Inspection on 23/08/05 for Connaught Court Nursing & Residential Home

This inspection was carried out on 23rd August 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.

Other inspections for this house

Connaught Court Nursing &... 29/08/08

Connaught Court Nursing &... 11/09/07

Connaught Court Nursing &... 19/09/06

Connaught Court Nursing &... 07/03/06

Connaught Court Nursing &... 19/01/05

Connaught Court Nursing &... 06/07/04

Connaught Court Nursing &... 15/03/04

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

CARE HOMES FOR OLDER PEOPLE Connaught Court Nursing and Residential Home St Oswalds Road Fulford York YO10 4FA Lead Inspector Anne Prankitt Unannounced 23rd August 2005 09:30 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. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Connaught Court Nursing and Residential Home Address St Oswalds Road Fulford York YO10 4FA 01904 626238 01904 611741 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) Royal Masonic Benevolent Institution Mrs Nancy Gray Care home with nursing 90 Category(ies) of DE(E) Dementia-over 65 (90) registration, with number Old Age, not falling within any other category of places (90) Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No Date of last inspection 19 January 2005 Brief Description of the Service: Connaught Court is a care home owned by the Royal Masonic Benevolent Institution. A maximum of 90 service users can be cared for at any one time. The home has 4 residential areas for up to 65 service users, known as Ebor, Yorvik, Knavesmire and Fairfax. One of these is for service users with high dependency needs. A nursing area called Viking is provided for up to 15 service users. There is a self contained area for up to 10 service users with dementia needs called Fred Crosland House. The home is situated in Fulford on the outskirts of York. Local amenities are accessible to service users. The home has its own grounds which are accessible to service users. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection lasted for approximately eight and a half hours, and was conducted by three regulatory inspectors; Anne Prankitt, Ros Sanderson and Jo Bell. Four hours preparation took place prior to the inspection. The registered manager, Nancy Gray and deputy manager, Margaret Cade, were available throughout the course of the inspection, and were present at the feedback session at the close. Each of the inspectors were responsible for the assessment of two units each. A tour of each area was undertaken, including a number of bedroom areas. Residents and staff were spoken with, and a mealtime observed. In addition to this, records were looked at, including some care plans, maintenance records, and also staff training and supervision records. What the service does well: The home is set in beautiful grounds, and many residents have a view of these from their room. It is spilt into six small units where dedicated staff work. They understand the needs of the residents who live there. One resident commented ‘I have no regrets moving here. I made the decision to come’. Residents said that the food is very good. They remarked that they can have a cooked breakfast if they wish, and that they get a choice of meal at each mealtime. The laundry is well organised, and residents’ clothes are returned to them well pressed, and in individual bags. Health and safety records showed that the home is well maintained. Residents comments about the staff were positive, and included that ‘the staff are wonderful here’ ‘I feel my privacy is protected at all times’. ‘The carers are my family’. ‘Staff are very kind; if you need anything, you only have to ask’. All service users have a care plan which tell staff about residents’ individual needs. Staff are provided with training to help them improve the skills that they need in providing care to residents. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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 Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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 Sufficient information is gathered prior to admission in order that the home can make an informed decision that the needs of prospective service users can be met. EVIDENCE: The registered manager or team leader generally carries out a pre-admission assessment prior to new service users being admitted to the home, and passes information on to the relevant unit. For prospective service users who live out of area, the organisation will make arrangements in order to visit service users prior to admission. The information is considered prior to admission. Where service users are admitted from other units within Connaught Court, information is passed on internally, following discussion with the service user and their family. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Service users’ individual needs are clearly recorded in the care plans, which need to include more information for staff about individual risk, and how it is to be managed. Locally agreed practices and matters of supervision need to be formalised, in order to ensure that the current procedures with regard to the administration of medication are robust, and service users fully protected from risk. Personal support is provided in such a way that the privacy and dignity of service users is promoted. EVIDENCE: Care plans throughout the home were generally of very good quality, and considered the holistic needs of service users. The health and social assessments completed are based on the activities of daily living. There are care plans in place where acute issues relating to care have occurred. The plans are reviewed and updated regularly. Where risk assessments result in cause for concern, a care plan is implemented to instruct staff how to manage the issue. There was detail of family and service user involvement. A number of care plans, especially in those units providing residential care, were signed by the service user. In Fred Crosland House there was evidence of input from Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 10 family members where it had not been possible to involve the service user. Additional information was seen in one care plan in this unit, which requested information about possible triggers which preceded challenging or unpredictable behaviour. There was evidence to support that service users are enabled access to the primary health care team. The nursing needs of service users in Viking wing are dealt with by the registered nurses who are available on the unit on a twenty four hour basis. The services of the district nurse are appropriately sought on those units providing residential care. Comments from service users included: ‘I like it here. If I need the doctor he is just down the road’, and ‘Staff come to me when I have appointments’. The following points were discussed with the registered manager: Viking Wing (Nursing care) • • In the case of a service user who suffered a pressure sore, there was no information available in the care plan which described the condition of the pressure sore at the point when it was attended to. There was no risk assessment in place for one service user who is nursed in a Kirton chair, which restricts movement. The registered manager confirmed that the service user is immobile, and that the chair was used for reasons of safety. However, this was not explained in the care plan. The risk assessment in place for the use of bed rails was a balanced assessment, looking at all areas of risk before making a decision as to whether bed rails should be used. However, there needs to be a system introduced whereby written evidence is provided that bed rails are checked on a regular basis. There is no formal policy for the use of bed rails. Reference is made within the Abuse policy that incorrect use of bed rails is classed as physical abuse. The policy should be expanded upon. • Fred Crosland House • • Details about wishes following death had not been completed in one of the care plans seen. Whilst a referral to the dietician was in hand, there was no care plan in place with regard to one service user where it had been identified that they were losing weight. Jorvik • In the case of one service user, it was difficult to assess whether weight had been lost or gained due to the anomalies in the way in which this was recorded, and also because of the different scales used. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 11 • In another case, the care plan did not refer to the loss of weight experienced by the service user, or of the nutritional assessment in place. The storage of medication is separated out into different areas of the building. Due to new legislation affecting homes providing nursing care, the pharmacy will now not accept unused or disposed of medication from any area of the home, despite all areas excepting Viking wing providing personal care only. This is an ongoing issue for the home, and one which they are currently seeking a solution to. All staff who administer medication are either trained nurses, or have completed training in the safe administration of medication. It was discussed with the registered manager about the ongoing problem in each of the areas whereby blister packs containing tablets were ‘out of sync’ with the twenty eight day cycle. This resulted in staff having to remove tablets from the pack prematurely where service users have been admitted ‘mid cycle’. Whilst service users have received the correct medication, this problem does increase the chance of error. Previous efforts have been made to rectify this, with only short term beneficial effects. It is recommended that further discussion takes place with the General Practitioner surgeries, or the pharmacy, in order to address the matter further. Viking Good systems were in place for the handling of medication. There is a fridge available for medication that needs to be kept cool, and temperatures are checked on a daily basis. None of the service users choose to self medicate. There is a clear record of medication received into the building. There are separate storage arrangements for controlled drugs. Only trained staff handle medication. Administration records seen on the day of the inspection were up to date. Additional systems have been introduced where two recent errors in medication administration have occurred. However, there was no evidence that these matters had been recorded or followed up during the course of supervision. Fred Crosland House There was one service user prescribed medication which needed to be kept cold. Alternative arrangements had been made for safe storage until the unit received delivery of a new medication fridge. The storage arrangements for medication held on the unit were appropriate. Records seen were up to date, and were reconciled with stock held. There was no written agreement with the General Practitioner available, about the arrangements for the administration of homely remedies. The agreed list must be provided on the unit in order that staff have clear instruction about what non prescription medication can be administered without first referring to the GP. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 12 Fairfax Medication was appropriately stored, and records were completed accurately. Temazepam was stored and recorded correctly. The temperature of the medication fridge had not been checked since 02.08.05. Staff said that the thermometer was broken. Knavesmire and Ebor These units share storage facilities. Service users who choose to self medicate have a completed risk assessment and also a locked facility for safe storage. Records kept were up to date and correct. Jorvik Written policy should be developed for staff and agreed with the General Practitioner to support the verbal instruction and current practice that staff do not check the pulse rate of service users admitted for personal care only prior to the administration of Digoxin. Service users in all units offered positive comments about the service. Staff were observed treating service users with respect and dignity, and appeared to understand individual likes and dislikes. Staff gave service users time to respond, and to engage in conversation. Staff training passports evidenced that matters of privacy and dignity are addressed during induction and also NVQ training. Comments from service users included ‘I feel my privacy is protected at all times’. The registered manager took seriously one isolated comment made by a service user within the nursing wing, with regard to the approach of staff when help was requested. The registered manager stated that this matter had been addressed before, and gave assurance that it would be investigated again. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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) 15 Service users are provided with a good choice of menu, and food is provided in pleasant and congenial settings. EVIDENCE: All meals are prepared and cooked in a central kitchen. Viking Wing has a ‘satellite kitchen’, from which meals are served. Meals are taken to Fred Crosland House in a hot trolley. All remaining service users congregate in the main dining hall for meals. Service users have a choice of menu at each mealtime. Excepting comments from two service users, who stated that the food was sometimes ‘bland’, and that it was ‘alright’, all service users were very satisfied with the meals on offer. There is a residents’ committee meeting held every 1-2 months. Six residents have a place on the committee, which is attended by the catering manager, and where any issues about the menu can be discussed. Observations made during the mealtime confirmed that service users who require assistance at mealtimes are provided with this in a dignified way, and specialist equipment, such as plate guards, are available in order to assist with independence. Meals were served in generous portions, and attention to detail was observed, with the provision on tables in the main hall of menu cards, individual name places and linen napkins. . Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Service users know they can complain. Complaints brought to the attention of the management are taken seriously. Service users are protected by an open culture which informs staff of their responsibilities where abuse is suspected. EVIDENCE: There is a full copy of the complaints policy available to all service users within the service users’ guide. Complaints are logged and monitored for all areas of the home by the management team. There have been no complaints made to either the home or to the Commission for Social Care Inspection during the period since the last inspection. All service users were clear that they would discuss any concerns they had with the management team. With regard to Viking wing, one service user was clear that there was a complaints strategy in place, but thought that service users were not told about it until it was too late. This isolated incident was discussed with the registered manager and deputy at the time of the inspection. They assured that they would look into this matter further. Since the last inspection a training officer has been employed to work at the home full time. They deliver to day and night staff training in abuse awareness. This is underpinned with training provided direct from the local authority on the protection of vulnerable adults. To further direct staff, the registered manager has provided in each of the units a clear flow chart, which Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 15 gives written direction about their responsibilities in the reporting of matters of abuse. Staff spoken with understood their responsibilities. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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 and 26 Service users live in a clean, safe and well maintained environment which is suited to their needs. EVIDENCE: The home is situated approximately one mile from the city of York, and comprises of six separate units, which are set in peaceful grounds. Many of the bedrooms overlook the grounds. There are local shops, a church and a General Practitioner’s surgery within walking distance. There is a communal area which benefits from a large dining area, entertainments hall with stage, and conservatory. Individual units are personalised, have a variety of communal space, and facilities are provided to assist in meeting the needs of the service users who live within, including specialist aids. All areas were clean and free from offensive odours. The premises are well maintained, and there are systems in place to protect service users from the risks of fire. Many of the corridors are wide, and allow easy access for wheelchair users. Fred Crosland House is designed to take into account the needs of those with dementia. It has a circular walkway, and safe access to the courtyard garden. The unit also has a ‘parlour room’ where service users can reminisce. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 17 Laundry facilities are based in the main part of the building. There is a separate drying room. Washing equipment is at an optimum height for staff. All staff who work in this area have a completed intermediate infection control certificate. There are good systems in place whereby service users’ washing is returned to the individual to whom it belongs in individual bags. The home has developed links with the infection control nurse, and contacts them if issues are raised. There is guidance on MRSA, and staff were observed washing their hands. One service user stated ‘The staff launder my clothes well. They are always nicely pressed’. There are separate laundry rooms around some areas of the home which are used for light washing such as tablecloths. Sharps disposal bins are available in the medication rooms, and there is a clinical waste system in place. Sluice disinfectors are available. Personal protective clothing is provided, and additional equipment such as ‘dissolvobags’ are available for soiled linen. All staff have completed training in infection control. There was a smell of urine in one room in the residential areas. The staff were aware of the problem, and systems were in place in order to attempt to eradicate the odour. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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 and 30 There are sufficient staff who are appropriately trained to meet the needs of service users. EVIDENCE: The registered person, assisted by her deputies, has responsibility for the overall running of the home, which is split into six units. Each of the residential units has a team leader, whilst Viking unit has a nurse in charge of each shift. The home employs the use of agency staff where staff shortage occurs. The team leader for Fred Crosland unit explained that when they employ agency staff, it is with the agreement that there will be continuity in the staff provided in order that there is less disruption for service users. Staff on each unit have the authority to seek cover in times of staff shortage. Staff were busy, but appeared to go about their duties quietly and calmly on the day of the inspection. Comments from service users included that staff were ‘very good’, ‘very kind’, and ‘if you need anything you just have to ask’. Comments from the residential units were that service users thought that there was normally plenty of staff. On the nursing wing, one service user though that they had to wait a long time for things to happen, and that there were not always sufficient staff. Within the main hall, three staff were available to assist with lunch time meals, and one member of staff administered medication. This staff member was observed leaving the medication trolley unattended whilst they assisted a service user in cutting up their food. This practice could lead to unnecessary medication error. Staff stated that there was normally one extra staff member available. Sufficient staff must be Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 19 provided to assist service users at all meal times to ensure that the medication round can be completed without interruption. There is a dedicated training room at the home, within which training is provided. A resource library is being developed which will incorporate the NVQ equality and diversity training. A full time training officer is now employed to work at the home, who is also an NVQ assessor. They are also actively involved in the Selby and York steering group which looks at the training needs of staff with regard to dementia care. Each member of staff is issued with a ‘training passport’ which explains the training that they have undertaken. All staff complete mandatory training. Training towards NVQ Level 2 in care continues. 60 of staff have achieved an NVQ at least to level 2, and there are further staff who are working towards accreditation. There are three staff who can provide training in manual handling, which has been provided to all staff, including registered nurses. Staff who are employed under the age of 25 complete a ‘modern apprenticeship’ qualification. Staff receive a minimum of three days paid training each year, and are encouraged to attend training which would be beneficial to their work and to the organisation. This includes training in dementia awareness and managing challenging behaviour. There are clear records kept which identifies who requires updates in training, and should staff consistently miss training sessions, then disciplinary action would be considered. Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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) 32,36 and 38 The enthusiastic workforce are supported and supervised, and demonstrated a clear understanding of their roles. The home is managed in such a way that the health and safety of service users and staff is considered. EVIDENCE: The deputy managers have responsibility for certain areas of the home. Discussion with staff in two areas of the home confirmed that their daily input and supervision was appreciated, and that communication between the units and the management team was good. The deputies also co-ordinate the supervision and appraisal process within the units for which they are responsible. Staff were confident that there was always someone available to whom concerns or matters of emergency could be referred. This included at weekends, where, in the first instance, the nurse in charge of Viking has Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 21 overall responsibility. However, there is a list of contact details for managers should their assistance be required. All staff at the home are supervised, whatever their position. The management confirmed that there has been a new system of supervision and appraisal introduced. From the records seen and through discussion with staff it was confirmed that this is provided on a regular basis, and discusses training needs and staff issues. Staff comments included that appraisal was ‘very useful, and helps you develop and move on’, and was described as a ‘two way process’. Specific information was sought about the supervision provided to staff following two medication errors which had occurred on Viking wing. Neither the errors nor detail of any follow up action taken in order to enforce good practice was recorded within the supervision notes. There are good maintenance systems in place at the home. Records were kept of both in house checks and annual contractor certificates. There is an accident book located in each area of the home, which was completed appropriately. A recent inspection by environmental health resulted in an excellent report. The HSE had also visited, and had raised issues about two manual handling issues. Following an assessment of risk, action is being taken in order to reduce the risk for staff. A new fire detection system has been installed at the home. Fire certificates were in date, and all staff have received fire safety training at appropriate intervals. The following health and safety matters were raised at this inspection: • All hot water temperatures within service users’ private accommodation were maintained close to 43 degrees centigrade. However, sluice rooms, the cleaners’ room and the service users’ laundry room containing electrical equipment and/or hot water supplies which were not maintained close to 43 degrees centigrade were not locked. (The registered manager has provided confirmation that a thermostatic valve was fitted to the hot water outlet in the laundry room last year). None of the staff have an up to date first aid certificate, and it was believed that trained nursing staff did not need to complete this training. • Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 1 Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 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 7 Regulation 12,13,15 Requirement A risk assessment must be incorporated into the care plan which explains why equipment which restricts the movement of service users is used Clear record must be kept as evidence that bed rails have been checked on a regular basis to ensure that they are safely fitted Staff must ensure that, wherever practicable, the wishes of service users upon their death are clearly recorded in the care plan 2. 8 17(1)(a) Schedule 3(p) 15(2)(b) Where service users suffer from pressure sores, their treatment and outcome must be clearly recorded, and reviewed on a continuing basis A clear record within the care plan must be kept with regard to weight gain or loss, and of action taken where problems arise With regard to the unlocked sluice rooms, cleaners room and residents laundry room, the registered manager must J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Timescale for action 30 September 2005 23 August 2005 30 September 2005 30 September 2005 Page 24 3. 38 13 Connaught Court Nursing and Residential Home Version 1.40 complete a written risk assessment, and provide locks to the rooms concerrned where it is concluded that service users are subject to unnecessary risk from the hot water supply and machinery within First aid training must be provided for sufficient staff to ensure that there is a qualified first aider available at all times 4. 30 November 2005 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 7 8 9 Good Practice Recommendations A policy on the use of bed rails should be developed It is recommended that the registered manager considers the current nutritional risk assessments in place, to include triggers for referral to the appropriate professional The registered manager should consider further ways in which the blister packs system can be better synchronised in order to reduce the risk to service users from error The staff in Fred Crosland House should be given a copy of the written agreement provided by the General Practitioner about the use of homely remedies Written policy should be developed for staff and agreed with the General Practitioner to support the verbal instruction whereby staff should not check the pulse rate of service users admitted for personal care only, prior to the administration of Digoxin In accordance with the Royal Pharmaceutical Society of Great Britain, the temperature of fridges provided for the storage of medication should be checked on a daily basis, and a record kept The registered manager should review the arrangements at meal times in order that sufficient dedicated staff are J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 25 4. 27 Connaught Court Nursing and Residential Home 5. 36 available to provide assistance to service users Supervision notes should include information about discussions held where matters of professional practice have been addressed Connaught Court Nursing and Residential Home J53-J04 S27959 Connaught Court V239692 030805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross York YO32 9GZ 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. 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