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Inspection on 16/06/05 for Collingwood Court Nursing Home

Also see our care home review for Collingwood Court Nursing Home for more information

This inspection was carried out on 16th June 2005.

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.

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

What the care home does well

Before service users are admitted senior experienced staff visit them to assess their needs. The home is comfortable and well presented and maintained to a high standard. All bedrooms are single occupancy. There is a good variety of pleasant communal facilities. The home offers people the chance to participate in fulfilling activities both in the home and to events outside the home. Staff are kind and considerate and have a good understanding of service user`s needs and aspirations, a small number have problems with communicating effectively as English is not their first language. Staff are supportive and recognise the importance of supporting service user`s relatives in time of need. Complaints are investigated and responded to promptly by the home.

What has improved since the last inspection?

Staff have become more competent and professional since the staff and training and development programme has become operational. Twenty care workers have also commenced NVQ Level 2 in care. Service users are treated with dignity and respect. Staff are competent and know what to do if there are doubts or suspicions of neglect or abuse. The staff team interact well with people with dementia and are competent at managing people who may exhibit challenging behaviour. Service users benefit from staff that are supported and supervised regularly. Management of the home gives stability and reassurance to service users and staff. Morale among the staff team is much better. The home has responded positively to requirements set at inspections.

What the care home could do better:

The majority of improvements needed relate to palliative care. The home must ensure that better preparations are made for people before they move into the home. All the essential equipment must be in place before residents are admitted to avoid any unnecessary delays or disruption to the delivery of care. A palliative care service that is more considerate and sensitive to service user`s needs and feelings must be developed. Staffing levels need to be reviewed and reflect the needs and number of service users. It is important that any changes arising in individual`s conditions are identified and recorded, and responded to promptly. Relatives must be kept informed of service user`s progress. People receiving palliative care often rely on relatives to pass on vital and essential information to staff therefore at all times staff must listen closely to what relatives say and communicate this to the staff team. Staff training must be further developed so that the staff team are competent and understand the needs of people receiving palliative care.

CARE HOMES FOR OLDER PEOPLE Collingwood Court Nursing Home Collingwood Court Rear Of 1-95 Nelsons Row Clapham London SW4 7JR Lead Inspector Mary Magee and Lynne Field Announced 16 June 2005 th 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 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. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Collingwood Court Nursing Home Address Collingwood Court, Rear Of 1-95 Nelsons Row, Clapham, London SW4 7JR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7627 1400 020 7720 1998 ANS Homes Limited CRH Care Home 80 Category(ies) of N Care Home with nursing registration, with number of places Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 28 Elderly women aged 60 years and above. 2 52 persons aged 55 years and above suffering from organic mental health disorders. 3 The 3 current physically disabled persons aged below 65 years. Date of last inspection 6th January 2005 Brief Description of the Service: Collingwood Court is one of several nursing homes owned and managed by a care provider called ANS. The home provides nursing care for 80 residents in a purpose built 2-storey unit. It is set in its own grounds on a quiet residential street. The location is convenient to public transport and the local shopping area of Clapham. It has a small but pleasant garden to the rear, limited parking facilities are available at the front. The home has three separate units – two of which are located on the ground floor. The third unit is located on the first floor. Two of the units (one on ground and first floor units) provide nursing care for people with mental health problems/dementia. The other unit on the ground floor is for frail elderly people and people with a physical disability that require nursing. Each unit has its own lounge and dining rooms. The main kitchen and laundry facilities are located in the basement. A hairdressing room and an activities resource room are available on the first floor. A passenger lift is provided for access to the first floor and the basement. The home is wheelchair accessible. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this announced inspection during the day. It lasted over 8 hours. During the day twelve-service users, five relatives and the GP were spoken with. Comments were received later from eight relatives, the podiatrist and the palliative care nurse. What the service does well: What has improved since the last inspection? Staff have become more competent and professional since the staff and training and development programme has become operational. Twenty care workers have also commenced NVQ Level 2 in care. Service users are treated with dignity and respect. Staff are competent and know what to do if there are doubts or suspicions of neglect or abuse. The staff team interact well with people with dementia and are competent at managing people who may exhibit challenging behaviour. Service users benefit from staff that are supported and supervised regularly. Management of the home gives stability and reassurance to service users and staff. Morale among the staff team is much better. The home has responded positively to requirements set at inspections. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 6 A full assessment of needs is completed before any person is admitted to the home. The preparations for newly admitted service users are not always adequate and consideration is not given to having all the essential equipment and plans in order before service users are received into the home. EVIDENCE: During the inspection three service users on the ground floor spoke with inspectors regarding contracts. They informed the inspectors that they had not received contracts and were unaware of the terms and conditions of the home. A number of service users have recently been admitted to the home. The wife of one man recently admitted with dementia spoke of the preparation made by staff at the home. She had found the decision very difficult to make but found staff to be supportive and really look after her husband very well as well as supporting her at the most difficult time. Direct observations made by both inspectors were that staff had responded well to the man’s assessed needs and developed appropriate care plans. Two other people recently admitted as well as their relatives were spoken to by an inspector. They said that the relatives did not wish to move to a hospice for Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 9 palliative care but expressed a desire to move to the nursing home. Service users also confirmed that they had taken this decision. It had been arranged via the hospital palliative care team to view the home. Both individuals had an assessment of need completed before admission that was held with care plans. The relatives of one man were disappointed with a number of the arrangements. They had found that the home had not responded sufficiently to his needs assessment as promptly as they should. The essential equipment such as a hospital bed and pressure relieving mattress were not in place for his admission. The other service user had been admitted the day before the inspection. She was receiving continuous oxygen as well as regular pain relieving drugs. This was recorded in her needs assessment. A problem had been experienced in the first twenty-four hours of her admission. She had not received her pain relief drugs entirely on time but found that staff responded to her needs promptly when alerted. It is essential that when service users are newly admitted to the home good preparations are in place to respond to the needs of individuals. There was no evidence to suggest that service users are admitted to the home for intermediate care. From enquiries made relating to the statement of purpose and the service users’ guide it was indicated that neither of these had been reviewed or updated recently to reflect the services offered at the home. These will be evaluated at the next inspection. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 10 Service users are treated with dignity and respect. Plans for the healthcare needs of service users need to be further developed. Service user’s changing needs must be identified and responded to more promptly. EVIDENCE: Care plans for eight service users were viewed. Care plans had been developed and describe how the needs of these service users individuals would be met. Progress notes were recorded daily indicating how people were progressing. There was evidence on six of the files viewed that good progress had been achieved. One fifty eight year old service user admitted to the home in 2004 had lost the use of his arms but since living at the home had been enabled to lead a more independent life. He demonstrated to the inspector how he could summon help, change his television channel and take fluids now that he had received a new remote control device. He also spoke about how much his life has improved and said that, “staff were very good and knew his routine”. Another service user, who has swallowing difficulties and a PEG feed, had found an improvement in his health. He was now taking pureed foods. The care plan had been adjusted to reflect this. Guidance was in place to support him with his social care needs. He was supported into the community two days Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 11 a week including trips to the local park. Risk assessments were in place on all the files viewed. These identified those people at risk of falls. There were also agreements regarding the use of cot sides. However, there were areas identified where staff have been slow to respond to the assessed or changing healthcare needs of individuals. One service user receiving palliative care was at high risk of developing pressure sores on admission. The necessary equipment had not been supplied before admission although the needs assessment identified that it was required. He developed a pressure sore eight days later. The relatives spoke to the inspector about their concerns. They had spoken to the doctor who recommended that he should have his position changed every two hours. This had not taken place. There were no repositioning charts or changes made to instructions on care plans. Relatives spoken to said that they acknowledged that his condition was deteriorating quite rapidly but that they found that staff were not as responsive as they should. The inspector met with the visiting GP. He attends the home every week but also provides an additional service to those receiving palliative care. He reported that there were some nurses that were highly skilled but that when they are absent replacement staff are not so skilled. The inspector also spoke with the palliative care nurse from the hospital. She visits the home every week. She reported that there had been some issues regarding having the correct equipment in place and in good time. She told the inspector that she had provided training on palliative care to staff and that this was ongoing. She also said that it was important for the home to maintain continuity and send the same staff team to each training session. Consultation and advice on the management of continence for service users had been sought. An unnecessary delay had been experienced in the home recently for one service user awaiting convines. The relatives were also concerned that one nurse had little experience on continence aids. Another relative said that she had found that staff did not always record important information or pass it on to appropriate authorities. From reading the relevant service user file it was evident that this was true. Information given by relatives had not been included on the care plan. The deputy manager reported that currently six of the service users had pressure sores, four had leg ulcers. Records indicated that the tissue viability nurse had been involved in their treatment and progress. Records indicated that wounds were dressed in accordance with prescribed treatment. The deputy manager has the role as link nurse with the tissue viability nurse. Records of communication indicated that consultation had taken place between the tissue viability nurse and the representative from the home. Eight service users had contracted MRSA. Records demonstrated that two service users had contracted this while hospitalised. The inspector found that there was Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 12 insufficient emphasis on staff to follow correct procedures. Appropriate equipment was placed in rooms but not all the staff spoken to were fully aware of the correct procedures to follow. Two relatives spoke of observations they made during visits to the home. They said that they were concerned that staff were not fully aware of the procedures to control and prevent the spread of infection. Feedback from one relative was that staff did not keep him informed of his mother’s condition particularly relating to her leg ulcer. He was also concerned that frequently when he visited the dressing had been removed by his mother leaving the wound exposed. He said that he has repeatedly requested that staff make sure that the dressing was attached more securely. A service user admitted for palliative care on the day before the inspection was on continuous oxygen from the time of admission. She had experienced her first night at the home. She had not received her prescribed morphine on time. Medication standards will be inspected later by the pharmacy inspector for which a separate report will be available. Discussions with six service users, four of whom have lived at the home for over one year, was positive on the way people are respected at the home. Staff addressed people in the way preferred by individuals. Observations were made on all three units. In two of these where the majority of service users had dementia, and some have challenging behaviour staff were responsive and supportive and demonstrated a good knowledge of individuals needs. Staff were seen to sit with service users at meal times and support them and encourage them with eating. There was good eye contact observed between service users and staff. Service users appeared well groomed. Two service users said that they, “had a bath every other day”. Interaction observed between staff and service users in the home was appropriate. Those that choose to had their wishes respected to remain in their bedrooms. Two service users said that staff were familiar with individuals and knew how they liked to be looked after. The podiatrist regularly visits the home. Feedback received on observations while she visited the home were that staff at the home were efficient and looked after people well. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 15 Service users are supported to lead a fulfilling lifestyle that takes into account their needs and interests and capacities. Meals served are according to service user’s preferences. More flexibility and consideration needs to be given to encouraging and supporting service users who are disinterested or who have lost their appetites. EVIDENCE: The inspectors were pleased to find that service users were supported to enjoy activities they participated in before admission and outside the home. Three service users receive additional one to one support to enable them pursue interests outside the home as part of the contract. Two of these spoke favourably of how much they valued this time. Staff rotas viewed demonstrated that additional staff were engaged on a regular basis to enable this extra support. One wheelchair using service user receiving this service said that it was, “very consistent”, and that he always had, “the same kind lady to assist”. There are three activities coordinators employed. Programmes were viewed of the weekly activities. These were varied and appeared to cater for a variety of needs. A number of external activities were planned for the summer. A service user recently admitted has experienced dementia and challenging Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 14 behaviour following the diagnosis of a brain tumour. Members of the family spoke of the kindness and understanding shown by staff members. The man’s wife said that when she accompanied her husband to the home, “staff could not have been more helpful”. She also said that this had, “enabled him to settle quickly as staff were skilled and knew how to manage him at his most difficult time”. A Golden wedding celebration with the cooperation of staff had been planned to celebrate their fiftieth wedding anniversary. Other observations made during the inspection were that staff were patient and understanding and devoted a good amount of time on one to one support. At lunch the inspectors observed the meals served. Service users gave different views on meals served generally. All agreed that the meal on the day was delicious but said that there were variations on occasions. One service user said that sometimes dishes such as pasta were not according to his taste. Three service users said that they are asked the day before what they would like to choose for the following day. Four other service users said that they knew when certain cooks had prepared meals and that they had their favourite. Generally people at the home choose the food they like and relay back to management when it is not to their satisfaction. This they said, “always works”. Relatives of one service user spoke of the difficulty when passing on vital information regarding likes and dislikes. They told of how their brother had lost his appetite and required much encouragement and coaxing with drinks and soft food. This information had not been recorded in his plans of care. A member of the family visits him every day especially to support him at mealtimes. He had a large supply of supplement available in his room. No records were maintained for him of his intake of fluids or solids. There was little evidence to suggest that simple things like ice cream and cold drinks were promoted for service users with terminal illness. Another service user spoke of staff not understanding fully when a person did not want a meal. She said that, “staff should be more practical and offer alternatives such as cool desserts and iced drinks when people had poor appetites and especially during hot weather”. Service users have personal allowances banked in an account known as a service users account. The manager informed the inspector of the action taken by the organisation in response to a requirement set at the previous inspection. Relatives and local authorities had been notified of the large amounts accumulated in the account and for recommendations on further action to be taken to dispose of these equitably. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 Service users and their relatives have their complaints listened to and dealt with promptly. Actions are taken to prevent reoccurrence. The staff team are knowledgeable on how to protect service users from abuse. EVIDENCE: The home operates a clear complaints procedure. Records of complaints received at the home for the past year indicated that there were ten complaints received. These were regarding dissatisfaction with aspects of the service. Records demonstrated that complaints were fully investigated. Three of the complaints were substantiated. Observations of records indicated the actions were taken to resolve them and prevent reoccurrence. It was evident that the complaints procedure was followed thoroughly and within accepted timescales. The organisation produced a new Adult Protection Policy in February 2005. Records indicated that staff had received training since then. Discussions with staff focused on knowledge regarding what to look for and what action to take. Five staff were spoken to. All of them demonstrated that they were knowledgeable on correct action to take if they suspected abuse or neglect. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 21 22 26 Service users live in a pleasant and safe environment. More preparatory work is needed for the admission of service users to the home. Essential equipment required for service users receiving palliative care must be available at the home before admission takes place. EVIDENCE: The home provides a safe well-maintained environment that is welcoming and pleasantly furnished. It is suitable for it’s purpose and meets individuals’ needs. It is wheelchair accessible and has a passenger lift. It has a good range of pleasant and comfortable communal facilities. A number of lounges are provided on each unit floor. The building is well presented with soft lighting and very domestic in style. Adequate numbers of toilet and bathrooms facilities are provided for service users at the home that have suitable adaptations and equipment. The inspectors found that repairs were responded to promptly and benefited from the presence of an excellent maintenance person. He demonstrated to one of the inspectors records of visual checks undertaken and of his actions in undertaking repairs as soon as possible. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 17 The inspectors saw evidence of the result of the provision of some excellent equipment to service users and which had made a great difference to their lives. Examples such as remote control equipment, good wheelchair provision and recliner beds. One area where the home has fallen short in responding to promptly is the provision of equipment in adequate time for people requiring palliative care. Although assessments completed indicated that specialist equipment was required, the home had failed to supply this before service users moved into the home. The specialist nursing / medical equipment required must be available and include specialist beds, pressure relieving equipment, suction machines, syringe drivers, infusion monitors, oxygenators. The home was clean throughout on the day of inspection. The inspectors had concerns that not all staff were aware of the universal precautions to take when dealing with MRSA. Two family members also raised this concern. Since the home is providing palliative care the risk of people developing, MRSA is much higher with people frequently entering and leaving hospital. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 28 29 30 Staff at the home are sensitive and kind and understand the needs of people with dementia. The home has not considered sufficiently the needs of people receiving palliative care resulting in people not receiving the quality of care it promises to deliver. EVIDENCE: The numbers of staff on duty and the number and needs of service users was assessed. Sufficient numbers were found on all units except on the Diana wing. Three service users had a contract specifying additional one to one support for periods during the week. The staffing rotas reflected this. Recently the home has admitted two people for palliative care. Both individuals have high needs but this has not been considered and it has not been reflected in staffing levels. The staffing levels of qualified nurses and four carers on duty during the day in Diana unit were similar to staffing levels prior to admitting these service users receiving palliative care. The relatives of one of these men said that they were disappointed to find that since his admission to the home he had not received adequate staffing input. His illness was terminal and he required more one to one support. The service user and his relatives had found that not all staff were as experienced in palliative care. Examples were given by the family of the shortfalls, firstly they said he was left for long periods and not offered to have his positions changes, he was not offered regular and frequent drinks, he received very little one to one support Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 19 from staff members to support or talk with him and help him express his feelings. The family had found that when they visited he had become frustrated at the lack of attention. Staffing levels must be reviewed urgently and reflect the needs of people living at the home. People suffering from terminal illness require specialist counselling and other alternative therapies. Three of the nurses have attended training with the palliative care team at the hospital. From discussions with members of staff this has been erratic with some staff participating in training provided by the hospital team although they did not work on units where people received palliative care. Recently twenty members of staff had commenced NVQ Level 2 in care. This should ensure that minimum levels are achieved by December 2005. Staff have received a variety of training by an internal trainer. Members of staff spoke of the topics of training recently covered that they attended, these included supporting older people in the heat wave, abuse awareness, respect and dignity, infection control. Direct observation made of staff interaction with service users with dementia was that staff had developed good skills in this field and that they used facial expressions and body language to communicate effectively. Staff were calm, sensitive and competent at managing people with challenging needs due to dementia. Two relatives were complimentary about staff approach to people with dementia. More training was planned in the training programme on palliative care and dealing with dementia. The progress on delivering the training and development programme was not fully evaluated and will be examined at the next inspection. Staff spoken to as well as the manager said that each member of staff had a training profile completed. Training needs were planned to respond to individual training needs. From discussions with relatives and service users an area where improvements were commented on related to communication. Staff were quoted by service users and relatives as generally kind but that they that there were a small number that had a poor command of English. The registered person should ensure that staff are supported with developing further English language skills. Recruitment procedures showed an improvement since the last inspection. On the four staff files viewed references and CRB disclosures, that included POVA checks, were present. The inspectors observed that there is a high turnover of staff at the home but there was an improvement in staff morale. Comments from relatives regarding communication difficulties reflected on staff changes and also the difficulties with staff understanding fully what is said. One Polish speaking service user was conversing freely with a member of staff that spoke Polish. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 35 36 38 There is a competent and experienced manager. Emphasis is placed on providing an environment that is well maintained and that makes proper provision for the health and safety of service users as well as staff. Staff are supported and supervised but improvement is needed in supporting staff to develop better communication skills. EVIDENCE: The registration of the manager has taken place since the last inspection. She is a dual registered nurse and has worked in services for older people for a number of years. She is currently studying towards a Masters in Business Administration with emphasis on health services management. Feedback from staff indicated that the management approach was open and inclusive. All seven service users spoken to spoke highly of her management skills. ANS employs a quality systems coordinator who undertakes a full quality audit annually of all service provision. Records were held at head office of recent Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 21 audit. The inspector should receive a copy of the most recent audit. Quality assurance is also measured through regular annual reviews and from feedback from service users and relatives. As stated in standard 14, a joint bank account for service users has operated to enable them to manage their personal allowances safely. A large amount of money has accumulated in the account. The home have taken action to distribute these finances equitably. A response was due from local authorities and relatives on the next steps to be taken. Staff spoken with said that that they received supervision regularly and felt supported Meetings are held regularly for the staff team as well. From observations made in the workplace there were indications that staff received guidance and support while working on the floors. Concerns raised by three service users and two relatives relate to communication difficulties with a small number of staff. This has affected how communication has been relayed and passed on. Although staff have received training on moving and handling people an observation made on one unit was that staff were not moving one person safely in a wheelchair. An induction and foundation training programme has been introduced for new staff. The inspector viewed copies of the training and development programme devised for staff. It included a number of identified training needs. Records viewed indicated that adequate precautions were taken against the risk of fire including regular fire drills. All areas of the home were observed to be well maintained and take into account the health and welfare of service users. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 2 x 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 3 x 3 3 x 2 Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 23 no Are there any outstanding requirements from the last inspection? 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 3 22 Regulation 14 (1) d Timescale for action The registered person must 30 July ensure that, having regard to the 2005 assessed needs of the service users, the home is well prepared and suitable for meeting the service users needs in respect of health and welfare. Suitable equipment assessed and required must be provided before admission. The registered person must 30 August ensure that care plans are 2005 reviewed and updated to accurately reflect change to individual needs and address objectives for personal and health care. The registered person must 30 August ensure that the home promotes 2005 and makes proper provision for people identified as having pressure sores or at risk of developing pressure sores. Risk assessments, care plans must be kept updated and reflect any changes in treatment advice or objectives. The regiostered person must 30 July ensure that professional advice 2005 regarding the promotion of continence is sought and acted Version 1.30 Page 24 Requirement 2. 7 15 (2) & 13 (4) c 3. 8 12 (1) a & b 13 (4) (c) 4. 8 13 (1) (b) Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc 5. 8 26 12 (1) (b) 6. 9 13 (2) 7. 15 16 (2) (i) 8. 27 18 (1) (a) 9. 7 30 38 13 (4) (b) & 13 (4) (c). 18 (1) (c) (i) 12 (1) (b) 10. 27 11. 27 38 upon. There must be no unnecessary delays in supplying aids and equipment prescribed. The registered person must ensure that staff are trained in infection control, and make proper provision for the care, treatment and supervision of service users particularly those that have contacted MRSA. The registered person must ensure that drugs prescribed for service users are administered at the time prescribed, particularly pain relieving drugs. The registered person must ensure that service users receive food and liquids that are suited to individuals needs. To be presented and offered in a manner that is attractive and appealing in terms of texture flavour and appearance in order to maintain appetite and nutrition. The registered person must ensure that at all times suitably qualified experienced and competent persons are working at the home in such numbers as appropriate for the health and welfare of service users. The registered person must ensure that staff are competent in moving and transferring people safely. The registered person must ensure that staff dedicated to palliative care receive training specifice to this. The registered person must ensure that staff are supported to develop effective communication with service users. 30August 30July 2005 30 July 2005 30 August 2005 30 August 30 Oct 2005 30Oct 2005 Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 1 30 14 Good Practice Recommendations The registered person should ensure that the statement of purpose and the service users guide are kept updated and reflect the service aims and objectives The registered person should ensure that staff are supported with developing further English language skills. The registered person should ensure that the home follows up on actions required by the local authority and relatives in relation to service users account. Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Southwark Area Office Ground Floor 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Collingwood Court Nursing Home G52-G02S7015 Collingwood CrtV231144200605 Stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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