Inspection on 10/10/05 for Country View Nursing Home

This inspection was carried out on 10th October 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

Country View Nursing Home 05/05/07

Country View Nursing Home 19/04/06

Country View Nursing Home 16/01/06

Country View Nursing Home 20/12/04

Country View Nursing Home 30/06/04

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

CARE HOMES FOR OLDER PEOPLE Country View Nursing Home Warkton Kettering Northants NN169XQ Lead Inspector Judith E Sansom Unannounced Inspection 2.00pm 10 & 11 October 2005 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 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. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Country View Nursing Home Address Warkton Kettering Northants NN169XQ 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) (01536) 484692 (01536) 518376 brian_webb@btconnect.com Country View (Warkton) Limited Mrs Margaret Jean Webb Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (4) of places Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No one falling within the category of OP may be admitted to the home where there are 29 persons of category OP already accommodated within the home. No one falling within category PD may be admitted into the home where there are 4 persons of category PD already accommodated within the home The total number of service users accommodated in the home must not exceed 29. 6th September 2005 Date of last inspection Brief Description of the Service: Country View Nursing Home is owned privately and managed by the owners. The nursing home is a large converted country house, with a large ground floor extension. It comprises double and single rooms with day spaces. The home has a large garden which is maintained to a high standard, and is accessible to service users. The home also has views over open countryside. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. The methodology of case tracking is used to find out if the care being provided to the residents is of an acceptable standard and meets their individual needs. ‘Case tracking’ involves the review of resident’s records, meeting with them and talking with the care staff that provides the personal care to the selected residents. The inspection also includes a review of the homes’ procedures and processes to ensure that all practices carried out by the staff protect the residents. This inspection was carried out on an unannounced basis and included the investigation of a complaint that had been received by the commission. Two Inspectors carried out the inspection in the home on an unannounced basis. The inspection process included two separate visits to the home, one during the afternoon and one during the late morning and afternoon. Compliance by the manager to action previous requirements placed at the inspection of December 20th 2004 was reviewed as part of the inspection process. The areas of complaint were varied but primarily covered poor care practices and the unacceptable condition of some areas of the environment. To ensure that all areas of the complaint were reviewed the Inspectors undertook the following process: ‘case tracking’ which involved selecting 3 residents and tracking the care they receive through review of their records, discussion with the residents, the care staff and observation of care practices. The Inspectors undertook a thorough ‘walk’ of all areas of the home, and a detailed review of relevant records that are held in the home. The topics of the complaint are addressed throughout the report. The requirements and recommendations placed at the conclusion of the report reflect the findings of the complaint inspection. Five immediate requirements relating to health and safety issues, were left at the conclusion of the inspection What the service does well: The senior staff, under the guidance of the registered person, all have delegated responsibilities. These responsibilities are divided into areas such as care plans and risk assessments, training, medication etc. The care staff were able to demonstrate that they had a clear understanding and knowledge of the residents’ individual needs. Sufficient staff were on duty Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 6 to meet the needs of the residents during both days of the inspection. The records maintained in the home evidenced that staff receive ongoing training and that there is in place induction training for all new staff. One member of staff has the overall responsibility of planning and organising the training. The home was clean and hygienic and there were no pervading odours in the home. The grounds of the home are maintained to a very high standard. The registered persons have responded to the previous requirement regarding the monitoring of the water temperatures in the home. Records are in place that identify regular monitoring is being undertaken. What has improved since the last inspection? What they could do better: Currently the information recorded by the staff in the resident’s files is not consistent resulting in essential information being left out. The result of this poor practice is that there is little evidence to show that individual identified care needs are being met. Important information is being omitted that could potentially put the residents at risk of harm. Residents, wherever possible, should be involved in the development of their plan of care and resulting risk assessments. Fundamental information such as their choice of where to sit in the home and how they wish to spend their day; what sort of food they want to eat and where they want to eat it; whether they want a key to their room are all central to ensuring that each resident is treated as an individual with rights as to how they want their care to be provided whilst they live at Country View. There are a number of activities that are offered to the residents on a regular and frequent basis. However the introduction of person centred and meaningful activities that reflects past individual hobbies and interests would be of benefit to each resident. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 7 Observations of the practices of staff by the senior staff must be more thorough to ensure that all staffs’ practices are safe and residents are not being put at risk of potential harm. For example a high number of wheelchairs did not have the footplates in place; staff were frequently in and out of the kitchen area, with no obvious hygiene routine being observed. These shortfalls should be included in the on-going training for all staff All staff receive training to enable them to care for the residents in the home, however the training programme would benefit from being developed further to include areas of training such as sensory impairment, continence awareness, care for the elderly, care for people with limited communication skills. All training needs to be pertinent to the needs of the service users currently in the home. The registered persons are encouraged to develop a method to ensure that all people are kept informed of the way in which monies that are raised from fund-raising activities are used. With the development of pertinent policies and procedures for staff to follow if a resident has lost the ability to understand the value of money. Five immediate requirements relating to health and safety issues were left at the home at the end of the inspection process. 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. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 8 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 Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 3 & 5. Standard 6 does not apply to this home Although the home has an admission process that includes the completion of an assessment form this format limits the amount of fundamental information that is sought and recorded prior to any admission. In the absence of this essential information there is no assurance that the potential resident’s individual care needs can be met. EVIDENCE: Information held on the care records of the residents gained prior to any admission was limited in its content. There is in place a ‘tick-box’ template that is used as a tool. However, the information recorded on this form does not identify whether the individual care needs of the potential resident can be met by the competencies, mix and numbers of staff employed in the home. There is no indication that the layout of the home and position of bedrooms is taken into account prior to an admission being agreed, and whether the new Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 10 resident would fit into the existing resident group. Prior to any new admission consideration must be made when placing two people in a shared room to ensure that the health needs of either party does not impact negatively on the other resident in the room. One resident said that he had visited the home before he came to live there and he was happy with what he saw, and is still happy to be in the home. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 7, 8 & 10 Although a care system has been installed in the home limited progress has been made since the last inspection to develop the plans of care and risk assessments to ensure that the health care needs of the residents are identified and met. These shortfalls have the potential to place residents at risk. EVIDENCE: The residents’ care plans contain limited information. There is no robust system in place to ensure that all relevant information is consistently recorded. This shortfall means that the reader could have difficulty in making significant and important decisions about the care of the resident. There was no consistency in the monitoring records of residents to ensure that the appropriate care was delivered in the form of fluid balance charts, however records contained completed tissue viability and water-low assessments. There was inconsistency in the information relating to the ongoing health care needs of the residents. Information recorded in one resident’s records demonstrated that health care professionals had been involved with the initial diagnosis and the identification of necessary treatment. However in another Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 12 resident’s file there was no evidence of specialist guidance having been sought to ensure the appropriate provision and management of continence, although there was evidence that staff were managing this residents’ bowels. Each file contained risk assessments. The recorded information was limited and gave the impression of being standardised. In that the same areas of risk had been reviewed for example risk of falling out of bed. There was no evidence to show that life style risks related to each resident were taken into consideration in the development of the risk assessments. For example the associated risks involved with peg-feeds and the incision site. There was no evidence to show how the staff reaches a decision in relation to the introduction of ‘bed-side’ protectors. Care plans and associated risk assessments should be developed with input from the resident and significant others when the resident is unable to understand the process. There was no evidence of involvement by the resident at any stage of the development of their plan of care or risk assessment. One resident said that the staff were pleasant and kind and that when they delivered personal care they were respectful and sensitive. However a high number of bedroom doors did not have in place a key lock so that residents’ could choose to lock their doors to maintain their privacy when they wanted to. This omission does not promote residents’ right to privacy. Proactive steps must be taken to ensure that each resident is encouraged to identify their individual preferences and choices in all aspects of their life in the home. Staff were sensitive in the way in which they talked to the residents about the need to go to the toilet and there was no evidence that personal care practices were undertaken when other residents were in the same room. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 Insufficient importance is given to seeking resident’s views in relation to everyday life in the home. There is minimal opportunity for residents to make informed choices and to take control over some aspects of their life in the home. These shortfalls indicate that independence and fulfilment, that is the right of each resident, are not promoted. EVIDENCE: There is in a place a detailed record of activities that all residents have the choice to be involved in. Staff have spent time and imagination in the development of the activities programme to try to cover a wide range of interests. However there is little evidence to show that resident’s views are sought and acted upon in respect of individual expectations, preferences, choices and meaningful activities that reflect past hobbies and interests. Staff must be proactively seeking out this essential information to ensure that each resident receives a fulfilled and meaningful life whilst they are at Country View. Where specific needs for stimulation are identified, it is the home’s responsibility to meet these needs as part of the agreement to care for this resident, it is also the right of the resident to expect the home to provide the equipment and numbers of staff to meet the identified needs. This is particularly important for one resident who is considerably younger than the rest of the resident group and has specific needs. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 14 During the inspection visits to the home a number of relatives and friends were in the home. Due to the way in which the seating in the main lounge is planned there is no opportunity for friends and relatives to talk quietly with their relative/friend in this area. Visitors are not able to sit alongside the person they are visiting but have to sit in front of their relative/friend, which then blocks the view of the television from other residents. There is little evidence in the records to show that residents are proactively encouraged to exercise choice and control over their lives. However one resident said that he had chosen not to eat his lunch time meal, and that staff would hold onto this meal to be micro-waved later if he wanted. Two residents were seen eating their mid day meal long after the other residents had left the dining room. The residents said that they had only just come down for their lunch. There is in place a planned menu on a weekly rolling basis. There are records to show the likes and dislikes and medical needs of the residents. One resident who had difficulty in swallowing and therefore needed her food to be liquidised had her meal presented in a very appetising way. Each component of the meal was individual and colourful. The resident said that she enjoyed her meals. Other residents made positive comments about the meal. Residents were heard to be asking for alternatives for their tea-time meal, and the menu identified different choices. One resident said that he always chose to have cheese sandwiches at tea-time, but knew that some residents had something hot instead and he could if he wanted. However the kitchen records are not consistently maintained to identify if the resident had chosen an alternative meal to the one being served. The menu was not always reflective of the meal served up to the residents. The menu detailed rice pudding or bread and butter for the choice of sweet on 10th October 2005. However due to the supply of milk having run out that morning a necessary change to the pudding had to be made. The residents were offered in its place two alternatives fruit salad or a fruit pie. Residents said that they enjoyed their pudding. At lunch time one relative was helping his relative to eat their meal. Staff were sitting giving aid to a number of residents during the meal time. However for two residents who were sat on either side of one staff member they were not given the courtesy of being served individually but simultaneously. This practice is unacceptable and does not afford respect to the resident. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 There is in place a detail complaints process that affords protection to the residents. EVIDENCE: The commission has received a complaint detailing a number of poor care practices that are in evidence in the home and concerns about the poor condition of the environment of the home. All complaint issues have been addressed as part of the unannounced inspection and the findings are reflected throughout the report. The details of the complaint are as follows: Environment: • Lounge to small for five residents to use – not upheld • Carpets not cleaned – not upheld • Food on the floor – not upheld • Incorrect chair size for resident – not upheld • The external paths are gravel, causing problems for wheelchair users – upheld • Sluice room is in a disgusting state – not upheld • The home is in a dirty state – not upheld • The blue room is hardly ever used - upheld Care Practices: • Wheelchairs do not have footplates in place – upheld • Residents not accessing the garden/grounds – upheld Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 16 4 televisions all playing at the same time in the lounge – upheld Residents’ catheter bags changed in public place into the same container –unresolved • Resident left in continence pad all day, unchanged – partly upheld • No stimulation for young resident – upheld • Staff do nothing for young resident – not upheld • No real choice from the menu – upheld • Residents offered only sandwiches at tea time – not upheld Staffing Issues: • Carers take their break at the same times – not upheld • Carers covering cooking and go from cooking to caring without change of protective clothing – unresolved • 2/3 staff very good not very good or trained – partly upheld Management: • When resident placed in a shared room there was no choice of bedroom when other resident who suffers from dementia is screaming and shouting all night – partly upheld • Monies raise through fund raising events for the residents is not spent on the residents – not upheld • Each resident is expected to pay £5 towards leaving gift for a staff member – partly upheld • Resident discharged home with specific health needs and the family had not been informed of the situation – partly upheld • Bedroom not suitable for a resident who permanently uses a wheelchair – upheld • Staff told not to wash dirty laundry before 7.00pm because electricity in the evenings is cheaper – unresolved • Staff members’ son aged 11 was wheeling residents in wheelchairs from the dining room to the lounge – unresolved The requirements and recommendations at the end of this report reflect the Inspectors’ findings and take into consideration the complaint issues. • • One resident told the Inspector that he had cause to complain a few months previously about a staff member who was disrespectful to him. Although he is not aware of what happened about this member of staff he hadn’t seen her since, so was satisfied with the outcome. Independent advocates are involved in the life of one resident, and as a result appropriate protection of vulnerable adult meetings have been held. However the registered persons must review the way in which they have responded to the advice and guidance given, to ensure ongoing protection for the resident. Records must evidence any actions and decisions taken. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 17 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The environment provides comfortable, clean and hygienic surroundings however some parts of the internal premises, for example the sash windows, are not being maintained to an acceptable standard. This inaction by the registered persons to address necessary maintenance could result in residents being at risk of potential risk of injury and harm. EVIDENCE: Country View is a home made up of two parts, one part is a listed building and as such is old the other part of the home is an extension on the ground floor and is more modern. The grounds that surround the home are well maintained and provide a number of areas for the residents to use. There is disabled access to both entrances of the home. A gazebo has been erected and residents commented positively about this. Each area of the home was seen to be clean and hygienic, there were no unpleasant smells or odours. The laundry and sluice areas were of an acceptable standard. There were a number of residents requiring individual Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 18 lifting aids and pieces of equipment to enable safe transfers and provision of on going care. The equipment was in evidence around the home, and staff were observed using them. Gravel is the medium used for the drive to the front and around to the rear of the home. This use of gravel could be problematic to people in wheelchairs, both manually propelled and electrically driven. The registered persons should be continually reviewing the accessibility of the home in light of the needs of the residents and visitors. The garden areas are available for the residents to use. The registered person advised that residents don’t usually access the external grounds without a member of staff taking them. During the inspection 2 residents in wheelchairs had independently accessed the rear of the building into the grounds and one resident was taken out into the garden from the dining room by a relative. To ensure that all areas of the grounds are safe for residents detailed risk assessments should be developed. The registered persons should be proactively encouraging the residents to freely access the garden without having to wait for a member of staff to escort them. The standard of décor and furnishings are showing clear signs of wear and tear. A number of areas in the home are in need of redecoration, and a number of items of furniture are in need of replacement or refurbishment. • • • • • • Wallpaper and paintwork in some bedrooms needs attention The commodes in a number of rooms did not have a lid, but had a cushion cover placed over the open pot, A number of commodes did not have a properly fitting lid in place with a lid loosely placed diagonally across the pot. The condition of some of the commodes is unacceptable in that the varnish on one was completely worn away, and the paint covering on the metal structures of other commodes had peeled away. The floor in one bathroom was found to be very slippery and unsafe, (previous recommendation has been placed regarding the risk of slipping following discussion with the registered person) A high number of bedrooms did not have a bedside light in position. Some rooms that were shared rooms had one small lamp placed on a bedside cabinet, this lamp was positioned facing away from one bed towards the other bed in the room. Sash windows – a high number of these were unsafe to be used in that blocks of wood had been positioned by the windows to enable the windows to remain in an open position due to the sash cord being broken. Some bedroom windows could not be opened at all, thus preventing the user from having fresh air into the room. There were no lockable facilities in the residents’ bedrooms • • • Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 19 • • • • There were a minimum of residents’ bedroom doors that were able to be locked A number of rooms did not have in place the items of furniture as detailed in the National Minimum Standards In bedroom 7, located in the old part of the home, one floorboard was raised. The position of the raised floor–board is a potential trip hazard to any user of the room. The water temperature gauge on the additional Jacuzzi adaptation for one bath is broken and has been taped. The registered persons are strongly encouraged to review the lack of personalisation in a number of the bedrooms. Where a resident does not have personal items to bring with them it is the responsibility of the registered persons to make each area of the home welcoming and homely. Records should be in place where the resident has specifically requested otherwise. The lounge is divided into 4 quadrants with a television playing in each corner. The current layout does not promote resident individuality, choice and preference. When the televisions are on which at times can be different programmes, residents would have difficulty in being able to concentrate on the programme that they wish to watch. There are two other lounge areas that residents should be proactively encouraged to use to promote individuality. With the numbers and physical needs of the residents the registered persons are strongly recommended and to develop detailed risk assessments for the possible evacuation from this room in the event of a fire. One bedroom currently being used by a resident who is wheelchair dependant, and needs a hoist for all transfers is small and difficult to access. The registered persons are strongly recommended to find an alternative room to ensure that the needs of this resident can be more easily met and that the room can also have the additions of visual stimulants displayed around the room and from the ceiling. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Staff are positive in their approach to their work and work together as a team to improve the quality of life for the residents. EVIDENCE: At the beginning of each shift the senior in charge advises which staff are to take 1st or 2nd break thus ensuring sufficient numbers of staff are ‘on the floor’ to meet the resident’s needs. During the inspections staff were seen to be taking their breaks in line with this procedure. Each staff file contained evidence of training that staff have undertaken. Staff are proactively encouraged to undertake the NVQ (National Vocational Qualification). The registered person has responded to the previous recommendation to ensure that all staff receives infection control training to ensure that their methods are in line with current good practice. The registered person is strongly encouraged ensure that future training includes issues that are specifically pertinent to the needs of the current residents for example, communication skills, sensory impairment, care for the elderly. Staff files contained the necessary information, although there were some minor shortfalls. These shortfalls were discussed and the way forward agreed with the member of staff who has the responsibility of maintaining the staff files. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 The registered persons present strong leadership in the running of the home, with some tasks being delegated to the senior members of staff. However this headship does not always take into consideration the residents rights, choices and preferences. EVIDENCE: The registered manager of the home is also the registered provider along with her husband. Mrs Webb is a very experienced nurse, who has managed the home for some years. The registered manager spends a considerable amount of time in the home and appeared knowledgeable in relation to the needs of the residents. A number of fund raising events are carried out to boost the residents’ fund. The funds are used for a variety of purposes. A gazebo had been purchased earlier in the year for the residents to use. The gazebo was still erected and Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 22 residents said how much they had enjoyed using it. The registered persons should consider how to introduce a system that would inform all relevant peoples about how much money has been raised and what the monies are spent on. Safeguards should also be put in place that protects the interests of all residents when they are given the opportunity of giving a monetary gift towards presents for staff. Policies and procedures should be developed to direct staff to follow if any resident offers more that a reasonable amount, for example £1, or if any resident has lost the capability of discerning the worth of money. Staff did advise that no resident was put under pressure to give towards any gift and that some residents give 10p or 20p towards the purchase of gifts and or flowers. In response to a previous recommendation formal supervisions have been introduced for each staff member. Notes are taken and recorded at each staff member’s formal supervision. The senior member of staff maintains the records of these meetings. A number of the senior staff have been delegated with specific tasks and responsibilities. However the registered person is reminded that it is her responsibility to ensure that observations and spot checks on staff’s practices are undertaken to maintain the safety of the residents. The following health and safety risks were identified during the inspection: • A numbers of rooms had tubes of a tooth-cleaning agent, Steradent, in residents’ rooms. These tubes were not locked away but on open display and could be accessed by any body in the home; ingestion of these tablets could prove fatal. A high number of wheelchairs did not have footplates in place. A high number of sash windows are in need of urgent repair The electric wires from the electric socket to a telephone and wheelchair charger were trailing across the floor There was no evidence of an occupational therapist having been involved in assessing the home. • • • • Risk assessments were limited in their information, and did not give sufficient instruction and guidance for staff to follow in managing and minimising any identified risk. Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 2 3 3 2 2 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 2 3 2 1 Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation Reg 14 Requirement The pre-admission assessment must be further developed to ensure that all relevant information is sought prior to any new admission. The care plan must contain sufficient instruction and guidance for all staff to aid the provision of care. Records must evidence that health care professionals are involved in maintaining the health and welfare of each resident. The registered persons must make arrangements to meet the specific stimulation needs of the identified resident. Records must evidence how all residents are empowered to exercise choice and control over their lives. The practice of feeding two residents simultaneously must stop. The Registered Persons must ensure protection to all residents in their care. All windows with sash DS0000012609.V256313.R01.S.doc Timescale for action 30/12/05 2 OP7 Reg 15 30/12/05 3 OP8 Reg 12 30/12/05 4 OP12 Reg 16 (m) & (n) Reg 16 30/11/05 5 OP14 30/12/05 6 7 8 OP15 OP18 OP19 Reg 12 Reg 13 Reg 13 30/11/05 30/11/05 11/10/05 Page 25 Country View Nursing Home Version 5.0 9 10 OP19 OP19 Reg13 Reg 23 11 OP19 Reg 23 12 OP19 Reg 23 13 14 OP22 OP23 Reg 23 Reg 23 15 16 OP25 OP35 Reg 13 Reg 13 17 OP38 Reg 13 18 OP38 Reg 13 19 OP38 Reg 13 mechanisms must be made safe. The trip hazard in Bedroom 7 must be made safe. A re-decoration and refurbishment programme must be developed to ensure that all parts of the home are maintained to a satisfactory standard. All residents must be provided with a lockable storage space, bedside lights and sufficient comfortable seating. Records must evidence where residents have declined this provision. All commodes are to be reviewed to ensure that there are sufficient covers for each pot, and that the condition of each commode is of an acceptable standard. An assessment of the home by an occupational therapist must be arranged. All rooms must meet the identified needs of the resident, including visual stimulants where identified as essential. Trailing electrical wires must be positioned so not to present a trip hazard. Policies and procedures should be developed to protect the residents when financial transactions take place in the form of monetary gifts. All wheelchairs must have the foot-plates in place, unless individual specific requirements are evidenced in a detailed risk assessment and retained in the individual’s plan of care. All tooth cleaning agents for example Steradent must be stored in a manner that affords safety to all residents. Where a risk for any person in DS0000012609.V256313.R01.S.doc 11/10/05 30/12/05 30/12/05 30/11/05 30/12/05 30/11/05 11/10/05 30/12/05 11/10/05 11/10/05 30/12/05 Page 26 Country View Nursing Home Version 5.0 the home is identified a detailed risk assessment must be in place that instructs and guides staff in how to manage and minimise the identified 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 Refer to Standard OP13OP12 Good Practice Recommendations The registered persons should be actively consulting and involving the residents in the development of any activities programme to ensure that individual expectations, preferences and choices have been identified and considered. The registered persons are strongly encouraged to review the current seating arrangements in the main lounge. The meal-time records must be consistently maintained and be a true reflection of the foods offered to the resident. The residents should be encouraged to access the gardens freely. The registered persons are strongly encouraged to review the current medium used on the driveways to and around the home to ensure that people using wheelchairs can access the home with ease. The registered persons are strongly encouraged to aid residents to personalise their rooms All staff files should be reviewed to ensure that they contain all documentation as detailed in the National Minimum Standards. The staff training programme should be reviewed to ensure that it contains specific training to meet the needs of the residents in the home. Records should evidence how residents have been involved in decisions that impact on their lives. The registered persons should consider ways in which they can be transparent and open in providing interested parties with results of fund raising events, and what the accumulated monies are to be spent on. 2 3 4 5 OP12 OP15 OP20 OP20 6 7 8 9 10 OP24 OP29 OP30 OP33 OP35 Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Country View Nursing Home DS0000012609.V256313.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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