users and kept appraised of changes in the condition of service users. One visitor stated that she has not seen the care plans and has not always been involved when the care plans were drawn or reviewed. The care plans inspected, did not also contain evidence that service users/representatives were involved in drawing up and reviewing the care plans. Service users presented as clean, appropriately dressed and looked cared for. Male service users were appropriately shaved and female service users had their hair done. The clothes of service users were appropriately laundered, ironed and arranged carefully in the wardrobes and drawers of service users. There was evidence that service users were referred to various healthcare professionals according to their health needs, including a psychiatrist. Service users are also referred to hospitals as required and nursing and care staff take an active role in supporting service users meet their health care needs when the service users have to attend out of patient appointments or when they need admission. A relative commented in a letter to the home: “thank you to the staff who accompany my mother to hospital for the appointment”. There were special sections in the care records to record the outcomes and visits by the chiropodist but records about the input of the GP were kept in the progress notes and not immediately accessible. The GP’s kept their own medical records. It is therefore recommended that the outcomes and visits by healthcare professionals are recorded in a special section of the care plan to ease retrieval of the information. It was noted that a few service users were acutely ill. The care plan of one such service users was inspected. The service user was seen by the GP and placed on antibiotics, as she was unwell. It was noted that the vital signs of the service users were not monitored when she was unwell and when she was referred to the GP. Vital signs were monitored two days after the service user was seen by the GP. A care plan was also not in place to address the action that need to be taken to monitor the service user and in cases when the service user should remain unwell despite the current treatment. There were no service users with pressure ulcers in the home. There were a few service users with other wounds, which required dressing. A service user, who had leg ulcers and required dressings to be carried out regularly, had a care plan in place. The care plan however was not clear about the type of dressing to use and frequency when the dressings were to be changed. Regular Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 15 progress notes were also not available to provide information about the healing of the ulcers. Medicines management in the home was inspected. Medicines were on the whole recorded and signed for when received into the home. Copies of prescriptions were kept as evidence that the medicines have been prescribed and for confirmation of the instructions with regards to administration. There were however a few areas where there have been omissions to sign the medicines administration records (MAR) sheets. It was noted that the instructions on the labels and on the MAR sheets for topical medicines were not always clear with regards to the location for the application of these medicines. The home has a clinical room where the medicines are kept. There is a medicines’ fridge and records of the fridge’s temperature were maintained. It however needed defrosting. The home had a medicines reference book (BNF) dated 2003. The home must ensure that a new medicines reference book is available in the home as a medicine, which was prescribed for a service user, was not included in the reference book that the home kept as it was a new medicine on the market. Some service users needed medicines to be administered in a covert manner to ensure compliance. Risk assessments were in place agreed by the home and service users/representatives but these were not always agreed with the chemist or the GP as per guidance from the NMC. Disguising medicines in food may alter the form of the medicines and therefore should be agreed with a chemist. It was noted that the home was using lancing devices, which were for self-use, for testing the blood sugar of service users who were diabetic. The home was not yet following the guidance of a recent Medical Device Alert (MDA/2006/066 about using lancing devices for professional use. An insulin pen was also in use in the home. The Medicines and Healthcare Regulatory Agency has advised against the use of such devices by healthcare professionals as they increased the risk of needle stick injuries. The manager stated that a few members of staff, including her have attended training on end of life care in relation to dementia care. She stated that relatives and friends of service users would be able to stay with service users who are dying and that service users who are in double bedrooms would be moved to a single bedroom if one were available. The care records of service users, however contained little information about the wishes and instructions of service users or of their relatives with regards to end of life care and death. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 16 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides suitable recreational and leisure activities for service users. Service users are able to express choices where possible, but the practice of using two handles on the doors could be limiting the choices of those service users who occupy those rooms. Meals provided in the home were generally suited for service users but more could be done to offer a choice of meals daily for service users. EVIDENCE: There was a section in care plans, where information about the social and recreational needs of service users, was recorded. This section was completed, but in some cases not as comprehensively as it could have been, particularly when service users were able to give feedback about them. Care plans were in place to address the social and recreational needs of service users and activities that they enjoyed doing. The home employs an activities coordinator. There was evidence of her work all over the home and in the lounges. Programme of activities were available on each floor and there was evidence such as pictures of service users being involved in outings or in activities. She was not on duty during the inspection, Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 17 but it was noted that members of staff were interacting with service users and playing music for some of them. During the night visit on the 15th February, it was noted that the lounges had been decorated for a Valentine’s party to take place on the 16th. A special menu was also on display, which also included choices of culturally varied meals. A service user said on the 22nd February that she had enjoyed the Valentine’s party and that tables were moved from the centre of the room to provide space for dancing. A relative, who was visiting the home during the inspection, said that parties and entertainment are provided for service users to mark special occasions. The manager stated that outings were arranged when possible. The home had its own transport to take service users out. The van was not wheelchair accessible, but the manager added that black cabs could be used if required. She also said, that due to the high needs of the service users, the opportunities for outings were at times limited. One visitor confirmed that it is difficult to take service users out and to ensure their safety at the same time, as the level of cognition of some service users is quite poor to the extent that the service user do not recognise their own relative. The home has an open visiting policy. A number of visitors were noted in the home during the inspection. They all gave positive feedback about the way they are received in the home. A relative in a letter to the home commented that, “the courtesy and attention to visitors by the staff is remarkable”. A resident said that she entertains her visitors in her room and that in summer they enjoy sitting in the garden. The inspector was informed that the Roman Catholic priest visits the home weekly and that the Church of England minister also visits the home on a regular basis. The manager clarified that the religious needs of service users from ethic minorities are also met where possible. In these cases the relatives of the service users and members of staff from the same backgrounds or those who have insight in the culture and religion of the services user play a part in supporting the service users with their religious needs and by involving them in the ceremonies and festivities. The care plans of service users contain a sheet with information about the choices of service users. If completed appropriately, it would contain information about the likes and dislikes of service users and the times that they like to get up or to go to bed. While the choices of service users seemed to be respected, the inspector noted a feature in the home, which would need reviewing. It was noted that a number of bedrooms’ doors had two handles. A second door handle, near the top of the door, has been fitted to two of the bedrooms Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 18 on the ground floor and on two of the bedrooms on the first floor. To open the door involves operating both handles, which could cause a problem for some service users with poor dexterity or for those with arthritis or a stroke and this therefore does not seem to promote independence. This arrangement had apparently been suggested at a relative’s meeting when discussing the problem of service users who may enter other service users’ rooms. This feature (using two doors handles) could however prevent a service user, who may be disorientated to place and time, from leaving his/her room or from entering his/her room during the day if he/she was out of his/her bedroom in the communal areas. Because this seems to be an infringement on the independence and freedom of service users, the registered person must carefully carry out a risk assessment and consider other control measures in the first instance and only use the two handles on the doors as a last resort. There is also an issue about what happens when a new service user moves into such a room with a door, which has this feature and whether he/she is consulted about this feature. The home has weekly menus, which are reviewed in relatives meetings. The menus were well presented with colours and in some instances pictures of the meals were available. A main meal is served in the middle of the day. The inspector was informed that if service users do not like the meal, which is offered to them, they are offered the option of an omelette or sandwiches, which are then prepared. In the evening residents may choose soup and either sandwiches or on other days a light hot meal. A service user said that if she didn’t like the meal on the menu she could have a salad instead. While choices are being offered to service users to some extent, it was also noted that the second meal on offer during lunchtime might not be of the same nutritional content as the main meal. The manager and the chef confirmed that fresh fruits are offered to service users. A visitor also confirmed that his/her relative receive fruits on a regular basis. It was noted that service users did not always have a jug of water and a glass in their room, to help themselves to a drink of water, particularly at night or for care/nursing staff to offer a drink to service users while attending to them. A comment was made during the relatives’ meeting in April 2006 that residents should have access to drinks throughout the day. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 19 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, 18 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place to protect and safeguard the rights of residents. Protection of vulnerable adults training for staff and familiarity with the home’s procedure and the interagency guidelines contribute towards the safety of residents. However, recruitment practices need to promote the safety and welfare of residents. EVIDENCE: The home has a complaints procedure in place and it includes the stages and timescales for the process. A statutory requirement was identified during the previous inspection that a complaints information leaflet needs to be displayed and needs to include reference to contacting the Commission for Social Care Inspection (CSCI), as necessary. This is now on display in the entrance hall and includes contact details for the local office of the CSCI although no complaints procedure was noted in the SUG or brochure. The manager stated that the complaint procedure is left in a pocket on the door of each bedroom of service users. Records were available for inspection although no complaints from residents or from relatives acting on their behalf have been recorded by the home since the last inspection. A number of anonymous complaints have been made to the CSCI and these have been or are being dealt with. The home has a procedure in place, which includes a link to the home’s whistle blowing procedures and information regarding the CSCI. Since the last Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 20 inspection the home has made a referral under the protection of adults procedures and a copy of the London Borough of Harrow’s interagency guidelines in the event of abuse was available. The manager said that the home also had a copy of the guidelines for each authority that had a contract with the home. It was noted that induction training for new staff included an awareness of protection of vulnerable adults procedures. An external trainer has also led sessions regarding abuse awareness and a list of attendees is available. There was evidence that new staff are automatically booked to attend a protection of vulnerable adults session and one for supporting residents with dementia. The home has a video about protection of vulnerable adults, which is used when giving refresher training. When recruitment practices were examined gaps were identified in obtaining references (see Standard 29). The accidents records were inspected. It was noted that one service user had a laceration on the leg and that it was not very clear how the incident had occurred. The manager stated that she has made enquiries with regards to how the service user sustained the injury, but there were no records in place to show how this matter was investigated and what was the outcome. While looking through the records of the service user, it was also noted that the service user had sustained another skin tear on the back of the hand, which was not entered in the accident book. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 21 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, 21, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home, which is decorated and maintained to a good standard. The numbers of bathing and toilet facilities in the home are sufficient to meet the needs of the residents, although accessibility of service users to the use of these is at time restricted because of their location and lack of disability aids. The standard of cleanliness is good. EVIDENCE: A site inspection took place during both visits to the home, but mostly during the first visit. It was noted that the home was clean and was maintained to a good standard. It was furnished and decorated in a homely manner with personalised touches to the communal areas and the bedrooms. Bedroom doors had a picture of and the name of the service user(s) occupying the room to promote orientation. The home was warm and well lit. There was lighting on the side of the home at night but the level could be increased. The nurse Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 22 said that new carpet has been laid in the corridors. However at night the noise of creaking floorboards on the first floor, as they were stepped on, was loud. It was noted that some of the en-suite facilities e.g. the en-suite bath in a shared room and in 3 of the single rooms were against a wall and could not be used with a hoist. En-suite facilities are in addition to communal toilet and bathing facilities. There are 11 communal toilets and it was noted that 2 toilets have grab rails on only one side of the toilet and that 1 toilet was being used as a storeroom. A little water was noted on the floor of the toilet near Room 1. There are 6 communal bathing facilities i.e. 2 showers, 2 baths and 2 assisted baths in the home. Facilities are situated on each floor containing residents’ bedrooms and close to lounge/dining areas. Sluices are not located in toilets or in bathrooms. However it was noted that some sluice rooms were being used to store cleaning materials/chemicals and equipment. During both inspection visits it was noted that all parts of the home were clean and tidy and free from offensive odours. A relative that was visiting the home during the inspection said that the staff paid prompt attention to continence problems and that there was “never a bad smell in the home”. A relative commented in a letter to the home about “the sterling efforts by the domestic staff” and another relative wrote that “the home always looked well kept”. Copies of the quarterly housekeeping audit were available. The cleanliness of the home and the provision of soap, towels etc are checked during the audit. The manager said that all members of staff i.e. carers, catering staff and domestic staff undertake training in infection control procedures. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 23 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, 30 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were sufficient to meet the needs of residents. Although the home continues to support staff undertaking NVQ training the target of 50 of carers trained to NVQ standards has not been met. Thorough recruitment practices protect the safety and welfare of residents and the home needs to ensure that references are not overlooked. A comprehensive programme of training for staff encourages good working practices. EVIDENCE: The rota was available for inspection and demonstrated that the number of staff on duty was sufficient to meet the needs of the residents. During the day there are 10 members of staff on duty i.e. 3 qualified nurses and 7 carers or 2 qualified nurses and 8 carers. At night there is a qualified nurse and 4 carers on duty. In addition, an activities co-ordinator works for 4 days during the week and on a Saturday. A housekeeper, laundry person, maintenance person, domestic staff and catering staff work are also employed. On the first inspection visit that took place at night the 2 carers working on the ground floor had been employed for 1 week and for 6 weeks. The 2 carers working on the first floor had been employed for 3 weeks and for 12 weeks. The nurse in charge said that the allocation on the night of the inspection was unusual and that usually newer staff were paired with more experienced staff. The staff on duty said that they covered extra shifts when their colleagues were absent. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 24 It was observed that care staff responded promptly to the service users’ needs and enjoyed a good rapport with them. A relative that was visiting the home during the inspection said that the staff “always have a smile and a hello”. It was noted that there are a number of Eastern European staff working in the home and a resident that is Polish is able to speak to some of the members of staff in his first language. Staff have access to “English as a Second Language” training and the manager had confirmation from the tutor that at the end of the course “the general standard of English amongst the group is very good”. There were 26 carers listed on the duty rota. Of these 1 had completed their NVQ level 3 training and 6 had completed their NVQ level 2 training. Five of the six carers that have completed their level 2 training are currently undertaking NVQ level 3 training and 3 carers are currently undertaking NVQ level 2 training. A member of staff is also a student nurse. A further 3 staff are enrolling on their NVQ level 2 training. Eight staff files were examined. These belonged to members of staff that have started to work in the home since December 2006. It was noted that each file contained a pova first check and an enhanced CRB disclosure. Each file contained proof of identity (passport details with a photograph). Five files contained 2 references and 3 files contained only 1 reference. Three references were addressed “to whom it may concern”. Four of the members of staff are Lithuanian and are defined by the Home Office as “A8 workers”. There is a requirement to register with the Worker Registration Scheme unless exempt from doing so and 1 file contained a certificate naming Clavering nursing home as the employer. The induction pack for new members of staff includes a copy of the General Social Care Council’s Codes of Practice. Induction training records were examined. A comprehensive package of training is arranged for new members of staff, which includes the Skills for Care Common Induction Standards and the home’s own “Learn to Care” programme which includes a series of videos. (The series includes the topics of food hygiene, infection control, protection of vulnerable adults procedures and dementia care). Records are kept in respect of both elements of training. In addition new employees also receive a copy of “Each Day is Different”, a booklet produced by the Alzheimer’s Society for carers of residents that have dementia. Carers confirmed that they had received induction training and one said that she had been supernumerary during her first 3 days of working in the home. The home completed a training needs analysis for 2006 and a copy of the Staff Training for 2006 document was supplied. The training record included a wide range of courses undertaken and included training in safe working practices, dementia care, medication, nutrition, bereavement awareness, managing aggression and tissue viability. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 25 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 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Continuing to undertake further training enables the manager to develop her knowledge, skills and understanding. Information gained through the quality assurance systems in place in the home is used to shape the future development of the service. Systems are in place to protect the financial interests of the residents. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. Testing and servicing of equipment and systems in the home demonstrate that they continue to be safe to use and this must include the portable electrical appliances. Storing furniture in the home must not compromise the health and safety of residents, staff or visitors. EVIDENCE: Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 26 The manger has been managing the home for more than 3 years and prior to this she worked as a manager for the company for 6 years. She is a registered nurse and has successfully completed the RMA. Since the last inspection she has undertaken training in leadership management, mentorship and dementia care mapping. There were systems in place to monitor the quality of the service provided in the home. There was a record of the unannounced spot checks carried out by the manager during the night shift. A number of themed audits/reviews e.g. medicines, care plans, housekeeping and catering are carried out every two months. Actions plans were drawn up to address the findings of these audits/reviews. There was evidence that a relatives’ meeting was being arranged for the 22nd February and the manager said that she would be discussing the changes in the staff team and the anonymous complaints. Copies of the minutes of previous meetings were available. An annual quality assurance questionnaire is distributed to relatives and stakeholders and the information is used in the development of the service. The home has Investors in People status, which is subject to external scrutiny and review. The manager gave details of the home’s involvement with residents’ finances. Relatives deposit money with the finance section at Head Office, on behalf of the resident. The home makes purchases on behalf of the resident e.g. hairdressing services and keeps a record of these, with receipts. This information is then sent to the finance section. The finance section uses the money deposited to cover the expenditure. Statements sent to the relatives, copies available in the home, included details of credits, purchases and interest on balances held. Records kept in the home were up to date and complete. Eleven members of staff, including nurses and carers, have trained to be fire wardens. There was a record of weekly testing of the fire alarm system and regular fire drills being held. Fire notices were translated into Lithuanian as the home has a significant percentage of carers that were born in Lithuania. Fire exit signs were present in the home although there was no sign in a ground floor lounge, which had doors to either end to indicate the nearest fire exit. During the site inspection it was observed that 2 stairwells were used as a storage area for unused mattresses, carpet remnants, a wheelchair and tables. Valid certificates were available for testing/servicing the fire extinguishers, the fire precautionary systems in the home, the gas supply, the electrical installation, the water supply, the passenger lifts and the hoists. The testing of the portable electrical appliances was overdue. A letter from the Environmental Health Officer, dated the 7th December 2006, commented on the “excellent standards throughout” and the “great improvement in documentation”. There was a record of training carers in safe working practice topics. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 27 Keypads, limiting access to members staff, were present on some doors but not on the internal set of stairs from the first floor. It was noted that the staircases that had a landing with banisters at waist level, had gaps between the spindles. This could pose a danger to service users if they access these areas. Although fire doors to the exterior had a break glass device to open the door, there were no alarms on the doors. Should a service user manage to break the glass and get out of the home, there is no system in place to alert staff that someone has gone out of the fire door. The conservatory was used for smoking and although there were windows open it smelt of tobacco. The manager stated that a new purpose-built smoking room would be built for service users. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 28 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 2 3 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 5 Requirement The registered person must ensure that the service users’ guide contains information about the range of fees charged by the home. The preadmission assessment, which is carried out by the home, must include information about the mental health needs and dementia care needs of prospective service users. Care plans must include comprehensive assessments about the needs of service users and must take into consideration the cultural and ethnic aspects of the care of service users. Evidence must be kept to demonstrate that service users and/or their representatives are involved in care planning. A record must also be kept when this is not possible. Risk assessments must be carried out comprehensively in cases where actions being taken seem to limit the independence and freedom of service users, such as by the use of bed rails, DS0000057551.V330364.R01.S.doc Timescale for action 30/04/07 2 OP3 14(1) 30/04/07 3 OP7 14(1,2) 31/05/07 4 OP7 15(2) 31/05/07 5 OP7 13(4,6,7) 30/04/07 Clavering Nursing Home Version 5.2 Page 30 6 OP8 12(1) 7 OP8 17(1)(a) 8 OP9 13(2) 9 10 OP9 OP9 13(2) 13(2) 11 OP9 13(2,4) 12 OP9 13(2) ‘tilt-in-space’ chairs or when service users are not given their call bells. The risk assessments must be agreed with the service user/representative where possible and with other healthcare professionals such as the GP. The registered person must ensure that the condition of service users are closely monitored in cases when they are not well, by recording the vital signs and having care plans in place to deal with these needs of service users. The registered person must ensure that care plans dealing with wounds of service users specify the dressings to use and the frequency of dressing changes. Wound progress notes must be kept as required. All medicines must be signed when administered or a code must be used to describe the reasons for not administering the medicines. The home must have an up to date medicines reference book such as a BNF The instructions for the administration of topical medicines must be clear with regards to the location for administering the medicines. The registered person must ensure that the appropriate lancing devices for professional use, are in use for the testing of blood sugar levels. The use of insulin pens must also be reviewed in line with guidance from the MHRA. Risk assessments in use for the covert administration of medicines must be agreed with other healthcare professional, DS0000057551.V330364.R01.S.doc 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 Clavering Nursing Home Version 5.2 Page 31 13 OP11 15(1,2) 14 OP14 13(7,8) 15 OP15 16(2)(i) 16 OP18 13(4,6) 17 OP22 23(2)(a) 18 OP28 18(1) including the chemist. Care records must as far as possible contain information about the expectations and the fears of service users for the future, including the wishes and instructions of service users with regards to end of life care and about managing death. With regards to the use of two door handles on some of the bedrooms’ doors, the registered person must carefully carry out a risk assessment and consider other control measures in the first instance, and only use the two handles on the doors as a last resort because this could be an infringement on the independence and freedom of service users. The registered person must consider providing all service users with the facility to have a drink of water either by providing service users with a jug water and a glass or otherwise, using a risk assessment approach. Records must be available to demonstrate that any unexplained bruises/injuries to service users are investigated appropriately with a view to finding a cause and to ensure that action can be taken to prevent further recurrence. All accidents must be recorded in the accident book as required. That assessments are carried out about the accessibility of toilets to service users and that consideration be given to the use of handrails on either side of the toilets to improve accessibility. That the home achieves a target of 50 of carers achieving an NVQ level 2 qualification in care. DS0000057551.V330364.R01.S.doc 30/04/07 30/04/07 30/04/07 30/04/07 30/04/07 31/12/07 Clavering Nursing Home Version 5.2 Page 32 19 20 OP29 OP29 OP18 19(1) 19(1) 21 22 23 OP38 OP38 OP38 13(4) 13(4) 13(4) 24 OP38 13(4) That each staff file contains 2 references. That references are obtained by the home and are returned, addressed to the manager of the home. That references are not supplied by the applicant and addressed “to whom it may concern”. That the stairwells are not used for the storage of items of furniture. That the portable electrical appliances are tested. That risk assessments are carried out with regards to access of service users to the doors leading to the internal sets of stairs and that the provision of a keypad is considered as one of the control measures. That the banisters which were at waist level and had gaps between the spindles be also part of the risk assessments. That service users’ access to fire doors, which open to the exterior of the home be risk assessed and that an alarm device on these fire doors be considered as one of the control measures to manage the risk. 30/04/07 30/04/07 30/04/07 01/04/07 31/05/07 31/05/07 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 OP8 OP15 Good Practice Recommendations It is recommended that the outcomes and visits by healthcare professionals are recorded in a special section of the care plan to ease retrieval of the information. The menu should be reviewed with a view to provide two DS0000057551.V330364.R01.S.doc Version 5.2 Page 33 Clavering Nursing Home 3 4 5 6 7 8 9 10 11 12 13 OP16 OP19 OP19 OP21 OP21 OP21 OP27 OP29 OP29 OP38 OP38 choices of equivalent nutritional value for each meal. That information about the complaints procedure is included in the Service User Guide and in the brochure. That the level of lighting provided on the side of the building be reviewed. That the cause of creaking floorboards on the first floor is investigated and resolved. That the provision of toilet and bathing facilities, both ensuite and communal, is the subject of an OT assessment. That the cause of water on the floor of the toilet near Room 1 is investigated and action taken as appropriate. That items being stored in sluice rooms or toilets are removed. That carers on duty at night, with less than 6 months service, are paired with a more experienced carer. That staff files contain a record when the home has verified that the “A8” member of staff is exempt from the Worker Registration Scheme. That there is a system for recording the receipt of 2 satisfactory references prior to the new member of staff starting to work in the home. That a fire exit notice is placed in the ground floor lounge. That the room where smoking is permitted has an extractor fan that removes the smell of stale tobacco. Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 34 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 Clavering Nursing Home DS0000057551.V330364.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!