Inspection on 18/11/08 for Craven Park Nursing Home

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Poor service.

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

Craven Park Nursing Home 11/12/07

Craven Park Nursing Home 10/01/07

Craven Park Nursing Home 20/10/05

Craven Park Nursing Home 11/04/05

Craven Park Nursing Home 18/11/04

Craven Park Nursing Home 14/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/02/2009.

CARE HOMES FOR OLDER PEOPLE Craven Park Nursing Home 1 Craven Road Craven Park Harlesden London NW10 8RR Lead Inspector Judith Brindle Unannounced Inspection 18th November 2008 8:20 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 Craven Park Nursing Home DS0000022925.V373184.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. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Craven Park Nursing Home Address 1 Craven Road Craven Park Harlesden London NW10 8RR 020 8961 5678 020 8965 2789 cravenpark@bmlhealthcare.co.uk www.cravenpark-nh.co.uk GSG Nursing Homes Limited BML Healthcare Limited Vacant Care Home 26 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) Category(ies) of Old age, not falling within any other category registration, with number (26) of places Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 26 11th December 2007 Date of last inspection Brief Description of the Service: Craven Park Nursing Home is a care home providing nursing and personal care, and accommodation, for up to 26 older people. The Commission for Social Inspection is currently reviewing the registration details of the organisation with the provider. The home has been operating since 1995, and is located within a residential area of Harlesden, within the London Borough of Brent. It is a few minutes walk from local amenities and Harlesden tube station. Bus routes are around the corner from the home. The home has a private driveway. There is parking for several vehicles on the forecourt of the care home. The building has three floors. Access is by passenger lift or stairs. One of the homes bedrooms is a double room. All bedrooms are fully furnished. All but two have en-suite toilet facilities. The home has three communal bathrooms that all have adaptations. One such room has a walk-in shower area. There are a number of additional toilets. The home has a large dining room that is also used as a day room for a number of service users. There is a separate main lounge. The home has medium-sized, enclosed garden, which includes a patio. Prospective residents and others have access to information about the service provided by the care home. Details in regard to fees can be accessed from the care home. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 Star. This means the people who use this service experience poor quality outcomes. The key unannounced inspection took place throughout a day in November 2008. Two inspectors including a Regulation Manager carried out this inspection of the care home. There were three vacancies Since the previous key inspection (11/12/07) there has been non-compliance of a statutory requirement notice, and further action is being considered. There has been a change of manager since the previous key inspection. The current manager has been in post since the beginning of October 2008, and spent time assisting with the management of the home prior to her taking up the post. The operations manager has been providing the manager with on going support. The key unannounced inspection focussed on spending a significant period of time with people living in the care home, and observing interaction between residents and staff. Several of the people using the service, due to their needs have significant communication needs and some were unable to respond to questions other than to a limited degree, so observation was a significant tool used in this inspection. Documentation inspected included resident’s care plans, risk assessments, staff training records, and some policies and procedures. We were pleased to speak to several residents, visitors and staff during the inspection. Staff were very helpful during the inspection, and supplied all documentation, and information that I requested. The inspection included a tour of the premises. Prior to this unannounced key inspection the manager supplied the Commission for Social Care Inspection with a comprehensively completed Annual Quality Assurance Assessment (AQAA) document. This includes required information from the owner /manager about the quality of the care home and any plans to improve the service. All sections of this document were comprehensively completed. Reference to some aspects of this AQAA record will be documented in this report. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, health and social care professionals, and staff. At the time of writing this report, we Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 6 had received seven completed surveys from people using the service (these had been completed with support from the activities co-ordinator), one survey from a staff, and none from a health professionals. Information from these surveys will be included in this report. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications, and are a legal requirement. The manager and the operations manager were present during most of the inspection. The inspectors thank all the people living in the care home, visitors, and the staff for their assistance in the inspection process. What the service does well: What has improved since the last inspection? Areas that were identified during the previous key inspection (11th December 2007) as needing improvement and development had been generally addressed. There was some improvement that had been made to resident’s care plans to ensure that their needs were better identified and met by the care home. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 7 Residents weight is being better monitored but there continues to be a need to improve record keeping. There have been some improvements made to the environment, which included repairing a crack in the wall of a stairway on the 2nd floor, and a crack in an outside wall. We were told that the call bell system has been reviewed, and assessed by engineers. What they could do better: The Commission for Social Care Inspection had served a Statutory Enforcement Notice on the 10th September 2008, following concerns with regard to the arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines that are received into the home. We found that there were still some areas of concern with regard to the management of medication. This includes the poor documentation of records of people who require their medical condition (diabetes) closely monitored. Permanent registered nursing staff need to be employed. A review of the numbers of nurses on duty, and their roles and responsibilities needs to take place to ensure that it is evident that the needs (including medication needs) of people using the service are met at all times, and their well being, and health and safety are upheld at all times. There could be further development and improvement in the format of some records. These could include the service user guide, some policies/procedures and care plans to improve the accessibility of information to residents who might have difficulty in reading, or who have English as a second language. The redecoration of some resident’s bedrooms, the bathrooms and communal areas should be carried out to provide a more pleasant and attractive environment for people using the service and visitors. Record keeping could be better, particularly with regard to complaints and health care appointments and treatment. It could be more evident that the health needs of all the residents are fully met. It could be more evident that people using the service participate in and are central to their plan of care. There should be recorded evidence that the care home supports and encourages residents and others to communicate any ‘concerns’ that they might have. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 8 The home should look at giving staff and residents the opportunity to participate in regular meetings to ensure that it is evident that they are listened too and have the opportunity to participate in the running of the home. It needs to be evident that all staff receive regular 1-1 staff supervision, which is provided to staff more often when they wish, or if there is a concern with regard to their skills and abilities. 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. Craven Park Nursing Home DS0000022925.V373184.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 Craven Park Nursing Home DS0000022925.V373184.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): People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 1 and 3 were looked at. People who may use the service and their representatives have the information needed to decide whether the home will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Some equality and diversity aspects of this assessment could be further developed. EVIDENCE: The care home has a statement of purpose, and service user guide. These provide information about the service provided to people living in the care home. The statement of purpose was viewed. It was comprehensive, and gave people the information that they need to make an informed choice about whether the care home would meet their needs. This document included complaints procedures and terms and conditions of residence. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 11 There have been some recent changes to senior management and the statement of purpose will need to be amended to reflect these changes. The format of the ‘service user’ guide documentation should be further developed to improve its accessibility to people using the service, particularly for the residents that have difficulty reading or whose understanding of English is limited. Staff told us that all prospective residents and/or their relatives/significant others are given a ‘welcome pack’ of documentation including leaflets about the service. We were informed by the AQAA (Annual Quality Assurance Assessment) that the care home has a referral and admission policy. It was evident from the AQAA that the manager had a good understanding of the emotional needs of people moving into the care home.. Two care plan files of residents who had been recently admitted to the home were assessed. There was evidence of a detailed pre-assessment of the resident’s needs that had been carried out by senior staff in either their own home or in hospital prior to admission. Further assessment of resident’s needs was carried out after admission. Information from the placing authority, the hospital, and relevant health care professionals (including hospital consultants) and others, were also in place. It was noted that risk assessments of people’s needs had been carried out after admission. These risk assessments included key areas such as moving and handling, falls, pressure care, nutrition and management of specific conditions such as diabetes. One person was receiving both oral nourishment as well as via a specialist ‘feeding’ regime. Clear information on diet, and supporting people to take food orally was in place from the speech and language therapist. Guidelines on managing people who are diabetic were in place. Care plans had been written to reflect the resident’s care needs, and included recorded staff guidance on managing certain aspects of their care. These were noted to have been reviewed on a monthly basis. It was evident that some work needs to be done on ensuring that resident’s equality, and diversity needs (gender and gender identity, age, sexual orientation, race, religion or belief and disability) care needs are better documented and reflected in their care plans. It is also recommended that life histories of residents should be documented, which would reflect these aspects of each resident’s life. A relative told us that she had participated in the process of initial assessment of their family member. Craven Park Nursing Home DS0000022925.V373184.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): People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 7,8,9,and 10 were looked at. Each person using the service has a plan of care, which set out the health, personal care, emotional, and social needs of residents. There needs to be further development to ensure that all the health needs of people using the service are met. People using the service are respected and their right to privacy upheld. People using the service are not always protected by the methods that some medication is managed and administered by staff. EVIDENCE: Six resident’s care files were assessed. These contained detailed pre admission assessments of resident’s needs, and information from placing authorities (social services), consultants and others. Care plans were in place for all the residents, and were seen to be detailed, and to reflect all aspects of their personal and health care needs. However Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 13 reviews of residents’ needs were at times perfunctory, and work is needed to ensure that these reviews are better developed, improved, and that there is more evidence that residents (and possibly relatives/significant other) are involved in the review of the care plans. Information received from professionals, relatives and others, which affects care provision by staff, needs to be clearly documented in the individual care plan file, and not left in daily notes or communication books. Some areas of staff guidance to meet identified personal care needs of residents could be better developed, such as the personal care guidance in a persons care plan records ‘give her a bath as often as possible’, it does not record how often, nor how this person likes her bath. It could be more evident that each person’s care plan is up to date and a ‘working tool’. AQAA told us that a key worker system had been introduced. Care staff that spoke to us had knowledge and understanding of their key person or persons (resident/residents) needs. They told us about their key working role, and confirmed that they are not involved in writing updates and resident’s changing needs in the care plans. There were no records of any social services reviews in the care files sampled. We asked the manager to check the dates of the last reviews and whether any were planned or had taken place. The home has a block contract with Brent Social Services as well as providing two “step down” beds for the local hospital. Risk assessments of resident’s needs were in place, and covered a range of needs pertinent to each person. However, these assessments were not always fully completed, and reviews of them were inconsistent. Clear records of weight monitoring of people using the service, were not easy to access. In particular it was unclear from looking at one care plan whether a significant weight loss of one resident had actually been referred to the GP as recorded as an action in the weight chart notes. There was no further reference in the multidisciplinary records of this being done. We were assured that this had been done and that all relevant practitioners had been made aware of this issue. It is important that all changes to a resident’s health are clearly documented and a record kept of any referral to GPs and other health professionals. Following the key inspection we were informed by the operations manager that action had been taken to train two senior care staff to undertake the responsibility of ensuring that residents have their weight monitored and body mass index (BMI) calculated. We were told that these care staff would be trained to take appropriate action, (including reporting to senior staff ) in response to any concern about a resident’s weight, and to report any changes in the person’s nutritional needs in accordance with their care plan. There were records of residents’ appointments with the GP, nurses, speech and language therapists, and physiotherapists as well as letters from hospital consultants, and others. There were no records of residents having had dental Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 14 checks or chiropodist visits in the files sampled. There were some records of optician’s visits and optical prescriptions. We were told that people using the service did receive regular chiropody care, and dental treatment as and when needed (though not generally regular dental check ups). The care home needs to ensure that it is evident that all residents receive health care (including dental and chiropody care) check ups and treatment. Another resident receives hospital dialysis treatment three times a week. Although it is documented in their care plan that this occurs there is no further information/guidance to assist care staff or nurses in relation to the times of assisting the person to get up, such as whether he can have any food/drinks, and other needs. Overall we found the care plan files to be difficult to access key information, and recommend that these are reviewed and out of date information be archived. In order to assist new staff particularly trained nurses who may only come for a short period we recommend that a profile of each resident is written which could be use to give clear information on residents needs. This could include their social history, behaviour, preferences in relation to food, activities, medication etc. It is also recommended that the care staff who clearly know the residents well, should be encouraged to be involved in writing these profiles, and possibly updating some care plan documentation. We examined the blood monitoring records of the people who have diabetes. There were a number of shortfalls identified with the records. In a file the list of people with diabetes was inaccurate as there were six people listed but another five records were also in the folder. There were gaps on the records in terms of staff signing, times, and dates of the blood tests. There was no indication as to whether people were on insulin or oral medication. There was no clear indication of the frequency of blood tests for individuals. We found when sampling care plans that there was a record of one person needing to have blood tests twice daily but this was not in the blood monitoring records. The manager also stated that the blood monitoring machine had broken the day before which was why tests hadn’t been done that morning. She had purchased a new monitor and was carrying out tests during the afternoon of the inspection. The home should ensure that there are at all times at least two blood monitoring machines. The manager told us that after the GP visit that afternoon that the GP had reviewed the frequency of blood tests being carried out and that these were not to be carried as frequently as on the charts. She stated that she would be amending the blood monitoring records to reflect this and also to include details of residents’ medication on each chart. We found that one residents care plan described how the home was puncturing particular medication capsules, and that the contents be squirted into the resident’s porridge. The reason for this was recorded as being Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 15 because the medication cannot be put through the particular feeding tube (PEG feed). The manager must check with the pharmacist to find out whether this medication can be prescribed in liquid form so that it can but administered via the feeding tube. There needs to be agreed (with the pharmacist) guidance if medication is to be administered covertly. We observed that staff interacted with residents in a sensitive manner and with respect to their privacy. A call bell was tested and found to be in working order. Call bells were answered fairly promptly during the inspection. We observed the medication administration lunchtime round, and checked the controlled drugs cabinet. The medication administration record sheets were signed appropriately, and the controlled drugs records were accurate. All medication storage cupboards were secure. New medication trolleys were observed to have been delivered to the care home. The home had had a number of serious medication errors reported to the Commission for Social Care Inspection (CSCI) during the past few months. A pharmacist inspector carried out three visits to the home to follow these up. The home did not demonstrate that it had met the requirements set at these visits, and enforcement action has since been carried out on the home to ensure they comply with the Care Homes Regulations relating to medication storage and administration. Compliance of the Statutory Enforcement Notice served 10/09/08 was found to be not met, and further enforcement action is being considered. There was evidence that regular auditing of medication is being carried out by the trained staff, manager, and the operations manager to ensure that further medication errors are not made. The absence of regular and permanent trained nursing staff in the home is of concern to the CSCI. This could possibly lead to some risk of further medication errors occurring. During the inspection, the operations manager assured us that the rota was covered to provide a trained nurse on each shift both day, and night for the next week. We were told that the home was in the process (this was commenced during the inspection following discussion between the inspectors and the manager and operations manager) of employing agency nursing staff for regular shifts over a significant period of time to cover the vacancies until recruitment was completed. Following the inspection we were provided with a staff rota that indicated that a number of agency nursing staff were now covering vacant nursing posts (see staffing section of this report). Records told us that all the registered nurses (in post at the time) had received medication handling and medication administration training on the 9th October 2008. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 16 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): People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 12,13, 14 and 15 were looked at. People have the opportunity to take part in a variety of preferred activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, nutritious, and wholesome, and meet the cultural preferences of people using the service. The menu could be more accessible to residents. EVIDENCE: There is a weekly activities programme. This was seen to be displayed in small print fairly high up on a wall of a communal sitting room. The weekly activities plan should be in a more accessible format for people using the service. The activities coordinator records resident’s daily activities on a notice board. The Activities Coordinator was on duty during the inspection. She has worked at the home for a number of years and clearly plays an important part in the residents’ daily lives. We spent some time in the dining room where the activities were being held and observed the interaction between the activities Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 17 co-ordinater and the residents. She held a word game with the residents, and encouraged all the residents present to participate. A number of the residents joined in enthusiastically, clearly enjoying the game. Care staff also supported the residents in the activity. We were informed that the activities co-ordinater has organised the Christmas party and was planning to take some residents out Christmas shopping. AQAA told us that ‘local church groups worship with residents weekly at the home’, and that there had been a number of parties held in the home. We were told that an Easter tea party, and a summer fete were held in the home and that relatives and others were invited to attend. We were told of other activities that take place in the home. These activities include keep fit sessions, painting, board games, discussion of news items/current affairs, arts and crafts, music, reminiscence, quizzes, and family fellowship’ sessions. Residents told us that they enjoyed the leisure pursuits. People using the service told us that they had choice. A resident survey told us that they chose when to participate or not participate in activities; another informed us that they chose when to go to bed. The care files also had a brief ‘activities for daily living’ plan for some of the residents. These had not been updated for some time. There should be individual records of activities leisure pursuits that people using the service take part in. This would ensure that it is evident that all residents have an opportunity to be involved in leisure pursuits, including exercise sessions. AQAA told us that there were plans to review the activity programme, and to ‘try and involve more outside organisations in the home’s activities’. Some visitors arrived during the inspection, and spent time with their relatives in their rooms, and the communal areas. They were observed to be welcomed by staff. A visitor told us that she felt that the home was welcoming, and that she and other family members visit their relative on a daily basis. Another visitor spoke of visiting the care home at different times of the day, and confirmed that the positive reception that she receives from staff does not change. A visitor also told us that their family member (a resident) had brought with him from home some personal items. The visitor’s record told us that the home had a number of visitors everyday. A relative of a resident told us that she was ‘happy’ with the care that her relative was being given by staff. AQAA information told us that the menu has been revised ‘ to accommodate different cultures and tastes’. We looked at the menu, which was displayed on the wall of the communal sitting/dining room. This included varied wholesome meals. The format of the menu should be more accessible to people using the service, particularly with regard to people who have difficulty reading or have English as a second language. This was a previous recommendation. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 18 We spoke with the chef who was on duty. He told us that people using the service chose their meals. It was evident that he was knowledgeable of the specialist dietary needs of residents. He spoke of residents being provided with meals that met their cultural dietary needs and preferences, and that fresh fruit was always available for residents. During the inspection, residents told us that they enjoyed their lunch. A variety of fresh, frozen, dried and tinned foods were stored in the kitchen. Craven Park Nursing Home DS0000022925.V373184.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): People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 16 and 18 were looked at. People using the service, and others are confident that their complaints will be listened to, looked into, and action taken to put things right, but there could be development in the recording of ‘comments/concerns’. Residents are protected from abuse, neglect and self-harm, and the care home takes action to follow up any allegations. EVIDENCE: The home has a complaints policy and procedure. We were told this is given to new residents as part of their information pack. AQAA told s that there had been three complaints received in the last twelve months, but there was one complaint recorded in the complaints recording book. This complaint had been responded to appropriately. The home and the Commission for Social care inspection had received a complaint from a member of staff prior to this inspection. We were also told, during the inspection, of a recent complaint from a relative of a resident. The operations manager, and manager informed us of the appropriate action that has been taken in response to these complaints, but there was no record of them in complaints book. These complaints, and that action taken by the home in response to them need to be recorded in the complaints record book, to ensure that it is evident that the complaints procedure has been followed in accordance to the complaints procedure. We advised the home that they were Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 20 to investigate the issues raised in the recent complaint, and to inform CSCI of the outcome of their investigation. Staff told us that they knew the procedure for responding to complaints from people using the service and from visitors/significant others. Resident’s feedback surveys told us that they knew how to make a complaint. We discussed the value of recording any concerns that are raised by residents and relatives as part of daily interaction. These ‘concerns’ can usually be resolved promptly. There should be recorded evidence that the care home supports and encourages residents and others to communicate any ‘concerns’ that they might have. The care home has a copy of the Local Authority Protection of Vulnerable Adults multi-agency policy and procedures, and their own safeguarding adult’s procedure. Records and staff told us that staff receive safeguarding adult’s training, and that they had knowledge and understanding of how to respond appropriately to any suspicion or allegation of abuse. There had been one safeguarding issue reported to the local authority The home has a whistle blowing policy/procedure. Systems are in place to ensure that resident’s finances are managed appropriately (see Management and Administration section of this report). Craven Park Nursing Home DS0000022925.V373184.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): People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 19, 24 and 26 were looked at. The environment of the home is safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose. Resident’s bedrooms are individually personalised, and meet their individual needs, but there are some rooms where redecoration is needed. EVIDENCE: The location and layout of the home is suitable for its stated purpose. It is located within a few minutes walk from the shops, and amenities of Harlesden. Bus and train public transport is accessible close to the home. The garden is attractive, enclosed, and has garden furniture. We toured the premises looking at a sample of rooms, bathrooms and communal areas. There are seating arrangements in the foyer of the home. It had been recommended at the last inspection to carry out some refurbishment, and this had partially been completed, including the replacement of some bedroom carpets. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 22 We discussed the ongoing issue of the need to refurbish the home through out to provide a more homely and comfortable environment for the residents. We were informed that as residents move out each room is to refurbished. The communal areas were also noted to be in need of refurbishment. During the tour of the premises, we identified that the bathrooms were shabby (including the blinds in a bathroom), and should be completely refurbished to ensure that residents receive their personal care in a pleasant environment. There was an ongoing issue with low water pressure in the ground floor bathroom, which we were told meant that residents have been unable to use the walk in shower since July 2008. There are other bathrooms that can be used by residents on other floors of the care home. The kitchen flooring is cracked in places, and some areas could potentially become a trip hazard. The kitchen flooring should be replaced. We were told that the microwave oven is in need of repair. A step at the bottom of the stairs leading to the administration office, was not easily identified when coming down the stairs, and could be a trip hazard. The administrator told us that she would display a sign warning people of this step. It was noted that one television in a communal sitting room had a poor quality picture, we were told that this was due to poor reception. Following discussion with people using the service the home could look at accessing television channels that might be of particularly interest , and/or meet aspects of residents equality and diversity needs. We were told that the operations manager and the manager would complete a room ‘audit’, with regard to redecoration ‘as soon as possible’, and from that the home would ‘prioritise the work required in the home’, which would ‘commence in the New Year’. The care home needs to supply the Commission for Social Care Inspection with an action plan, which includes the timescale of when the improvements to the environment would be carried out, and the plan should relate to the environment recommendations in this report. Redecoration and improvements to the environment would ensure that the residents live in attractive surroundings. The resident’s bedrooms that we looked at were generally personalised with some photos, ornaments, and some had their own furniture. A resident spoke of liking their bedroom. At the time of the inspection we tested the call bell system on the top floor, and found that the indicator lights were not working so staff could not tell from which floor the person who is using the call bell is located. We were told that the maintenance person was aware of this issue and was planning to get it repaired the call bell system had been reviewed, and that improvements to it were planned. The manager needs to ensure that improvements to it are Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 23 carried out to ensure that staff in all areas of the home, as well as the ground floor, know from which room a resident is calling from. The care home has a policy/procedure in regard to infection control. Protective clothing including gloves and aprons were accessible to staff. Laundry facilities are located away from food storage and food preparation areas. We spoke with the member of staff who is responsible for the laundering of resident’s clothes, and bed linen. It was evident that he continues to ensure that there is a quality laundry service provided to people using the service. Records confirmed that staff receive infection control training. The home was found to be clean and free from unpleasant odours throughout. Craven Park Nursing Home DS0000022925.V373184.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): People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 27,28,29 and 30 were looked at. Staff receive appropriate training, to ensure that they have the skills and knowledge to carry out their roles and responsibilities in meeting the varied care and support needs of people using the service. There could be review of registered nurse staffing needs. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: On arriving at the home we found that there was an agency registered nurse on duty. She told us that she had administered medication to some residents and had been due to go off duty, but was unable to do so until a nurse arrived to take over. We noted from the staff rota that there was no nurse scheduled to work that day. Shortly after our arrival the operations manager, and manager arrived. The manager took on the role of trained nurse to carry out medication rounds for the rest of the day. The staff rota was examined and found that the numbers of staff on the rota corresponded with those actually on duty, but had not recorded the details of the agency nurse who had worked the previous night. On examining the staff rota for the month, we found that some care staff were working for more days than was reasonable to expect, in excess potentially of working time directive employment legislation. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 25 We were informed that one of the trained nurses had been dismissed following disciplinary action linked to findings from the last Commission for Social Care Inspection pharmacist inspection. There were a couple of bank nurses documented on the staff rota. We were told that several staff recorded on the current staff rota no longer worked in the home. The absence of permanent trained staff was discussed in detail with the operations manager, who informed us that she was in the process of recruiting agency nurses on a longer tem contract to provide stability in the home whilst registered nurse recruitment takes place. She told us that she was also working with the manager to review staff duties and developing a rota that would ensure that there were sufficient staff on duty at all times. Following the inspection, the home supplied us with a staff rota dated 23rd November to the 20thDecember 2008. This indicated that four agency staff had been employed to cover shifts during this period. This staff rota needs to clearly record that these staff are trained nurses. The shifts that the manager works in the home needs to be evident on the staff rota, and it needs to be clear with regard to details of the length of the shifts worked by staff. The staff rota indicated that most of the shifts worked by registered nurses (and other staff) are ‘long days’. It was not evident from the staff rota what the exact number of hours these shifts were but possibly could be as much as twelve hours, which could lead to tiredness, particularly as trained nurses generally work (outside 9-5pm hours) with only care staff support. For some weeks there have been issues with regard to shortages of permanent trained staff employed within the home. There has been significant reliance upon one or two trained nursing staff to cover shifts. We were told that these nurses have now left employment in the home. The care home needs to ensure that it employs permanent trained staff promptly, particularly in view of the recent medication errors that have taken place in the home. There also needs to be a review as to whether there is a sufficient number of registered nurses on duty during each shift in the home. To ensure that it is evident that the registered nurses are able to carry out the duties with regard to their role (e.g. the present system of ‘daily’ auditing of all medications, at the morning and evening handover between the trained staff) and to ensure that the needs of people using the service are met. We were told that there had been efforts made to recruit trained nursing staff but there had been no suitable applicants for the vacant posts. There are four to five care staff on duty during the day. There were four care workers on duty, when we arrived at the home. Another care worker arrived later in the morning. Care staff told us that they thought that this number of care staff was sufficient to meet the needs of people using the service. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 26 Staff on duty told us that they were aware of their particular duties for each shift. We were shown a staff ‘shift planner’, which told us which staff member supported each resident that day. A staff feedback survey told us that staff are always given up to date information about the needs of people using the service. Staff were observed to interact with residents in a sensitive manner during the inspection. Feedback from staff told us that they had a good understanding of treating all residents with respect. Staff told us that staff enjoying working in the care home and confirmed that teamwork amongst staff was positive. It was evident from talking to staff and from observation that the care staff knew the residents well, cared about providing a quality service to the residents, and that they were motivated and competent. A staff member told us that ‘we provide a very good service’. Residents, and visitors who kindly spoke with the inspector confirmed that staff were approachable, ‘caring’ and had a good understanding of residents’ needs. A resident commented that the staff were a ‘good crowd’. Three staff personnel files (including a registered nurse and a newly appointed care staff member) were looked at. All recruitment checks that are required to ensure people are protected from harm had been carried out. A staff training plan was available for inspection. Records and staff confirmed that staff receive varied, and appropriate training in regards to their roles and responsibilities. This training includes completion of a comprehensive staff induction programme. Other training includes moving and handling training, basic First Aid, fire safety, and health and safety training. During this inspection staff, and records confirmed that they received a variety of training to develop their skills and competency. Records told us that there had been specialist training for some staff. This training included pressure area care, dementia awareness, managing aggression, care planning, managing palliative care, death and dying, and nutritional needs training. It should be evident that all staff receive training with regard to meeting the equality and diversity needs of residents, and in understanding the significance of the Mental Capacity Act 2005 for staff and residents. A staff told us that they usually have the right support and experience to meet the equality and diversity needs of residents. A staff member commented that ‘some faith needs present themselves occasionally, but with sensitivity it is nothing that can’t be overcome’. Records confirmed that staff (including the trained nurses) receive an induction. An agency nurse told us that she had received an induction prior to commencing her shift. She said that this induction focused upon emergency and ‘on call’ procedures. Given the recent medication ‘concerns’ there should be arrangements that all agency nurses have an induction that includes details Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 27 of resident’s medication arrangements. There should also be an accessible up to date record of the day and night duties of trained nursing staff. Care staff that spoke with us told us that they had received an induction in regard to the care home and of their roles and responsibilities. A feedback survey from a staff member recorded that the induction mostly covered what they needed to know their job when they started. AQAA (Annual Quality Assurance Assessment) informed us that ten out of eighteen permanent staff have achieved an NVQ (National Vocational Qualification) level 2 or above care or Health and Social Care qualification. The home should ensure that all care staff have the opportunity to complete an NVQ care training course. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 28 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): People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards 31,33,35, 36 and 38 were looked at. The manager is qualified, competent and experienced to run the care home appropriately. There are some quality assurance, and quality-monitoring systems in place to monitor, develop and improve the quality of the service provided to people using the service, but these could be further developed. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded EVIDENCE: The Commission for Social Care Inspection (CSCI) had been informed on the 3rd November 2008 that the registered manager had resigned. We were told Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 29 that the present manager was the registered manager of another care home. She is a trained nurse and has a significant number of years working with older people. The manager told us that she was planning to apply for registration with the CSCI. We were told that she had worked in the home for several weeks prior to the registered manager’s resignation to address medication issues of concern that had been raised following inspection by a CSCI pharmacist inspector. We were told that the manager took up ‘full time management of the home at the beginning of October’ 2008. Despite the manager having been in post for a relatively short time, the AQAA was completed comprehensively. It was evident from talking with the manager that she was aware that there were developments, and improvements that could be made to the service. She told us of some of the improvements that she had started to make in some areas of the service. We were told that the operations manager was spending two days a week in the home to support the manager. Staff spoken to spoke positively about the new manager and felt that she would to a good job in running the home. We looked at a number of records. Records of incidents and/or accidents reported to us were not accessible in a central record. We were informed that these were kept on the individual residents file. We recommend that a central file of these notifiable events be in place.. The accident and incident folders only held information with regard to monthly review of accidents, up to May 2008. A system of auditing this information was started for 2008 but not continued. This should be resumed. AQAA told us of plans for further changes to be made as a result of listening to people who use the services. These include regular ‘review of the menu, refurbishment of the home’, and to ‘continue to improve the care planning process to reflect a more ‘person centred approach’. At the time of the key inspection the operations manager supplied us with an ‘Operations Action plan’. This plan included information about the systems in place, and the plans for improvement in four areas of the home. These areas included management of the home, staffing, medications and environment. There are some systems for monitoring the quality of the service. This include staff training needs, monthly medication audits, maintenance checks, reviewing some records, including care plans. Staff meetings, and resident meetings take place. Records told us that there had been two staff meetings, and one resident/relative meeting, in 2008. The home should look at giving staff and residents the opportunity to participate in more regular meetings to ensure that it is evident that they are listened too and have the opportunity to participate in the running of the home. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 30 The home has a system of supplying feedback questionnaires to some stakeholders for obtaining the views of relatives/significant others about the service that it provides to people. Records of regular unannounced visits to the home by the representative of the owner to monitor the quality of the service, were available for inspection. Details of findings were recorded, but a need for an action plan in response to the findings of each visit is recommended to ensure that there is an appropriate response within a set timescale to ensure that improvements (such as ensuring that 1-1 staff supervision takes place) needed are responded too. There was evidence in records of some previous action plans being in place. These should be continued. The staff information/communication folder should be reviewed and updated particularly in relation to various contact (including emergency contact) details. Information if out of date should be archived. AQAA told us that several policies and procedures had not been reviewed for a few years. The operations manager told us that the care home is responsible for reviewing the policies relevant to the service, and that this would be taking place. In regards to monitoring the quality of the systems in place in the care home, there are useful forms in place but some are not currently in use i.e. for care plan audits. We discussed the need to demonstrate ongoing improvements with clear evidence. Having a clear quality assurance system and audit trail will support evidence of improvement. The operations manager told us that an annual development plan for the home was in the progress of being developed. We were told that relatives, or social services generally manage the finances of people using the service, and that they are invoiced by the home for purchases made on behalf of residents. The home manages some resident’s cash used for their personal items and other purchases. We checked the finance records and cash balances of three residents monies. These were up to date and balanced. Records of purchases were seen. The care home has a supervision policy. Care staff, and records confirmed that care staff, and nurses received 1-1 staff supervision, but these supervision sessions occurred intermittently. According to records provided to us, a nurse (who has recently left employment in the care home) had received staff supervision in May 2008, and prior to that November 2007, another nurse received 1-1 staff supervision in April 2008, and prior to that in May 2007. In view of the medication issues (which commenced in July 2008) we would have expected that these staff members would have received 1-1 staff supervision more frequently. The operations manager told us that the manager had received 1-1 supervision two months ago. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 31 A care staff member told us that she received 1-1 staff supervision approximately twice a year. Required checks of the electrical and gas systems, and other health and safety checks are carried out. Certificates and service records for appliances and equipment used in the home were noted to be in order and up to date. The care home has an up to date fire risk assessment. There was a detailed record of all regular fire safety and other checks carried out in the home. Fire guidance was displayed in the home. The employer’s liability insurance certificate was displayed and up to date. Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 32 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 33 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 OP1 Regulation 4 (1)(c) Requirement The statement of purpose needs to be amended to include the up to date details with regard to the management of the care home. It needs to be evident that all changes to a resident’s health are clearly documented and a record kept of any referral to GPs and other healthcare professionals. The care home needs to ensure that it is evident that all residents receive health care (including dental and chiropody care) check ups and treatment. There needs to be clear recorded individualised staff guidance in a resident’s care plan that meet the person’s health and care needs/hospital appointment needs. The diabetic information file needs to include a clear, up to date, accessible record of all the residents who have diabetes, details of the medication that they are prescribed, and details of the frequency of the blood DS0000022925.V373184.R01.S.doc Timescale for action 01/02/09 2 OP8 12 (1)(a)(3) 13(1)(b) 01/02/09 3 OP8 12 (1) 13(2) 09/01/09 Craven Park Nursing Home Version 5.2 Page 34 4 OP9 13(2) tests that they need. The manager must check with a pharmacist for advice as to whether a particular medication can be prescribed in liquid form so that it can but administered via a resident’s feeding tube. There needs to be agreed (with the pharmacist) guidance if medication is to be administered covertly. The registered person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines that are received into the care home. Timescales made re statutory enforcement notice served 10/9/08, and found not to be met 29/10/08. Further enforcement action is being considered. It needs to be evident that all complaints made under the complaints procedure are fully investigated. Recording complaints ensures that it is evident that the complaints procedure has been followed, and the complainant listened too. The issue of the water pressure in a ground floor bathroom needs to be resolve so residents have the opportunity to use this facility. The care home needs to supply the Commission for Social Care Inspection with an action plan, which includes the timescale of when the improvements to the environment would be carried out, and the plan should relate to the environment recommendations in this report. Redecoration and improvements DS0000022925.V373184.R01.S.doc 09/01/09 5 OP9 13(2) 19/11/08 6 OP16 22 (3) 01/02/09 7 OP19 23(2) 01/02/09 8 OP19 23(2) 01/02/09 Craven Park Nursing Home Version 5.2 Page 35 9 OP19 23(2) 10 OP27 17(2) to the environment would ensure that the residents live in attractive surroundings. The manager needs to ensure 01/02/09 that improvements and repair are carried out to the call bell system to ensure that staff in all areas of the home, as well as the ground floor, know from which room a resident is calling from. This staff rota needs to clearly 10/01/09 record that the designation of agency staff is recorded on the staff rota. So that it is clear as to which staff are registered nurses. The staff rota needs to record the shifts that the manager works in the home. The staff rota needs to include details of the exact length of shift worked by staff. The care home needs to ensure that it employs permanent trained nursing staff, to ensure that people using the service receive continuity of care, from experienced, qualified staff that are known to them. The care home needs to review as to whether there is are a sufficient number of registered nurses on duty during each shift in the home. To ensure that at all times there are sufficient numbers of suitably qualified, competent and experienced persons are working in the care home to meet the needs of people using the service, and to carry out all the nursing tasks. The care home needs to ensure that it is evident that all persons working in the home are appropriately supervised. To ensure that staff receive support DS0000022925.V373184.R01.S.doc 11 OP27 18(1)(a) 28/02/09 12 OP27 18 (1) 01/02/09 13 OP36 18(2) 01/03/09 Craven Park Nursing Home Version 5.2 Page 36 and guidance to carry out their role and responsibilities in meeting the needs of people using the service. 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 OP1 Good Practice Recommendations The format of the ‘service user’ guide documentation should be further developed to improve its accessibility to people using the service, particularly those that have difficulty reading or whose understanding of English is limited. Equality, and diversity (gender and gender identity, age, sexual orientation, race, religion or belief and disability) needs could be better documented and reflected in resident’s care plans. ‘Life histories’ of residents should be documented, which could also include and reflect these aspects of their lives. It should be more evident that people using the service and/or their relatives are involved in the review of their plan of care. Some areas of staff guidance to meet identified personal care needs of residents could be better developed. The format of resident’s care plan files should be reviewed to ensure that information about the person is easily accessible by staff, and that some documentation be archived if appropriate. It is recommended that a profile of each resident be written. This could give clear information about each residents needs, and could include their social history, behaviour, preferences in relation to food, activities, medication etc. It is also recommended that the care staff (who clearly know the residents well) be encouraged to be involved in writing these profiles, and possibly updating some care Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 37 2 OP3 3 OP7 4 OP8 5 OP12 plans information. The care home should ensure that there are two accessible blood monitoring machines, so that if one breaks down there is another one that can be used to ensure that resident’s health needs are met. The weekly activities plan should be in a more accessible format for people using the service. The ‘activities for daily living plan’ recorded in people’s care plans should show evidence of being reviewed regularly. There should be individual ‘daily’ records of activities that people using the service take part in. To ensure that it is evident that all residents have an opportunity to be involved in leisure pursuits everyday, if they wish. The manager should ensure that the menu available in a variety of formats to ensure that the information about the meals provided is easily accessible to all residents. Previous recommendation There should be recorded evidence that the care home supports and encourages residents and others to communicate any ‘concerns’ that they might have. All complaints should be recorded in the complaints record book. We recommend that a central file of notifiable incident/accidents events be in place.. The kitchen flooring should be replaced. The microwave oven located in the kitchen should be repaired. The bathrooms should be refurbished to ensure that residents receive their personal care in a pleasant environment. A sign warning people of the location of a step at the bottom of the stairs leading to an office, should be displayed, as this could be a possible trip hazard. The manager should ensure that improvements to the call bell system are carried out to ensure that staff in all areas of the home, as well as the ground floor, know from which room a resident is calling from. The care home should review the length of shifts that are worked by staff, particularly the registered nurses. The home should ensure that all care staff have the opportunity to complete an NVQ care training course. It should be evident that all staff receive training with regard to meeting the equality and diversity needs of DS0000022925.V373184.R01.S.doc Version 5.2 Page 38 6 OP15 7 OP16 8 9 OP18 OP19 10 11 OP19 OP19 12 13 14 OP27 OP28 OP30 Craven Park Nursing Home residents, and in understanding the significance of the Mental capacity Act 2005 for staff and residents. There should be arrangements that all agency nurses have an induction that includes details of resident’s medication arrangements. There should also be an accessible up to date record of the day and night duties of trained nursing staff. It is recommended that a central file of accident and incident notifiable events be in place.. The home should look at giving staff and residents the opportunity to participate in regular meetings to ensure that it is evident that they are listened too and have the opportunity to participate in the running of the home. It is recommended that there is an action plan in response to the findings of each provider audit visit to ensure that improvements to the service that are needed are responded too, within an appropriate timescale. The staff information/communication folder should be reviewed and updated particularly in relation to various contact (including emergency contact) details. Information if out of date should be archived. 15 16 OP33 OP33 17 OP33 Craven Park Nursing Home DS0000022925.V373184.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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