Inspection on 14/11/06 for Cowbridge Nursing Home

This inspection was carried out on 14th November 2006.

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

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

Other inspections for this house

Cowbridge Nursing Home 26/03/09

Cowbridge Nursing Home 09/10/08

Cowbridge Nursing Home 28/03/08

Cowbridge Nursing Home 15/08/07

Cowbridge Nursing Home 10/05/07

Cowbridge Nursing Home 15/05/06

Cowbridge Nursing Home 06/03/06

Cowbridge Nursing Home 16/08/05

Cowbridge Nursing Home 27/01/05

Cowbridge Nursing Home 20/07/04

Similar services:

Fairfields Country Rest Home

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Fairfax House

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

CARE HOMES FOR OLDER PEOPLE Cowbridge Nursing Home Rosehill Lostwithiel Cornwall PL22 0JW Lead Inspector Diana Penrose Key Unannounced Inspection 14th November 2006 09:00 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 Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cowbridge Nursing Home Address Rosehill Lostwithiel Cornwall PL22 0JW 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) 01208 872227 01208 873109 Cornwallis Care Services Limited Mr Vaithilingam Herren Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30) Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include one named adult under 65 years of age with a mental disorder (MD). 15th May 2006 Date of last inspection Brief Description of the Service: Cornwallis Care Services Ltd, own two nursing and one residential care home in Cornwall. Cowbridge Nursing Home is registered to provide accommodation and care to 30 service users who may experience mental health problems or dementia. Cowbridge Nursing Home is a detached property situated on the outskirts of Lostwithiel. The original house has a modern day extension. The grounds are extensive with views over the surrounding countryside. There is an area of garden and a patio that are enclosed and accessible to service users. Accommodation is provided on two floors with a small passenger lift for access. There are rooms for both single and double accommodation - only one room has en-suite facilities. Assisted bathing and shower facilities are provided although limited. All rooms have call bells. There are three non-smoking sitting rooms with dining incorporated. One sitting room is being used as a staff room at the moment. Information about the home is available in the form of a service users’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £467 to £565 per week; the registered manager supplied this information to the Commission. Additional charges are made in respect of chiropody and hairdressing. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited Cowbridge Nursing Home on the 14 November 2006 and spent eight hours and fifty minutes at the home. This was the second key inspection and an unannounced visit since April 2006. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that service users’ placements in the home result in good outcomes for them. It was also to gain an update on the progress of compliance to the requirements identified in the last inspection report dated 15/05/06. All of the key standards were inspected. On the day of inspection 29 service users were living in the home. The methods used to undertake the inspection were to meet with a number of service users, relatives, staff and the registered manager to gain their views on the services offered by Cowbridge Nursing Home. Records, policies and procedures were examined and the inspectors toured the building. This report summarises the findings of this inspection. The home is poorly managed and run. There are many issues that present risks to service user’s safety. These are mainly due to the failure to identify and assess risk and make appropriate safeguarding arrangements. There is a lack of knowledge and skills around environmental and care practice issues for people with dementia. This home is subject to a management review, which is a key part of our enforcement process. A review will draw up an action plan for each service included in a regional improvement strategy and for services where serious concerns are raised about the delivery of care. The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2006 came into force on 1st July 2006. This allows us to ask registered persons to send us an improvement plan and makes it an offence it they do not. We have already met with the registered persons and required an improvement plan. Some of the areas of concern in this report are to be addressed in this plan. Failure to comply with the improvement plan could lead to enforcement action being taken. What the service does well: Information about the home is available for prospective service users. Service users appear to have their personal care needs addressed appropriately for instance they appear clean, dressed well and appropriately Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 6 and receive suitable portions of food. Staff appear to be caring and showed compassion and concern regarding service users needs. Sufficient numbers of staff are on duty and they respond to service users promptly. The building was warm clean at the time of the inspection, and there were no unpleasant odours. What has improved since the last inspection? What they could do better: This key inspection has produced a significant number of statutory requirements, many of which are re-notified. These are legal requirements, which must be implemented by law. As above an improvement plan is already in place for this home. The assessment of prospective service users needs to be thorough and include information from other agencies, the records examined were inconsistent. Although all service users have a care plan they tend to be generic and not Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 7 tailored for individual needs. They must be more detailed and be updated to direct staff in the care to be provided. There are some areas of improvement required in respect of medications including the review of the policy. Significant improvement needs to occur regarding arrangements for service users’ daily life and social activities. Most service users in this home have significant physical health and mental health problems. There needs to be more emphasis on assisting service users to maintain some degree of selfdetermination and self-respect. For example, despite impairment, many service users have the ability to make some degree of choice such as what they want to eat, how to spend their time and when to get up and go to bed. There does not seem to be much evidence of choices being encouraged or opportunities, for example, for mental stimulation being offered. Requirements have been made to improve arrangements for meal times, activities, and arrangements for getting up and going to bed. The physical environment is poor. Despite the outside of the building being attractive and it being situated in generally pleasant surroundings, maintenance seems only reactive. Significant improvement to facilities provided, decoration and furnishings is necessary. For example there are insufficient specialist bathing facilities, and furnishings and decorations in places are shabby and in need of refurbishment / replacement. Although the registered persons do need to ensure service users are physically safe, some of the restrictions on movement of individuals may be over cautious. For example all bathrooms and toilets are locked, so it is not possible for service users to go to the toilet without asking, and people appear to be restricted to a small area (lounge and corridor) during the day. Recruitment and training of staff needs improvement. Some staff still do not appear to have a criminal records bureau check / protection of vulnerable adults check which is required by law. The provision of two references is not complied with for some staff that have started since the last inspection in May 2006. Although some training has been provided, there are still gaps in the provision. For example there needs to be an appointed first aider always on duty and moving and handling training needs to be comprehensive. Staff need to have some training in mental health needs and the needs of people with dementia. This will assist, what appears to be a caring and compassionate staff team, to have better awareness and guidance regarding the needs of people with these diagnoses. The management of the home is poor; there is a great deal to be done and many regulatory issues to address. An improvement plan is in place and an operations manager has been employed to assist all three homes owned by the company. The registered persons still do not have a quality assurance system, although inspectors were told this is in hand. There is subsequently no formal method of ascertaining service users and other stakeholder’s views, developing quality practice and improvement in the home. Despite the legal requirement for the Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 8 registered provider (or representative) to visit the home unannounced on a monthly basis and send a report to the commission, reports have not been forwarded to CSCI since August 2006. There is therefore no evidence the registered provider is meeting their legal responsibility to monitor (and where necessary) bring improvement. Health and safety standards have improved since the last inspection. However emergency fire lighting needs to be tested regularly by staff, portable electrical appliances need to be tested annually and the electrical hardwire circuit needs to be tested at least every five years. Copies of testing of portable electrical appliances, the electrical hardwire circuit and gas appliances need to be forwarded to the commission when this work is completed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users are given information about the home to enable them to make an informed choice of home. Most service users have a written contract and terms and conditions of residency but this is not consistent and some are not signed. Service users are only admitted to the home following an assessment of their needs the format of this assessment is appropriate but tends not to be signed or state who was involved, information from other relevant healthcare departments is not always obtained prior to admission. EVIDENCE: Evidence was provided in the form of documentation, records, case tracking three service users, interviews with service users, relatives, staff and registered manager Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 11 The home has a statement of purpose and service users guide. The statement of purpose has been reviewed and updated and now includes the information listed in Schedule 1. It also gives more information about the services provided, or not provided, by the home. Te requirement set at the last inspection is now met. It was recommended at the last inspection that all service users have a signed contract with terms and conditions of residency. Contracts inspected had been signed but not all service users’ that were case tracked had a contract or terms and conditions. The registered manager said that the newer service users adult social care contracts maybe with the family for signing and the company terms and conditions may not have been issued from head office. The recommendation remains. The registered manager said that prospective service users are visited, often in hospital, prior to deciding to admit them to the home. The form used to record the assessment is comprehensive and covers all of the areas listed in standard 3.3. Not all of the assessments inspected were signed or dated by the person carrying out the assessment and this was discussed with the registered manager who agreed to do it in future. Three service users files were inspected and only one had an adult social care assessment on file, these assessments and any hospital information, and so on, must be obtained prior to agreeing to admit a service user and this was discussed with the registered manager. It is again recommended that the assessment document state who is involved in the assessment process and from where the information is obtained. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual care plans are generated for each service user but they do not fully inform and direct staff in the care to be provided. Service users have access to health care services as necessary, policies must be updated to ensure staff deliver care appropriately and ensure that assessed needs are met. There is a system for dealing with service user’s medicines; the policy is still being updated extra vigilance is required in some areas to ensure service users safety. Systems are in place to ensure that service users are respected and their privacy is upheld. EVIDENCE: Evidence was provided in the form of documentation, records, observation, case tracking three service users, interviews with service users, relatives, staff and registered manager. Four requirements and two recommendations were notified at the last inspection in respect of care planning. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 13 The requirement that care plans be available to staff is now met. The manager said he sends a copy of the individual’s care plan to the power of attorney or designated representative and they sign to agree this, which meets another requirement. The two requirements in respect of risk assessment are renotified. There needs to be more detailed risk assessments for each service user and the care plans must refer to these to safeguard service users. Some risk assessment forms are on file but many are not completed. There must be a specific risk assessment undertaken for those at risk of falling; for example the Tullamore assessment tool. There is no written risk assessment undertaken for those requiring restraint but relatives do sign agreeing to the use of cot sides and wheelchair lap straps as recommended at the last inspection. Staff have not received training about restraint. It was recommended at the last inspection that all care documentation for an individual service user be held in one file, this is still not happening. Care plans are held in individual folders and some contain the initial assessment information and a few individual risk assessments. The rest of the documentation for individuals is held separately. There was little evidence that care plans are reviewed regularly, if at all. Care plans are generic and not updated to reflect the individual’s needs, for example one service user assessed as at risk of developing pressure sores had no care plan in respect of the prevention of sores developing. The registered manager said he will consider a change to handwritten care plans and involve the nursing staff. Life histories should be compiled for all service users, to inform staff and enable them to provide appropriate care, this was recommended at the last inspection. Staff confirmed they are aware service users have a care plan, and said these are available to them. The majority of service users the inspector spoke to were satisfied with the care they received. Care practices observed were satisfactory. Dementia training would enable staff to have a greater understanding of the cognitive abilities of service users with this condition. For example, a member of staff said a service user did not understand what was being said although the inspector was able to have a reasonably coherent conversation with her about the home and her family. The registered manager told the inspectors at the start of the inspection that 95 of service users could not communicate but the inspectors were able to communicate with service users who had varying degrees of impairment. Staff do appear to be caring and considerate to service users, but attitudes and knowledge need nurturing to enable service users to have a greater degree of selfdetermination and self-respect. There was evidence within the care documentation of visits by healthcare professionals. Suitable equipment is available to staff for moving and handling purposes and pressure relief. Records are maintained for the treatment of pressure sores and other wounds, a nurse said that the community tissue viability nurse specialist is auditing the homes wounds in December 2006. The Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 14 manager said the home’s pressure sore policy is still in the process of being updated, the requirement is re-notified. None of the nurses specialise in a particular subject or act as links with external specialists. The medicines policy is still being updated, the requirement is re-notified. A monitored dose system is in use. Medicines are only administered by registered nurses, the manager and one of the nurses said that all the nurses have recently undertaken training in medicine matters facilitated by a pharmacist; the training records do not show this clearly. The medicine administration records were complete however ‘as required’ medicines must state the number of tablets administered. Disposal records must include individual medicines refused, dropped on the floor, and so on, this was discussed at the last inspection. Thick and easy powder prescribed for an individual service user must not be administered to anyone else, this requirement is re-notified . There must be an approved list of homely remedies signed by a GP. The storage of medicines and medicinal gases is satisfactory. All of the issues were discussed with the registered manager and one of the nurses. Service users’ privacy was upheld during the inspection. Shared rooms are provided with appropriate screens. Privacy and dignity is included in the home’s statement of purpose and there is a policy. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provides some activities but it is not clear whether they meet service user’s needs. Links with family and friends are good and allow service users the opportunity to socialise in the home. Staff respect some of the service users individual preferences and choice however more needs to be done to ensure they are provided with suitable choices and opportunities to live as they wish. Dietary needs of service users are catered for with a varied menu; this menu and the dining experience for service users is not acceptable and must be reviewed. EVIDENCE: Evidence was provided in the form of documentation, records, observation, case tracking three service users, interviews with service users, relatives, staff and registered manager. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 16 Structured activities are arranged twice a week. For example a musical entertainer visits. Interaction between staff and service users was generally satisfactory on the day of the inspection. The registered manager said staff try to spend time talking with service users. Staff said most of their time is taken up attending to service user’s care needs although they do try to engage in conversation. Service users were positive about support provided. The more able service users tend to spend time in their bedrooms watching TV or listening to the radio. One member of staff acts as an activities co-ordinator, some records are maintained, although spasmodic. There are posters on display advertising a forthcoming Christmas bazaar and the manager talked about a Christmas party. There is no evidence of community contact such as contact with the church, trips out or contact with community groups. The evidence from this inspection suggests there is more scope to develop activities for greater stimulation in line with service users’ interests. Some staff said that although service users do not get up before the day staff come on duty at 07:30, service users have to be ready for breakfast at 09:00. This creates significant pressure on both staff and service users. They said breakfast is only served until 9:30. Other staff however did not state there was a problem. The registered manager said breakfast time was relatively flexible, although some service users needed to have their medication with food. The registered persons, and other staff need to monitor this situation to ensure, where appropriate, service users are provided with a choice of when they can get up and when they can have their breakfast. If medication needs to be administered, this can be given, with food, in a service user’s bedroom if that is the service user’s wish. Service users spoken with said they could get up and go to bed when they wished. Some staff said all service users have to be ready for bed by 19:30 before the end of the day shift. This may be the case even if some service users want, for example, to watch television. Other staff did not state there was a problem. The registered manager said it was appropriate that some of the more vulnerable service users, who have complex needs, go to bed before 19:30. He said that where possible choice of bedtime is encouraged. It is again essential the registered persons monitor this situation to ensure, for example, care routines are not organised around shift times and so on. Service users confirmed they can have visitors when they wish. Visiting times appear to be flexible. The inspector spoke to two visitors who said they are happy with the care and support provided to their relative. One visitor said her mother’s health has improved a lot since she has lived in the home, and was very positive regarding the support provided by the staff. Service users are able to bring personal possessions into the home, and this is evident in service user bedrooms; the presence of photographs, ornaments and pictures etc. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 17 The inspector was present at the mealtime. A majority of service users had their meal in their lounge chair in one of the two lounges, a few got up to the table. A similar situation was observed at the last key inspection in May 2006. There is no dedicated dining room for service users. The manager said it had been agreed it would be difficult for many of the service users get up and go to another room, considering pain suffered and mobility difficulties. He also expressed concern that service users may go into the kitchen or outside through one of the external doors if walking to the dining room. Although it is accepted that some service users may not be able to get to the dining room, others may be able with appropriate support. This may, in itself, prove an enjoyable experience for service users. The food storage trolley remained in the centre of the lounge while people were eating their meal. Dirty crockery and cutlery was placed on the top, this does not inspire appetite. There was also a strong smell of food, which must be unpleasant for service users who do not wish to eat. The inspectors are concerned this situation was not historically the case and recently the dining room has been decommissioned without any consultation with the Commission for Social Care Inspection. Staff support with meals seemed to be satisfactory; staff were assisting service users with feeding and there was some interaction. The meal was sausages and gravy, with potatoes and frozen peas. A sweet of treacle sponge was served afterwards. Food was pureed for service users who could not eat solid food. Most service users the inspector spoke to said the food was okay although others said they did not like it very much. Homemade cakes are available for service users. The kitchen was clean and tidy, the cook and a kitchen assistant were on duty. The cook was making a birthday cake for a service user, which looked very appetising. A menu is displayed in the kitchen. The cook said a separate record of food actually provided was not kept although some records of food brought in by relatives was seen. She said there is seldom deviation from the menu unless the nurses instruct her, for medical reasons. There does not seem to be any provision for service users to be given a choice of food. The inspectors suggested even if service users could not express a choice themselves, their preferences could be recorded in their care plans and / or a record of this kept in the kitchen. Some staff and service users said the menu did not vary very much. The registered manager has accepted this and is hoping to introduce a new menu shortly. The manager and another member of staff expressed concern that some of the meals could present a choking hazard. The registered manager said this matter would be addressed in the current review. Arrangements for mealtimes, support given to service users and the food provided must be reviewed. Service users’ preferences regarding food must be considered, for example there should be a choice of meal and possibly a ‘sweet trolley’ introduced. Suitable records must also be kept. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 18 Many of the service users are not able to make significant decisions about their lives due to their physical health and cognitive impairment. However the inspectors do feel there is further scope for encouraging service users to make decisions. The areas of daily routines and mealtimes have been discussed in this section of the report, and improved practices here could provide a start for improving choices. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that ensures complaints are listened to and acted upon. Arrangements are in place for the protection of service users; further action is required to safeguard them from harm or abuse EVIDENCE: Evidence was provided in the form of documentation and discussion with the registered manager and staff. The home now has a suitable complaints policy and a method for recording complaints. No complaints have been received by the home but concerns have been raised to the Commission on one occasion since the last inspection. These were regarding moving and handling and accessing staff in the home, they were investigated by the registered manager and not upheld. The home’s adult protection policy has been a longstanding issue, which has been notified three times. The manager says this policy is still in the process of review and will be completed by the end of the year; the requirement is notified for the fourth time. Many staff have received training regarding the protection of vulnerable adults from abuse delivered by Cornwall County Council. Staff who have attended this found it informative and interesting; the rest of the staff now need to receive appropriate training. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 20 There has been one abuse issue in the home since the last inspection, referred to adult social care. The registered manager must ensure that suitable employment checks are undertaken prior to staff working in the home. These issues have been raised with the registered manager at previous inspections and requirements notified. This area is covered under standard 29 of this report. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is maintained to a very basic standard and a lack of equipment and suitable facilities may put service users’ health and safety at risk in certain cases; decoration, furnishings and fittings require refurbishment and replacement, so service users can be provided with a suitable, pleasant and homely environment. There are sufficient toilets in the home however bathroom facilities require significant improvement to assist service users who are frail and/ or have mobility problems to bathe. The home is kept clean and the strong smell of disinfectant is reducing. EVIDENCE: Evidence was provided in the form of a tour of the building, documentation, and interviews with service users, relatives, staff and registered manager. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 22 The building was inspected and although clean, the building is getting very run down. Carpets are beginning to look worn and many areas of the home are in need of redecoration. The grounds are generally pleasant and the decoration of the outside of the home is satisfactory. A new patio area has been developed for service users use. Security and safety have improved. Building work was being done at the time of the inspection; some window frames are being replaced, and a staff / storage area is being created at the rear of the building. Staff commented that a lot of work is being done all over the home and it looks untidy, they would prefer one area to be completed before another is started. The window frames in one of the lounges did not appear to contain safety glass, despite the frames being replaced. The registered persons health and safety audit highlighted safety glass needed to be fitted in line with current regulations. Urgent action must be taken to safeguard service users and staff who may be injured by broken glass in the event of an accident. Bedrooms offer basic accommodation. As stated in the previous inspection report there is some individualisation of bedrooms, but on the whole colour schemes and carpets offer little variety. Many articles of furniture in bedrooms look worn and in need of replacement. Bedrooms do not have locks on the doors. Wallpaper in bedroom 22 is peeling off, this was reported at the last inspection in May 2006 but no action has been taken. Bathroom facilities are inadequate. Many of the bathing facilities are domestic in type and not suitable for service users who are in pain and or have mobility problems. There are currently no specially adapted facilities on the first floor resulting in service users having to go downstairs to have a bath. Some of the service users on the first floor have to spend significant periods of time in bed, so bathing facilities are particularly inappropriate, especially as the lift is on the small side. Work was being completed on the day of the inspection to refurbish the upstairs bathroom. Although the bath to be fitted will be better situated to enable a hoist to be used, the bath will still be domestic in type. The registered manager said it was too expensive to purchase, for example, a ‘Parker’ type bath although such a facility would be more appropriate than that proposed. Staff said many service users were currently washed in bed, and they felt service users should be able to have a bath. Staff reported that arrangements for washing service users hair (who are in bed) are not adequate. For example there is not suitable equipment, and staff have to manoeuvre the persons head over the side of the bed in order to wash hair. Suitable equipment to prevent this arrangement needs to be purchased as a priority. Bathrooms and toilets on the ground floor of the home are locked denying service users free access. The registered manager explained this is attributed Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 23 to the inappropriate behaviour of service users, one in particular. It is of concern that all service users are restricted from using toilet facilities freely and that the design of toilets and bathrooms are unsuitable for the client group. Many service users are situated in one lounge, during the day, although they can walk up and down the corridor internal doors are locked causing restriction. This means for some service users confinement to this part of the home for long periods of the day. The home is poorly managed in this area and there is a lack of knowledge and skills around environmental and care practice. The inspectors are also concerned that a lounge / diner facility intended for the use of service users is being used as a staff room. This means there has been a reduction in the level of communal facilities available. There has been no consultation with the Commission of Social Care Inspection regarding the change of use of this room. Concerns have been raised earlier in the report regarding dining arrangements. It has been agreed with the inspectors that the registered persons will provide the commission with the dimensions communal rooms available to service users so the commission can ascertain whether the space is adequate. The registered manager raised concerns that using a dining room facility could result in service users going outside the building, via the kitchen for example, subsequently putting themselves at risk. The registered manager must remember that service users are not held under any form of section under the Mental Health Act 1983 and their rights of freedom of movement cannot be restricted under the Mental Capacity Act. If there are issues where service users could be put at risk this needs to be managed through suitable staff support, and appropriate aids and adaptations. An occupational therapist would be able to advise on suitable aids and adaptations. Any restrictions or restraint must be risk assessed, and the service user’s representatives need to be involved in such decisions. A door to the kitchen has been blocked halfway up the doorframe. The manager said he intends to get a hatchway fitted there. Staff did not know what was being done and said they were not consulted; the boarding at the moment looks unsightly. There is a ‘fire door’ sticker on the inside of the door; the manager stated that he has liaised with the fire officer and he is satisfied with the door being blocked off. The home was observed to be clean and the unpleasant smell of disinfectant, evident at the last inspection, has reduced. The laundry facilities are satisfactory and suitable hand-washing facilities are provided with alcohol hand cleansing gel available for staff use. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels appear to be satisfactory so service users can be assured they will receive appropriate levels of support from staff. Service users should be in safe hands and benefit from the 88 of care staff trained to at least NVQ level 2 in care. Recruitment procedures are not robust enough to offer maximum protection to the service users. The training provided for staff is not sufficient for them to be fully skilled and competent in their roles and assure service users safety. EVIDENCE: Evidence was provided in the form of documentation, records, observation, case tracking three service users, interviews with service users, relatives, staff and registered manager The rota was inspected, and the inspector was provided with the names of staff on duty on the day of the inspection. There seemed suitable numbers of staff on duty, and service user’s needs appeared to be met promptly. On the day of the inspection the following staff were on duty: • From 0730 until 13:30 2 nursing staff. • From 0730 until 1330 6 care staff. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 25 • • • From 13:30 until 1600 2 nursing staff, one of whom is working until 19:30. From 13:30 until 18:30(1) or 19:30 (5) care staff From 19:30 until 07:30 1 nursing staff and 2 care staff. Auxiliary staff such as cooks, cleaners and maintenance staff are also provided. Staff support was observed to be professional and competent. The majority of service users said staff were supportive, friendly and caring. The registered manager appears to have a satisfactory approach to ensuring staff have a National Vocational Qualification in care. The registered manager stated that seven care staff have achieved NVQ level 3 and seven have achieved NVQ level 2, only two care staff are not qualified. Copies of NVQ certificates were maintained on staff files inspected. The registered persons approach to recruitment appears to take issues regarding equal opportunities and diversity into consideration. There is an equal opportunities policy in place. Staff from different nationalities and cultures are employed. The inspectors spoke to staff who said they are treated fairly and have not been subject to any racist behaviour by the employers, service users or colleagues. Staff files were inspected; ten in total. Information obtained for recruitment purposes was adequate. Two of the three staff recruited since the last inspection did not have two written references. Some staff did not have a suitable CRB check (e.g. the CRB was not re-checked if the person commenced working in the home after July 2005) and in some cases there was no evidence that a CRB check had been completed. The registered managers approach to ensuring staff have the training, required by regulation has improved since the last inspection. There was evidence that most staff have received training in fire prevention / fire procedures, moving and handling, and infection control. This training is completed internally. In respect of moving and handling training, some staff said they had not been shown how to use the hoist or other moving and handling equipment, they also said the training had been quite basic; for example they had been shown a DVD. Other staff however said they were shown how to use the equipment. Any moving and handling training must be thorough, demonstrate the correct use of equipment and only be completed by an appropriately qualified trainer. The registered manager said he does the training for staff; he said he has completed the trainer’s course and had documentation in respect of this. The cook on duty had an intermediate food hygiene certificate and there were copies of food hygiene certificates for the other catering staff on the kitchen wall; most require updating. Any member of staff who handles food (for example making sandwiches) should have a food hygiene certificate. There is little evidence that staff have completed first aid training to appointed persons Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 26 level. The registered manager said three care assistants, and two nurses are appointed first aiders. The registered persons must ensure there is always a first aider on duty. Staff training regarding mental health issues and dementia is minimal. Of the ten staff records inspected, there only appears to be one member of staff who has training regarding dementia. There seems to be no other training regarding mental health issues. No staff have received any training regarding challenging behaviour. The registered persons previous action plan however states staff will receive this training by 31/12/2006. New staff must receive a comprehensive induction including statutory training. The registered manager has completed a suitable induction checklist for new staff. Staff the inspector spoke to said they had spent their first day with the registered manager. They then had worked with experienced staff who explained processes and procedures, until they were deemed competent. However there was no evidence on the three staff files inspected (staff who commenced employment since May 2006) of any induction taking place. The registered manager said the staff maintained these records until the induction was completed. These records must be available for inspection, and will be inspected on the next key inspection. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This home is poorly managed and run, in many areas as practices evidence a lack of skills and knowledge about environmental and care issues. The company has appointed an operations manager to co-ordinate the management of the company’s three homes; he should provide support to the registered manager and communication between the home and the registered provider. It is not clear that service user’s can air their views or that the home is run in their best interest as there is no quality assurance system in place. There is a system in the home for dealing with service users’ money; further safeguards must be put in place to protect the service users’ financial interests. The supervision of staff is inadequate and does not assure that staff are supported or assisted in their roles. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 28 Health and safety measures are completely unsatisfactory; there is little assurance that service users live in a safe environment. EVIDENCE: The registered manager is a Registered Mental Nurse and he said he has achieved an executive diploma in management (level 5). He said he has recently undertaken training in medicine matters, heart failure and a moving and handling update. He also said he is working towards a PhD in Alzheimer’s disease. The home is poorly managed and run. There is still a great deal to achieve and many requirements outstanding. The company has appointed an operations manager to co-ordinate the management of the company’s three homes; the registered manager said this would increase the level of support available to him. Staff in general said the manager is approachable, enthusiastic and does get things done. Some said he tries to do too many things at once rather than completing one task at a time, this mainly referred to environmental issues. One commented that he tends to rush into things without thinking. At present there is no evidence of any quality assurance processes, consequently there appears to be no formal consultation between the registered persons, service users and their representatives to improve the service. There are no surveys, no regular staff meetings, no service user / relatives meetings and no internal audits. There has been one external health and safety audit that has not been fully addressed. At the last inspection in May 2006, the registered manager said he had received a quality assurance package, but not had time to implement this. This still seems the case and a system must be introduced as a priority. The quality assurance system must incorporate a suitable system of ascertaining the home clearly meets regulatory requirements and checking that any action by statutory regulators is being implemented within agreed timescales. The registered manager said the new operations manager would be developing a quality assurance system and re-commencing the visits and reports necessary under regulation 26. The Commission for Social Care Inspection has not received any copies of visits by the registered provider (or designated representative) since 02 August 2006. These must be completed on a monthly basis and copies of the reports forwarded to the commission. The policy for the management of service user’s money still requires updating and the requirement set at the last inspection is re-notified. Service user’s money is held in a non-interest account, the registered manager and clinical manager are signatories. Individual records are kept on the manager’s computer and receipts are kept in the safe. The registered manager said a copy of the service user’s record is available to the family on request. He also said that copies are printed, signed by him and another staff member, and Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 29 then kept in the service user’s file. Receipts are given to relatives when funds are paid to the manager. The registered manager stated that money is only held to cover the cost of services such as hairdressing and chiropody and the receipts for these services are signed by two staff members. Service user’s family deal with personal purchases for clothing and so on. Petty cash is held for emergency use. Care staff appear to be supervised by the nursing staff on a day-to-day basis. There is documentary evidence that the registered manager and the clinical manager have undertaken some one to one supervision sessions jointly. Supervision has not been undertaken for all care staff and it is not regular. Staff the inspector spoke to say there are formal staff handovers each day where they are given an update on service users care. The requirement set at the last inspection is re-notified. The home has a health and safety policy. A health and safety audit was completed by an external organisation and lists a significant number of requirements. The registered persons have completed an action plan regarding the audit; although some action has been taken further progress needs to be made. Health and safety records were inspected; health and safety risk assessments were completed in 2005, these should be reviewed at least annually. A fire risk assessment is in place (dated 10/2003). Again this should be reviewed regularly. There are suitable test records regarding fire alarm call points, but there is no record that emergency lighting is tested in accordance with guidance by the fire authority. However external contractors are completing their tests of emergency lighting and the fire system, and a contract for servicing the fire alarm and lighting is in place. The registered manager said the temperature of the hot water is controlled centrally. Records show on 7/11/06 the hot water was discharged at 42 degrees upstairs and 44 degrees downstairs. This needs to be monitored carefully as temperatures should be no more than 43 degrees at the outlet. The external health and safety audit states there is no temperature control of hot water and it did not seem apparent that regulators were fitted to baths and wash hand basins. Considering the diagnoses and vulnerability of the service users accommodated, the registered persons must review and risk assess to ensure that hot water is discharged within the ranges set by the Health and Safety Executive (HSE). There is no policy regarding the prevention of Legionella and no risk assessment is in place regarding this. However Restormel Borough Council has completed a test on the home’s water, and the results of this were satisfactory. After discussion at our previous inspection the registered manager said he had liaised with the Health and Safety Executive regarding regulations about Legionella. Unfortunately it appears the registered manager was referred Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 30 back to CSCI. The HSE publishes a leaflet on Legionnaires’ Disease, which can be obtained from the HSE (Tel 01787 881165). This details legal requirements e.g. issues that need to be considered when preparing a risk assessment. Information is also available on the HSE’s website at www.hse.gov.uk There are also a number of consultants who will carry out a specialist survey which may be required. Portable electrical appliances were last tested in October 2005 and now need to be done again (annual test). An electrical contractor carried out an electrical inspection and issued a list of defects. It does not appear that an electrical hardwire certificate has been issued. Subsequently the remedial work must be completed and a copy of the electrical hardwire certificate subsequently sent to the commission. By law this must be completed every five years. The boiler appears to have been serviced in June 2006, but there does not appear to be a landlord’s gas safety certificate, a copy of this needs to be forwarded to the commission and appliances must be serviced at least annually. The home has a very basic moving and handling policy that requires reviewing. Manual handling risk assessments are not completed for many service users and should be done for all service users. New wheelchairs have been purchased with suitable footrests in situ, practice was observed to be safe during the inspection. Staff have received some health and safety training. This is documented in full in the previous section of the report. Several requirements are re-notified in respect of this section of the report. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 2 1 1 x x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 2 x 1 Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered persons shall prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered persons shall keep the plan under review. • The care plans must detail all of the service user’s needs to inform and direct staff in the care to be provided. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety, any activities in which service users participate are so far as reasonably practicable free from avoidable risks and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. • Relevant risk assessments must be undertaken for each service user and there must be a specific risk assessment undertaken for those at risk DS0000009169.V320551.R01.S.doc Timescale for action 01/03/07 2 OP7 OP21 OP22 OP38 13(4)(b) (c) 01/03/07 Cowbridge Nursing Home Version 5.2 Page 33 of falling and for the use of any form of restraint. • There must be an indication as to how risk assessments are scored and the actions to be taken must be recorded in the care plans to direct staff rd 3 notification • Service users must be individually risk assessed regarding their ability to use bathroom / toilet facilities, and where necessary suitable support measures put in place. The registered persons should seek specialist advice from external professionals regarding alternative strategies to locking bathrooms / toilet doors to prevent access. • The registered persons must liaise with the Health and Safety Executive to ascertain that precautions to control the temperature of hot water (at outlet) are satisfactory. Any recommendations must be implemented. 3 OP8 12(1) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users and to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. • The pressure sore policy must be reviewed and updated. • The registered provider must improve bathing facilities throughout the home. (These must be provided at appropriate places in the premises and in sufficient DS0000009169.V320551.R01.S.doc 31/12/06 Cowbridge Nursing Home Version 5.2 Page 34 numbers. Suitable specialist facilities such as a ‘Parker’ type bath and walk in shower must be considered) 2nd notification 4 OP9 13 (2) The registered persons shall 31/12/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. • The medicines policy must be further reviewed and updated • ‘As required’ medicines must state the number of tablets administered on the chart • Anything prescribed for an individual must not be administered to anyone else • Disposal records must include individual medicines refused, dropped on the floor, and so on • There must be an approved list of homely remedies signed by a GP 2nd notification The registered persons shall consult with service users about their social interests, and make arrangements to enable them to engage in local, social and community activities. The registered persons must, so far as practicable, enable service users to make decisions with respect to the care they are to receive and their health and welfare. They shall so far as practicable take into account their wishes and feelings. • For example the registered persons need to monitor and ensure service users can get up and go to bed according to DS0000009169.V320551.R01.S.doc 5 OP12 16 (2) (m) 01/02/07 6 OP14 OP12 OP15 12(2)(3) 16(2)(i) 31/12/06 Cowbridge Nursing Home Version 5.2 Page 35 • • their wishes Arrangements for mealtimes, support provided to service users and food provided must be reviewed. Service users’ preferences regarding food must be considered, for example there should be a choice of meal. Suitable records to evidence this must be kept. Freedom of movement around the building must be assessed and confinement of service users kept to a minimum. 7 OP18 13 (6) The registered person shall make 31/12/06 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. • The home’s adult protection policy must be reviewed and updated. 4th notification • All staff must receive appropriate abuse training • The policy for service user’s money must be reviewed to include the action to be taken by staff when handed money on behalf of service users and the procedure to be followed in the absence of the registered manager. 2nd notification The registered persons must provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users. They must also ensure that all parts of the care home are reasonably decorated. DS0000009169.V320551.R01.S.doc 8 OP19 16 (2) (c) 23 (2) (d) 28/02/07 Cowbridge Nursing Home Version 5.2 Page 36 • The registered persons must provide the Commission with an action plan for the complete refurbishment of the building including timescales. • The peeling wallpaper in bedroom 22 must be repaired. • The registered provider must provide bedrooms with a suitable locking device. nd 2 notification 9 OP21 OP22 13, 16, 23 The registered persons shall provide suitable facilities and services to service users. • there must be suitable equipment to wash service users’ hair if they cannot get out of bed 17 (2) The registered persons shall maintain in the care home the records specified in Schedule 4. (All of the recruitment records required by legislation must be obtained and maintained). 5th notification The registered persons must ensure all staff have a Criminal Records Bureau check / Protection of Vulnerable Adults check. Immediate requirement on the last inspection 15/05/06. 2nd Notification. The registered persons must ensure that the persons employed to work at the care home receive, training appropriate to the work they are to perform including structured induction training. This includes training: • in the management of challenging behaviour and DS0000009169.V320551.R01.S.doc 01/02/07 10 OP29 31/12/06 11 OP29 OP18 13, 19 31/12/06 12 OP30 18 (1) (c) 01/02/07 Cowbridge Nursing Home Version 5.2 Page 37 restraint techniques. required by regulation such as fire training, first aid, food hygiene, infection control and moving and handling. • regarding medication • regarding abuse and protection • regarding people with mental health needs and dementia • and induction to the home 2nd notification • 13 OP31 26 Where the registered provider is an individual, but not in day-today charge of the care home, he shall visit the care home in accordance with this regulation, and supply a copy of the report to the Commission. The registered persons shall establish and maintain a system for evaluating the quality of the services provided at the care home. The registered persons shall ensure that persons working at the care home are appropriately supervised • All care staff must be provided with regular supervision including one to one supervision, at least six times a year, with records kept nd 2 notification The registered person shall provide for staff suitable facilities for the purpose of changing and storage. 4th notification The registered person shall ensure that all parts of the home to which service users have DS0000009169.V320551.R01.S.doc 01/12/06 14 OP33 24 (1) 01/02/07 15 OP36 18 (2) (a) 01/03/07 16 OP38 23 01/02/07 17 OP38 13(4) 23(4) (5) 01/02/07 Cowbridge Nursing Home Version 5.2 Page 38 access are so far as reasonably practicable free from hazards to their safety, any activities in which service users participate are so far as reasonably practicable free from avoidable risks and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The 18registered persons shall take adequate precautions against the risk of fire and undertake appropriate consultation with the authority responsible for environmental health. • Emergency fire lighting must be tested at intervals recommended by the fire officer. • An electrical hardwire test must be completed at least every five years. Once completed a copy of the documentation must be forwarded to the commission. • There must be a suitable system of health and safety risk assessment including the prevention of Legionella. Risk assessments must be dated and reviewed at least annually. • The boiler and any gas appliances must be tested at least annually, and a gas safety certificate obtained. A copy of the documentation must be forwarded to the commission. 2nd Notification • Portable electrical appliances must be tested on an annual basis. A copy of the documentation must be forwarded to the commission. Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 39 18 OP38 OP19 13, 16, 23 All parts of the home to which 01/02/07 service users have access are so far as reasonably practicable free from hazards to their safety. • Safety glass should be fitted where appropriate. Liaison with the Health and Safety Executive should occur regarding this issue. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP3 Good Practice Recommendations All service users should have a signed contract with terms and conditions of residency. The initial assessment document should state who is involved in the assessment and the document should be fully completed Individual life histories should be compiled for each service user All of the care documentation for an individual service user should be held in one file. Registered Provider should seek the advice of other agencies that specialise in the provision of facilities and services for people with dementia, particularly those involved with environmental design. A sluice with a washer disinfector should be provided upstairs. 3 4 5 OP7 OP7 OP19 6 OP24 Cowbridge Nursing Home DS0000009169.V320551.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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