Inspection on 09/07/07 for Clavering Nursing Home

This inspection was carried out on 9th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clavering Nursing Home 15/02/07

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 Julie Schofield Key Unannounced Inspection 09:35 9th and 19th July 2007 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.V340815.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.V340815.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.V340815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia over 65 years of age - Code MD(E) 2. Dementia over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 49 15th February 2007 Date of last inspection 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 residents through the building. The building consists of three floors. There is a passenger lift, which serves the first and the ground floors where residents 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 four bedrooms, which are en-suite, but there are bathroom/shower toilet facilities on each of the floors where residents are Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 5 accommodated. There are two lounges and a conservatory with a seating area on the ground floor and a lounge on the first floor. At the time of the inspection there were 46 residents accommodated in the home. Details of the fees charged may be obtained, on request, from the manager of the home. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of 2 visits to the home. The first visit was carried out by Julie Schofield and Ram Sooriah on the 9th July. During this visit discussions took place with the manager, members of staff, residents and relatives. Records were examined and policies and procedures checked. Case tracking was carried out. A tour of the premises took place and the serving of a meal was observed. The second visit took place on the 19th July and Julie Schofield spoke with the person responsible for health and safety in the home. Records were examined. A survey of relatives, carers and advocates was undertaken and 11 completed forms were returned. They provided a wealth of positive comments regarding the service provided. A relative commented that Clavering Nursing Home “should be held up as an example to the rest” and that “you would have to go a long way to find an equal”. Another relative commented “this home is the way forward for the care of the elderly in the future”. What the service does well: Feedback seen and received from relatives and representatives of residents during the inspection was positive and complimentary about the standard of care provided by the home. One relative said ‘Thank you for the care and love shown to my mother’. Other relatives commented that the staff are “always caring”. A relative commented that the manager “is doing an excellent job” and that “nothing is too much trouble” for the manger and her staff team. Another relative commented that the staff are “very friendly and they try to create a home from home atmosphere”. Residents and their relatives are offered information about the service and are encouraged to visit the home and to talk to staff and other residents to get information about the way residents are cared for in he home. All residents are visited by the manager or her senior staff to have an assessment of their needs prior to the home offering a place to them. The home has the necessary facilities and staff have the necessary experience and competency to meet the needs of those residents who are admitted to the home. Residents in the home are seen by healthcare professionals according to their needs. Meals are served to residents according to their choices in appropriately prepared dining areas and there is an activities programme in place during the Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 7 day. Visitors are made welcome when they come to the home and residents said that the home was clean, that they liked their rooms and that there was a nice garden to enjoy. Staff have access to a comprehensive training programme and receive good support from the manager. The quality assurance systems in place give opportunities for feedback from all interested parties. The home ensures that the servicing and checking of all equipment and systems in the home is kept up to date. What has improved since the last inspection? The service users’ guide has been updated to include information about the fees that the home charges. Care plans include an assessment of the cultural and ethnic needs of residents. Residents and/or their representatives are involved in care planning and a record is kept when this is not possible. The condition of residents is closely monitored in cases when they are not well, by recording the vital signs and having care plans in place. Care plans dealing with wounds specify the dressings to use and the frequency of dressing changes. Wound progress notes are kept, as required. All medicines are signed when administered or a code is used to describe the reasons for not administering the medicines. The home now has an up to date medicines reference book. The instructions for the administration of topical medicines includes clear information regarding the location for administering the medicines. Care records contain information regarding end of life care and managing death. Risk assessments are in place for doors having 2 handles. Facilities are available for all residents to have easy access to a drink of water. Following a review of bathing and toilet facilities in the home an ordinary bath is being replaced by a parker bath. The home meets the target of a minimum of 50 of trained carers i.e. holding an NVQ level 2 qualification in care. Each staff file contains 2 references. References are obtained by the home and are returned, addressed to the manager of the home. References supplied by the applicant and addressed “to whom it may concern” are not accepted. Stairwells are no longer used for the storage of items of furniture. The testing of the portable electrical appliances was up to date. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 8 What they could do better: During the inspection 14 statutory requirements were identified. Preadmission assessments of the needs of prospective residents must include information about the mental health or dementia care needs of the residents. Mental health needs of residents must be comprehensively identified and addressed, consideration being given, not only to the behavioural assessment of residents but also to the assessment of the cognitive needs of residents. The action to take to meet the health, social and personal care needs of residents must be clearly detailed to enable a nurse/carer reading the records provide care to meet the needs of the residents. Issues about manual handling must be addressed to ensure the safety of residents. The type of hoist and the sling to use must be identified in care plans and accepted manual handling practices must be used in the home. Residents must have a nutritional risk assessment. The weights of residents must be appropriately recorded to enable a judgement to be made about the weights of residents. Plans to manage the prevention of pressure ulcers for residents identified as high or very high risk must include details of the equipment to use for prevention and of the arrangement for seating. Appropriate lancing devices for the testing of blood sugar levels must be used and the use of insulin pens be reviewed, in line with guidance from the MHRA. There must be risk assessments in place for all situations where the independence of the resident is limited. All toilets must be in a good state of repair. References must be sent to the personal department of a hospital and not to the line manager’s home address. Risk assessments must be in place for residents’ use of the doors leading to the internal sets of stairs (and for the provision of a keypad). The risk assessment must include the area where the banisters are at waist level and have gaps between the spindles. Residents’ access to fire doors, which open to the exterior of the home must be risk assessed and an alarm device on these fire doors be considered. Good food hygiene practices must be observed when defrosting meat in the fridge. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 9 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.V340815.R01.S.doc Version 5.2 Page 10 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.V340815.R01.S.doc Version 5.2 Page 11 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, 3, 4, 6 People who use this service experience good outcomes in this area. Prospective residents and their representatives are provided with appropriate information to make a choice about moving into the home. The resident is assured of a service tailored to their individual needs by an assessment process being carried out prior to admission. The home needs to develop the range of information recorded on the assessment form. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the service users’ guide (SUG) were on display at the reception area and available for visitors to the home. Copies had also been placed in the bedrooms of residents. The SUG has recently been reviewed and now contains information about the range of fees charged by the home. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 12 A statutory requirement was identified during the previous inspection in February 2007 that the preadmission assessment format be reviewed and developed so that it contains more information about the mental health or dementia care needs of residents. Although the manager has started to review the format and make changes the task is not complete so the requirement remains outstanding. This was confirmed by the pre-admission assessment of needs for a respite care resident admitted on the day of the first inspection visit. However the manager reported that either she, or a senior member of the staff team, visits each prospective resident to assess their needs prior to admission to the home, even if the records were not always comprehensively maintained. Many staff in the home, particularly senior members of staff, have worked in the home for a number of years and are familiar with the needs of the residents. Care records, observation of care practices and feedback from relatives/visitors confirm that members of staff are able to care for residents who are admitted to the home. There was also evidence that the cultural needs of residents were being recorded in the care records to ensure that any one reading the records would be familiar with the needs of the residents. The home does not provide an intermediate care service. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 13 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, 10, 11 People who use this service experience adequate outcomes in this area. Although residents or their representatives are consulted about care plans and risk assessments some care plans lacked sufficient detail to assure residents that their needs would be met. Although the healthcare needs of residents are attended to poor manual handling practices or the lack of nutritional monitoring could compromise the resident’s well being. The management of medicines in the home promotes and protects the safety and well being of residents although the use of specific lancing devices must be reviewed. Residents must be assured that their rights are protected at all times and risk assessments are needed to demonstrate this. The dignity of residents is respected by the recording of their needs in relation of end of life care and dying. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 14 The care records of four residents were inspected. There has been some improvement in the content of the assessment of residents’ needs. Residents preferred names were clearly identified on the care plan. There has also been progress with the involvement of residents/relatives in drawing up care plans and risk assessments. The manager said that this involvement would continue when care plans are reviewed on a six monthly basis. She added that she always kept residents’ relatives, that do not visit often because of the distance, informed of the well being of the resident either by letter or email. A number of letters and emails were indeed seen, thanking the manager for this endeavour. This is good practice. A relative commented that the “all reviews have been excellent” and that the manager has always promoted a positive response to any issues or concerns raised. There was an additional form in the care records, which contained information about the choices of residents. These included the likes and dislikes with regards to food and the times for getting up in the morning and for going to bed. The assessment of the mental health needs of residents concentrated on behaviour. There was also a general risk assessment, which addressed wandering, self-harm, suicide, falls and inappropriate sexual behaviour. The assessment did not give an indication of the cognitive aspects of the needs of residents. It was noted that some care plans lacked detail in respect of the action to take to meet the needs of residents. For example the care plan for one resident with epilepsy said to give ‘prescribed medicines properly’ and ‘if diazepam is prescribed administer as per protocol’. This was considered vague as the person reading the records would still not know what medicines were prescribed, whether diazepam was prescribed and the actual protocol to follow should the resident have a fit. It was noted that a protocol to manage the epileptic fits of individual residents was not always in place. The care plan for toileting was also not clear with regards to the frequency for residents to be toileted for continence promotion and the type of pads that the residents use for incontinence management and the frequency to change the pads. All residents had manual handling risk assessments and care plans on manual handling. It was noted that these at times did not clarify the hoist and the sling to use when carrying out manual handling manoeuvres. In one case one resident was getting bruises below the knee as a result of a standing hoist being used, but there were no risk assessment to address this issue and no control measures were in place to manage the risks. The inspectors also observed an inappropriate lifting technique during the course of the inspection (a through-arm lift). Another member of staff was walking backward leading a resident by both hands. This could pose a risk to the member of staff and to the resident, as the member of staff could not fully appreciate what was in her way. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 15 It was noted that not all residents had a nutritional risk assessment in place. This must be in place for all residents. Weights of residents were monitored monthly but these were not always entered on the weight chart in the care records, as there was a special book to record weights. It is strongly recommended that the weight of residents be entered on their individual weight chart with a record of the date when the weight was taken. This would help comparison of the weights of residents during previous months and to help detect any significant changes to ensure that prompt action can be taken when residents are loosing weight. In one case a resident had lost approximately 10 of her body weight over a period of three months. There were no care plan in place in manage the recent weight loss. The home did not have any residents with pressure ulcers at the time of the inspection. Residents were monitored for the risk of developing pressure ulcers. Although appropriate action appeared to be taken and equipment provided to prevent the development of pressure ulcers, a care plan was not always in place to detail the action needed when residents were identified at high or very high risk of developing pressure ulcers. The equipment in use and the seating arrangement of the residents were also not identified in care records. Residents who had short terms problems had short term care plans addressing their needs. Those who were unwell and needed their condition to be monitored were also being monitored. This is good practice. It was noted during the last inspection that a number of doors had two door handles, one near the top of the door and the other in the usual place. The door could only be opened by turning both door handles at the same time. While these would prevent some residents from entering the room of a resident who did not wish to be disturbed, other residents could be prevented from entering their own room or getting out. The manager stated that the issue with having two door handles has been resolved by some of them being removed and with the rest of them having risk assessments in place for their use, which have been agreed with the residents/relatives. It was noted that residents were not always provided with a call bell even though at times their care plans noted a need for them to be given a call bell. At least two residents were case tracked and it was noted that risk assessments were not in place to justify the reasons for a call bell to be withheld. The overall management of medication in the home was good. Medicines were signed when received into the home and when administered. The appropriate codes were in place to give a reason when medicines have not been administered. Most liquid medicines had a date of opening and the instructions of topical medications have been clarified with regards to the location for administration. The temperature of the fridge was monitored but the Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 16 temperature of the clinical room was noted to be around 24 degrees centigrade. Most medicines should be kept under 25 degrees centigrade and therefore consideration should be given to ensure that medicines are kept under 25 degrees centigrade by using measures such as installing air conditioning. The home had a recently issued medicines reference book (BNF). The home was using a lancing device, which was meant for self-testing and not for professional use. The manager stated that she has received advice that these were safe to use but a recent Medical Device Alert has mentioned that self-testing devices must not be used because of the risk of cross infection and that single use devices or devices for professional use must be in place. Similarly pen injection devices were still in use in the home despite recent guidance of the increased risk of needle stick injury with the use of such devices. The manager informed the inspector during the same week that the inspection took place that she has addressed the above issues to ensure the safety of residents at all times. The home has made progress with regards to ensuring that information is available about the wishes and instructions of residents/relatives with regards to managing end of life care and death. There was a section in the care records, which now contained this information. Having this information on file would ensure that end of life care is tailored to the individual needs of the residents. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 17 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, 15 People who use this service experience good outcomes in this area. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships. Residents are offered a varied and wholesome diet to maintain their well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care records contained information about the residents’ social and recreational needs. Care plans were also in place addressing the identified needs of residents. The home employs a full time activities coordinator who works flexible hours to suit the needs of the home. A programme of activities was available, which was flexible according to what residents wanted to do on the day. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 18 An aromatherapy session was arranged for the morning of the first visit to the home. The aroma therapist did not visit the home but there were records to suggest that this is a regular practice in the home. Aromatherapy is restricted to hand massage. The fees for the aroma therapist are paid by the home so that all residents are able to benefit from this service. During the inspection a music session was being held in the main dining area and some residents were listening and responding. One resident that did not appear to be listening when observing their face was tapping their fingers to the rhythm of the music. . A party was arranged over the weekend to celebrate the 13th anniversary of the opening of the home. There were decorations around the home and bunting on the outside of the front of the building. Food and drinks were made available to residents, their relatives and visitors to the home and entertainment was also provided. Feedback from the manager and staff suggested that everybody enjoyed the occasion. A resident said that the day had also been her birthday and that she had enjoyed the event. The home has a van for transporting residents but it is not wheelchair accessible. Residents who are wheelchair users have to use dial-a-ride or taxi cars with ramps. Although trips out for wheelchair users were therefore restricted there was evidence that some residents were being taken out. The manager said that some residents are taken to the café in the supermarket, which is situated close to the home. Other residents have gone to places of interest including Pinner Memorial Park, Hendon museum and the Ruislip Lido. On the day of the inspection, the weather was pleasant and a number of residents were observed sitting outside of the home. Relatives were present during the inspection and they confirmed that they were made welcome when they called by the manager and the members of staff on duty. Visits could take place either in the resident’s room or in the lounge areas. It was noted that residents could bring small personal items with them on admission to the home to make their room more “homely”. It was noted that representatives from the Church of England and the Roman Catholic Church visit the home weekly to offer spiritual support to the residents. On the day of the inspection the representative from the Roman Catholic Church visited the home to offer communion to those residents who were practising Roman Catholic. Staff supported residents to ensure that they were all assembled in one place for the service. Lunch consisted of Cajun chicken or haddock as the main meal with carrots, peas and mash potatoes. There was sponge and custard for desert. It was also observed that those residents who did not want a main meal were offered sandwiches and that those who did not want the main desert were offered fruits or ice cream. The home has acted on the recommendation to provide more choice at mealtimes and a relative commented that there is an “excellent Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 19 chef”. Two residents confirmed that they enjoyed the meals served. However a relative commented that the cultural needs of their resident were not met. Staff were observed providing assistance to residents with their meals. In general this was appropriate but on two occasions, residents were observed being fed by members of staff that were standing. The home has a number of residents who require soft food and some who require pureed food. The provision of soft and pureed meals was discussed with the manager and some of her staff as residents who were on soft food diets were being offered pureed meals. The manager agreed that a soft food diet is different from a pureed meal or mashed up meal (when all the components of the meals are liquidised to promote swallowing) and that the presentation of the meals is important to make the food more appetising to residents. With regards to presentation it was observed that pureed meals were served in soup bowls. The kitchen was clean and tidy. It was also noted that both the radio and the TV were on in the main dining/lounge area during mealtimes. As these could be seen as signs of distraction, their use should be reviewed during mealtimes. The manager stated that residents are now provided with a jug of water according to their choices. There are also water dispensers in two of the lounges but not in the main lounge of the home. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 20 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 People who use this service experience good outcomes in this area. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place and it includes the stages and timescales for the process. A copy is on display in the entrance hall and it includes contact details for the local office of the CSCI. The Service User Guide was inspected and it contains information regarding the complaints procedure and contact details for the CSCI, the local Primary Care Trust and the local Social Services department. 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 in February 2007. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 21 The home has a protection of vulnerable adults procedure in place, which includes a link to the home’s whistle blowing procedures and information regarding the CSCI. Since the last inspection the home has made a referral under the protection of adults procedures and this has been investigated. 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 kept. External training sessions are recorded on the monthly training record sheets. The home has a video about protection of vulnerable adults, which is used when giving refresher training. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 22 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, 26 People who use this service experience good outcomes in this area. Residents enjoy comfortable surroundings that are 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 the use of these is at times restricted because of their location and lack of disability aids. Residents are assured of hygienic surroundings as good standards of cleanliness prevail. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A site inspection took place during the first visit to the home. 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 Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 23 areas and the bedrooms. However a relative commented that furniture in one of the lounge areas is in need of replacement. Bedroom doors had a picture of and the name of the client(s) occupying the room to promote orientation. The new garden room/meeting room was seen during the inspection and new carpet was being laid in this room and in the meeting room on the second floor. It was noted that some of the Perspex panels below the handrails were damaged. There is level access to the home at the front of the building and into the garden area and the provision of a passenger lift linking ground and first floors ensures accessibility within the building. 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. One of the ensuite baths had been sealed over to prevent use, after a risk assessment had been undertaken. 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. There are 6 communal bathing facilities i.e. 2 showers, 2 baths and 2 assisted baths in the home. The home is awaiting the replacement of a bath on the ground floor by a parker bath. There was water leaking from the pipe behind the toilet in the ground floor shower room. Facilities are situated on each floor containing residents’ bedrooms and close to lounge/dining areas. Bathroom and toilet doors had a picture of the bath or toilet to promote orientation. 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 and a discussion took place regarding an alternative storage solution for the shampooing machine that is used on a daily basis. A physiotherapist report is being commissioned to review the suitability of all bathing and toilet facilities in the home. During the inspection visit it was noted that all parts of the home were clean and tidy and free from offensive odours. Laundry facilities are sited away from any area where food is stored, prepared or consumed. The manager said that all members of staff i.e. carers, catering staff and domestic staff undertake training in infection control procedures. The home uses a distance learning training course run by a college for infection control procedures. It also provides Hand washing Programme training for all staff. Relatives confirmed that the home is “always clean “ and that it is kept “spotlessly clean. A relative said that clothing is changed regularly and laundered properly. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 24 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 People who use this service experience good outcomes in this area. Residents were assured of sufficient staff on duty to meet their needs. Residents benefit from a service provided by carers that have demonstrated their skills and understanding through NVQ training. Thorough recruitment practices protect the safety and welfare of residents and the home needs to ensure that the source of references is valid. A comprehensive programme of training for staff encourages good working practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A discussion took place with the manager regarding staffing levels in the home and the rota was available for inspection. During the day either 2 or 3 qualified nurses are on duty and up to eight carers. The manager said that sometimes there are additional staff on duty on a Sunday as it is a particularly busy day, with extra visitors to the home. 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, administrator, domestic staff and catering staff work are also employed. Observations by the 2 Inspectors confirmed that the staff Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 25 levels were sufficient to meet the current needs of the existing residents although a relative commented that they would like to see more staff on duty. It was observed that care staff responded promptly to the residents’ needs and enjoyed a good rapport with them. A relative that was visiting the home during the inspection said that she was pleased about the way the manager and members of staff had come to meet her mother and to help her mother to settle in during her mother’s first day in the home. A relative identified the fact that staff have access to “English as a Second Language” training (if needed) as a positive feature of the home and it was noted during the inspection that staff were able to communicate well with residents, relatives and with each other. A discussion took place with the manager regarding the provision of NVQ training for staff. The rota was examined and of the 21 names entered for carers, 11 of the staff have completed either their NVQ level 2 or 3 training. The manager said that at present a further 5 members of staff are studying and hope to complete their training by the end of December 2007. The home has met the target of 50 of carers having achieved an NVQ level 2 in care qualification. Five staff files were examined. It was noted that files contained enhanced CRB disclosures, pova first checks (as required), proof of identity (passport details), right to work documents (as required) and 2 references. However the references on 1 of the files related to periods of employment in hospital settings and had been sent to the line manager’s home address and not to the personnel department at the hospital. The manager confirmed that induction training took place and was recorded. 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. Monthly training plans were available for inspection and they demonstrated that a wide range of courses is offered. These included training in safe working practices, dementia care, medication, nutrition, bereavement awareness, managing aggression and tissue viability. There was also a 3-day training course for team leaders. Training in equalities and diversities was programmed. Training record sheets include formal training and handover discussions where there is a training element. Separate training profiles were seen and copies of attendance certificates for training courses were seen when staff files were examined. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 26 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, 38 People who use this service experience good outcomes in this area. Continuing to undertake further training enables the manager to develop her knowledge, skills and understanding and to provide a service that is responsive to the needs of residents. Information gained through the quality assurance systems in place in the home is used to shape the future development of the service and ensure that the changing needs of residents are met. 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 although the storage of food in the fridge needs to be checked. Testing and servicing of equipment and systems in the home demonstrate that they continue to be safe to use. This judgement has been made using available evidence including a visit to this service. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manger has been managing the home for more than 4 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 update training in safe working practice topics and in protection of vulnerable adults procedures. She has received training in relation to the Mental Capacity Act and in relation to end of life care. She has arranged to attend a first line management 3-day training course. There were systems in place to monitor the quality of the service provided in the home. There was a record in a staff file of the outcome of a spot check undertaken by the manager during a night shift and the manager said that it is her practice to call to the home unannounced at various times during the day or the night. A number of themed audits/reviews e.g. medicines, care plans, housekeeping and catering are carried out every two months and actions plans are drawn up to address the findings of these audits/reviews. The minutes of the relatives’ meeting that took place on the 22nd February 2007 were available. An annual quality assurance questionnaire is distributed to relatives and stakeholders and to staff in August and the information is used in the development of the service. The information is analysed and used to form the basis of an action plan. The manager said that a copy is put on the notice board for relatives. 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. Four statements were examined. Records kept in the home were up to date and complete. A number of 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. 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 portable electrical appliances, the electrical installation, the passenger lifts and the hoists. A letter from the Environmental Health Officer, dated the 7th December 2006, commented on the “excellent standards throughout” and the “great improvement in Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 28 documentation”. There was a record of training carers in safe working practice topics. 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. The manager said that keypads for the remaining doors were on order. 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 manager said that the equipment is on order to provide an alarm for these doors. It was noted that frozen chicken was defrosting on one of the top shelves in a fridge and there were items of food on lower shelves e.g. vegetables. Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 2 X X X 3 STAFFING Standard No Score 27 3 28 3 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.V340815.R01.S.doc Version 5.2 Page 30 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) Requirement The registered person must ensure that the preadmission assessment includes information about the mental health needs and dementia care needs of prospective service users so that identified needs can be met. (Previous timescale of the 30th April 2007 not met) The registered person must ensure that consideration is given not only to the behavioural assessment of residents but also to the assessment of the cognitive needs of residents so that mental health needs are identified and addressed. The registered person must ensure that health, social and personal care needs of residents must be clearly detailed to enable a nurse or carer to use this information to inform their care practice. The registered person must ensure a) that manual handling risk assessment and care plans DS0000057551.V340815.R01.S.doc Timescale for action 15/09/07 2 OP7 14(1), (2) 30/09/07 3 OP7 15(1), (2) 30/09/07 4 OP8 13(5) 31/08/09 Clavering Nursing Home Version 5.2 Page 31 5 OP8 12(1) 6 OP8 15(1) 7 OP9 13(2)(4) 8 OP10 13(4,6,7) contain details of the type of hoist and the size of sling to be used b) that staff adhere to all manual handling guidance and use accredited manual handling techniques c) that a risk assessment is carried out in circumstances where the equipment might be causing injury to a resident to promote the safety and welfare of the resident. The registered person must ensure that in order that the nutritional needs of residents are monitored nutritional screening is carried out and that care plans are in place for residents that lose or gain a significant amount of weight. The registered person must ensure that plans to manage the prevention of pressure ulcers for residents identified as high or very high risk include details of the equipment to use for prevention and of the arrangement for seating so that they demonstrate that the health and well being of the resident is promoted. The registered person must ensure that the health care needs of residents are met by the use of appropriate lancing devices for the testing of blood sugar levels and that the use of insulin pens is reviewed, in line with guidance from the MHRA. (Previous timescale of the 30th April 2007 not met). The registered person must promote the independence of the resident at all times and ensure that risk assessments, agreed by all parties concerned, are in DS0000057551.V340815.R01.S.doc 30/09/09 31/08/09 31/08/07 30/09/07 Clavering Nursing Home Version 5.2 Page 32 9 OP21 23(2) 10 OP22 23(2) 11 OP29 19(1)(c) 12 OP38 13(4) 13 OP38 13(4) 14 OP38 16(2) place for any action taken that may limit the independence of the resident. (Previous timescale of the 30th April 2007 not met). The registered person must ensure that all toilets are in a good state of repair so that residents have the use of safe facilities. The registered person must ensure that all bathing and toilet facilities are accessible to residents. (Previous timescale of the 30th April 2007 not met). The registered person must ensure that the validity of references is demonstrated to assure residents that unsuitable persons are not employed. The registered person must ensure that risk assessments are in place for residents’ use of the doors leading to the internal sets of stairs, and for the provision of a keypad, to avoid the risk of accidents. (The risk assessment must include the area where the banisters are at waist level and have gaps between the spindles). (Previous timescale of the 31st May 2007 not met). The registered person must ensure that residents’ 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 to the safety of residents. (Previous timescale of the 31st May 2007 not met). The registered person must ensure that good food hygiene practices are used when DS0000057551.V340815.R01.S.doc 31/08/07 01/12/07 31/08/07 01/10/07 01/10/07 31/08/07 Clavering Nursing Home Version 5.2 Page 33 defrosting meat in the fridge, so that the health of residents is not put at risk. 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 4 Refer to Standard OP8 OP9 OP15 OP15 Good Practice Recommendations That the weight of residents is entered on their individual weight chart with a record of the date when the weight was taken. That consideration is given to ensure that medicines are kept below 25 degrees centigrade by using measures such as installing air conditioning. That the menu is reviewed so that it includes dishes to meet the cultural needs of all of its residents. That clarification is made with regards to the provision of soft and pureed meals to ensure that the meals are suitable to the identified needs of the residents. That the serving of pureed meals in soup bowls be reviewed to enhance presentation of these meals. Members of staff feeding residents should always sit down when feeding residents to promote the dignity of the residents whenever possible. That the manager reviews the need to have the radio and TV on during mealtimes as these could be sources of distraction for residents and prevent them from concentrating on their meals. That a review of the furniture in lounge areas is undertaken and replacements made as necessary. That any sections of Perspex underneath handrails in corridors that are cracked or missing are replaced. That a storage facility is created in nearby first floor bathroom for the shampooing machine. That when a reference request is sent to a personnel department in a hospital the line manager’s name is noted on the request. 5 OP15 6 7 8 9 OP19 OP19 OP21 OP29 Clavering Nursing Home DS0000057551.V340815.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London 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.V340815.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. 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