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Inspection on 18/05/06 for Daneside Court Nursing Home

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

This inspection was carried out on 18th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

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

What the care home does well

Residents were complimentary about the food, no complaints made. The nursing unit now has a dining room with tables nicely set out with appropriate cutlery and crockery. Most of the staff were seen to respect residents privacy and treat them with respect. GPs comments were positive about the care provided at the home.

What has improved since the last inspection?

The corridor carpets have been replaced since the last inspection.

What the care home could do better:

The quality of recording in some of the care records is poor, which could result in residents not having all their needs met appropriately. The health care needs of some of the residents are not being met. There are insufficient specialised chairs provided to meet the needs of the residents on the nursing unit. As a consequence some residents are left in bed instead of being given the option to sit out.There were problems with the administration and storage of medications, which could result in residents not receiving their medicines as prescribed. There were no purposeful activities going on at the home during the day. Residents were sitting in their rooms or the lounge areas watching television. Relatives expressed concern that there was nothing for residents to do. The environment needs to be improved. Several areas of the home are poorly maintained and require attention. A lot of the window units have `blown` and require attention. The garden was overgrown and appeared neglected. There is enough communal space for residents but this is sometimes used for other purposes e.g. stores and staff room. Some of the residents` rooms were in a poor state and did not look homely. Carpets are stained and require either deep cleaning or replacing. The condition of the sheets was unacceptable with several looking grey and old, others with a hospital label on. Some had the appearance of not being ironed; they were crinkled and the beds poorly made. Several pillows were lumpy and needed to be replaced. A washing machine, dryer and iron were broken and required repair. Staff said that these had been broken for some time. There is no home manager at present and so the home lacks purpose and direction. Staff are not supervised adequately and induction training is not consistent throughout. The quality assurance process needs to be more robust so that any shortfalls in quality can be identified and rectified without delay.

CARE HOMES FOR OLDER PEOPLE Daneside Court Nursing Home Chester Way Northwich Cheshire CW9 5JA Lead Inspector Helena Dennett Key Unannounced Inspection 18th May 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 Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 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. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Daneside Court Nursing Home Address Chester Way Northwich Cheshire CW9 5JA 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) 01606 40700 01606 40621 Southern Cross Healthcare Services Limited Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (64) of places Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is registered for a maximum of 64 service users in the category of OP (old age not falling within any other category). The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 9th September 2005 Date of last inspection Brief Description of the Service: Daneside Court is a purpose built care home, built in the 1990s, which provides both personal and nursing care for up to 64 older people. It is owned by Southern Cross Healthcare, a company which operates care homes throughout the country. The home provides single room accommodation on the ground and first floors. There are four lounges for residents to use. There is access into the garden, which has seating and tables. The home is situated in the centre of Northwich within walking distance of local shopping facilities, public houses, bus stops and open park areas. It is well established within the local community. The current range of fees is £343.34 - £707 per week. Additional charges are made for the hairdresser, chiropodist, optician, dentist and newspapers. This information was provided in the pre inspection questionnaire signed as accurate by the deputy manager on 5th May 2006. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit took place on the 18th May 2006 and was carried out by Denis Coffey and Helena Dennett, CSCI Regulatory Inspectors. The last inspection took place on 9th September 2005. An action plan was submitted following that inspection. An additional visit was conducted on 25th November 2005 and improvements were noted at that time. However, it is of concern that some of the requirements from 9th September 2005 remain outstanding despite the detailed action plan submitted to CSCI. This inspection took into account events that have occurred since the last inspection, e.g. notifications of accidents and incidents, and other information received by CSCI, as well as findings of the site visit. The visit took place over a 7 hour period that included a tour of the premises, speaking with residents, visitors and members of staff, and examination of care records and the home’s general records. What the service does well: What has improved since the last inspection? What they could do better: The quality of recording in some of the care records is poor, which could result in residents not having all their needs met appropriately. The health care needs of some of the residents are not being met. There are insufficient specialised chairs provided to meet the needs of the residents on the nursing unit. As a consequence some residents are left in bed instead of being given the option to sit out. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 6 There were problems with the administration and storage of medications, which could result in residents not receiving their medicines as prescribed. There were no purposeful activities going on at the home during the day. Residents were sitting in their rooms or the lounge areas watching television. Relatives expressed concern that there was nothing for residents to do. The environment needs to be improved. Several areas of the home are poorly maintained and require attention. A lot of the window units have ‘blown’ and require attention. The garden was overgrown and appeared neglected. There is enough communal space for residents but this is sometimes used for other purposes e.g. stores and staff room. Some of the residents’ rooms were in a poor state and did not look homely. Carpets are stained and require either deep cleaning or replacing. The condition of the sheets was unacceptable with several looking grey and old, others with a hospital label on. Some had the appearance of not being ironed; they were crinkled and the beds poorly made. Several pillows were lumpy and needed to be replaced. A washing machine, dryer and iron were broken and required repair. Staff said that these had been broken for some time. There is no home manager at present and so the home lacks purpose and direction. Staff are not supervised adequately and induction training is not consistent throughout. The quality assurance process needs to be more robust so that any shortfalls in quality can be identified and rectified without delay. 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. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality for this outcome area is adequate. Assessments of care needs are carried out for people before they move into the home to ensure that all their needs can be met at the home. However, not all of the residents have been given the service user guide and so may not be aware of the facilities and services that are on offer. EVIDENCE: A statement of purpose is on display in the main reception area. However, when two staff were asked what the purpose of this was they were only able to comment on this in very vague terms. Copies of the service user guide have not been given to all residents at the home. Copies of the written statement of terms and conditions of residency given to residents are kept in the administrator’s office. These identified the weekly fee payable and what services are included in the fee, the period of notice to terminate the agreement by both parties, additional services that are not covered in the fee and the arrangements for insuring personal belongings. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 9 The care records of four people who had moved into the home since the home since the last visit were looked at. These contained copies of assessments that had been carried out before the resident had moved into Daneside Court. Intermediate care is not provided at the home so Standard 6 does not apply. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome area is poor. Although care plans in place these were not detailed enough to establish the exact care to be provided to the resident and so there is a risk of residents’ needs not being met. Improvement is needed on the administration and recording of medicines as residents are at risk of not being given their medication as prescribed. EVIDENCE: As part of the inspection, the care records of four residents were examined as part of the process of tracking the care provided to residents. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 11 Resident 1 (Residential Unit) An assessment of care was completed on admission and care plans developed on the basis of this. Risk assessments with regard to safe moving and handling and skin care were included. A social history had been completed that identified some aspects fo the person’s life history and dietary preferences. The section dealing with social and family contacts was not completed. A continence assessment had not been carried out. There was a general risk assessment form in the records that was blank giving no indication of risks. A placement review was recorded which showed that the family and resident were happy with the home and the care provided. This was not signed by either the resident or her family representative. Care plans were in place detailing how the residents needs in respect of her health and welfare are to be met. However one of the care plans was not revised when the residents needs changed. There was no care plan in place for incontinence or osteoarthritis. Daily records had been kept. One entry recorded a conversation with the resident’s family regarding the appropriatness of the continence aids being used. Assurances were given that a re-assessment of the aids used would take place the following week. There was no further reference in the records about this problem. Resident 2 (Residential) Although there were care plans for this resident, they were not detailed enough to establish the exact care to be provided to the resident. The daily notes recorded that the resident was seen by the GP as she had a swollen leg. Antibioics were presecribed and staff asked to observe and elevate the resident’s feet. There was no plan of care in place for this. Resident 3 (Nursing) An assessment on the activities of daily living was in place, which provided information for staff on the care the resident needed. The social assessment was not completed. An assessment on the dependency of the resident was completed inaccurately as it identified that the resident had a catheter in place. However, there was no other mention of a catheter in the care files notes and the nurse confirmed that the resident does not have a catheter. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 12 Risk assessments were in place. These identified possible risks to the resident and how these could be minimised. Some of these had been evaluated, however the risk assessment for aspiration dated 22/11/05, although complete, had not been reviewed since that date. The bedrails risk assessment required reviewing as it did not provide evidence that staff were aware of the risk of gaps between the mattress and bed side rails. The nutritional assessment for this resident was also completed inaccurately. It was recorded in the notes that the resident had last been weighed on 12/2/06, and that the scales were broken in March and not charged in April. However, other residents were weighed during that time. Resident 4 (Nursing) Assessments were in place. Care plans were in place for most of the residents’ needs but the care needed of the resident’s mouth was not identified in any of the care plans. There was evidence of a care review with the resident’s family, which recorded that the family was happy with the care and facilities provided at the home. Some of the residents’ needs on the nursing unit are not being met. Several residents were in bed late (11.30am) on the morning of the site visit. When asked why, staff confirmed that there are not enough suitable chairs for residents to sit in so they alternate who sits out in a morning taking into account resident’s wishes. The nurse call bell was rung several times during the site visit. One resident had to wait for more than six minutes for the bell to be answered. Nine residents were spoken with during the site visit. One resident expressed concern about the attitude of staffv and others said they were happy with the care and facilities provided at the home. Two sets of relatives were spoken with. One relative was concerned about the care provided and felt that there was no guidance for care staff. Some of the carers were seen to address residents appropriately and ensure that residents’ dignity and privacy were maintained. Two members of staff spoken with displayed a good awareness of the need to assist residents maintain their dignity. They said they had gained this knowledge in their previous employment and had not received guidance or training on this since working at the home. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 13 Two CSCI comment cards were received back from GPs. Both were positive about the care provided at the home. Some of the residents’ beds were found to be in an unacceptable condition. Apart from the cleanliness of the bedside rail bumpers (see standards 19-26) the bedsheets were wrinkled and poorly fitted which could contribute to a resident developing a pressure sore. The medicines were looked at on this visit. A tube of betnovate cream was found in one resident’s room and staff said it was left there for them to apply. Members of staff confirmed that they had not received training in the administration of this preparation. An inhaler was found in another resident’s room and GTN spray and tramadol in a third residents room. Staff confirmed that the resident had assumed responsibility for administering these medications. However staff were not checking whether these medications were being used in the correct way and at the prescribed times. The medicine administration record (MAR) sheets were found to be filled in correctly with the correct codes being used when a medicine had not been administered. A random sample of medicines checked for stock reconciliation was found to be correct. Stocks and storage of Temazepam were correct. Eye drops were dated upon commencement of use. These were stored in the medicine trolley once opened, and it was suggested that they be stored in the medicines refrigerator. Some of the residents had a homely remedies sheet signed by their GP, but there was no system in place for recording administration of these apart from the care records. There was no record of any training on medication in place for a senior member of care staff who had the responsibility for the administration of medicines to residents. The security of the medicines needs to be improved as the medicine keys were left on the desk in the vacated office so unauthorised persons could have accessed the medicines. After the inspection the regional manager of the company that owns the home has informed CSCI that a serious issue regarding the storage of medication has been identified and that this is currently under investigation by the company. On the nursing unit medicines were found to be managed satisfactorily with MAR sheets filled in correctly. Eye drops were dated when opened but these were stored in the medicine trolley. It is advisable to store these in the fridge. A nurse was observed giving out medicines to residents. The trolley was left unattended whilst she was in a resident’s bedroom. The trolley was open and Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 14 blister packs of medicines placed on top so there is a risk that unauthorised persons could have accessed the medicines. See Requirements 1 – 5 and Recommendation 1. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. There are not enough activities available at the home to keep residents stimulated and active. Residents’ wishes are not always listened to by staff but they do receive a varied diet that takes their preferences into account to help them maintain their health. EVIDENCE: There is no activity organiser currently working at the home. At the time of the visit there was no evidence of the residents being engaged in leisure or social activities that would provide them with stimulus or that would meet their preferences. The home has a visiting policy so that people that they can visit at any reasonable time. Visitors were present in the home during the course of the day. Residents were wearing their own clothes and those spoken with said they could choose what they want to wear. Residents said that they are offered choice with regard to their daily life. Two members of staff were seen interacting with a resident. The resident asked to go to a particular lounge and the members of staff told her that there were no chairs left in that lounge so she would have to use the other quieter lounge. The resident was later seen sat in the quieter lounge. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 16 A daily menu was on display in the main entrance hall and in the dining rooms. Lunch was a choice of either pork steaks with boiled potatoes or chips, fresh carrots and cauliflower. Homemade apple pie and custard or pears and cream were served as dessert. Residents said they had a choice of a cooked breakfast or cereals and toast. Residents were complimentary about the food and no complaints were made. The nursing unit now has a dining room with tables nicely set out with appropriate cutlery and crockery. See Requirements 6 & 7. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality outcome in this area is adequate. Although there is information available to residents and visitors to the home on how to make complaints and how these will be dealt with, these are not always responded to within the timescale. EVIDENCE: The information provided by the home before the inspection showed that seven complaints had been recorded as being received in the last twelve months. Relatives expressed concern that they did not know who to approach if they had a complaint. Concern was also raised that written complaints made to the head office of the company have not been acknowledged or addressed. The operations manager said she had received a complaint relating to fees but this was not recorded in the complaints book. A procedure for adult protection was in place but training on adult protection has not been provided for staff. Two members of staff who were spoken with knew the correct procedure to follow if they witnessed or suspected abuse taking place. They confirmed that they knew this from their previous employment. See Requirement 8 and Recommendation 2. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 & 26 Quality in this outcome area is poor. The exterior and interior of the home was not generally well maintained. The standard of cleanliness, some carpets and furnishings in the home were poor, so residents did not have a comfortable and homely environment in which to live. EVIDENCE: Several problems were identified during this site visit. When the inspectors arrived at the home, they saw that a plastic chair was overturned on the grass, a plastic table and two other chairs were placed near the fire exit and were used by members of staff. The gardens were overgrown and appeared neglected, so residents would not be able to sit outside in the gardens. Several of the window units have ‘blown’ and require attention. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 19 The hospitality lounge, which is situated off the reception area, was cluttered with books so residents or relatives wishing to have a quiet conversation would not have been able to use this room. The staff room off the reception area was designated as a residents’ smoking area. This contained a washing machine, sink, cupboards, cola machine and several easy chairs. This area was not a pleasant environment for residents to use. The corridor carpets on both units have been replaced since the last inspection. Residents have the use of two-lounges/dining room upstairs and two downstairs. However, several of the residents’ communal areas appear to be used for the benefit of staff. For example: The large lounge upstairs has a smaller area that has been previously used for aromatherapy etc. This part of the lounge had a computer, desk and papers placed there, used by staff. In addition there were several items stored there including mattress, chest of drawers and two medicine trolleys. The small lounge downstairs near the kitchen was not homely or pleasant. A hot trolley was stored there. Inspectors were told this was from Daneside Mews (a separate home on the same site) and there was no room in the kitchen to store it. Three members of staff were using the residents’ lounge whilst on their break. This was also observed during a previous inspection and a requirement made at that time. Assurances were given at that time by the management of the home that this practice would not reoccur. The only designated smoking area for residents in the home was the staff room. This is not acceptable. Residents’ rooms contained many of their own furnishings and possessions. Several of the residents’ beds were found to be in an unacceptable condition. Staff confirmed that the beds had been made on the morning of the site visit. However on closer examination several bottom sheets were very wrinkled and could compromise the residents skin integrity. One sheet was marked and stained. Bedside rail bumpers were placed under the top cover next to the sheet. One of these had tea stains in several places and needed cleaning. One bed had four pillows in place; the bottom pillow had no pillowcase on. Several of the pillows were found to be lumpy and not fit to use. One sheet had a hospital trust name marked through it and several sheets were grey, old and worn. Several of the residents’ bedroom carpets were stained and required deep cleaning or replacing. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 20 The bath in one of the bathrooms upstairs required cleaning. A large wheelchair was stored in the bathroom. A foam wedge was stored on top of the toilet in this bathroom. A handrail was off the wall near the toilet in bathroom Zone 2 downstairs. The laundry was visited during the day. One washing machine and a drying machine were out of order. The inspector was told that these machines have been out of order for some considerable time. The roller used to iron clothes had a part missing and so sheets are not ironed properly. See Requirements 9 - 15. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality outcome in this area is poor. Although enough staff are rostered on duty to care for the number of residents, they are not always supported in their training and development so residents may be at risk of not receiving appropriate good quality care. EVIDENCE: Residents and relatives said there are usually enough staff on duty to meet their needs but one relative expressed the opinion that staff do not appear to be supervised sufficiently. On the day of the site visit there appeared to be enough staff on duty to meet residents’ needs. However, on two separate occasions, it took more than six minutes to respond to a resident’s call bell. Staff training and development need to be improved. Out of a total of 29 members of care staff, only 4 have a qualification at the equivalent of NVQ level 2 or above. This falls considerably short of the national minimum standard. Staff said that they have had induction before being employed at the home. This included watching videos, touring the building, being told about fire systems, and working alongside a senior member of staff. However there was no written evidence of induction for one member of staff. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 22 The training records identified that several members of staff have not had any moving and handling training in the previous twelve months. According to the information provided by the home before the inspection, training on COSHH, fire safety, moving and handling, medication, NVQ and continence management have been provided for staff. Recruitment records were satisfactory in the main, although the references received for one member of staff did not correspond with the people identified on the application form, or their last employer. See Requirements 16 & 17 and Recommendation 4 Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is poor. There is no home manager in post at the moment. The interim arrangements for the management of the home are not satisfactory and as a consequence the home lacks purpose and direction. EVIDENCE: Since the last inspection two managers have left and so there is currently no manager in post. As a result the home lacks purpose and direction. The deputy manager is acting up in the interim. She was being given six hours supernumerary time per week in which to carry out management tasks. This is not enough to ensure that all aspects of the management of the home are covered. Subsequent to the site visit, CSCI was informed verbally that the supernumerary hours of the deputy manager has increased to approximately 30 hours per week. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 24 A new administrator had started working at the home on the day of the site visit. A senior administrator from the company was in the process of carrying out her induction. Following the last inspection, an action plan to deal with the requirements made was sent to CSCI on 26th September 2006. This identified the need to ensure efficient management and administration of the home but this has not been achieved. The quality assurance system within the service is not robust enough to ensure that the home is meeting residents’ needs. Monthly visits to the home are being carried out by a representative of the company that runs it, in accordance with Regulation 26 of the Care Homes Regulations. The last one recorded was in March 20906. It is of concern that this did not pick up on some problems identified as a result of this inspection. For example, the home’s statement of purpose was given an ‘excellent’ rating on the audit carried out by the company. Minutes of residents/relatives meetings are kept. The last meeting recorded on file is dated 22/03/05; the last staff meeting is 26/09/05. Records of accidents were kept and are audited regularly. However the outcome of the audit did not identify any trends that may have occurred and the action to be taken to prevent reoccurrences. Relatives expressed concern about the absence of a manager in the home and the impact this has on residents’ care. Members of staff who were spoken with did not have supervision sessions regularly, even though the action plan from the previous inspection identified that this would happen. The home holds small amounts of personal money for the residents from which services such as hairdressing, chiropody and aromatherapy are paid for. The records and cash balances of a resident was examined and found to be correct. Records were seen of the fire alarm and emergency lighting systems being tested regularly, and current satisfactory test certificates for these were in place. Fire drills are recorded although the names of the members of staff are not identified. The access door to the loft had a sticker on ‘ fire door keep locked’. When tested, it was open. This could put residents at risk. Maintenance records were found to be satisfactory. See Requirements18 – 21. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 25 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 3 3 X x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 x x 1 1 2 x 2 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x 2 2 Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 26 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 Timescale for action Care Plans must be kept up to 30/06/06 date and accurate kept under review and where appropriate in consultation with the resident revised to reflect any changes in the planned care. (Previous timescales of 9/10/05 & 30/12/05 not met) Clinical records must be kept up 30/06/06 to date and completed accurately at all times. The registered person must 30/06/06 make proper provision for the health and welfare of the residents in the home The registered person must 30/07/06 provide in rooms occupied by residents adequate furniture and equipment suitable to the needs of the residents. The registered person must 30/06/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Requirement 2 3 OP7 OP8 17 12 4 OP8 16 5 OP9 13 Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 27 6 OP12 16 7 OP14 12 The registered person must 30/06/06 consult resident about the programme of activities arranged and provide facilities for recreation. Staff must take into account 30/06/06 residents wishes and feelings and provide an adequate explanation if they are not able to meet residents wishes. The registered person must ensure that all complaints are handled within 28 days after the day on which the complaint is made. Arrangements must be made to ensure that the outside of the home is kept in an acceptable condition including regular mowing of the lawn. The registered person must ensure that the ‘blown’ window units are replaced. Residents lounges must be for the use of residents and not staff. A suitable designated area must be provided for residents who wish to smoke Adequate bedding including good quality sheets and pillows must be provided by the care home All parts of the home must be kept clean The registered person must make sure that the washing machine, dryer and iron equipment is repaired or replaced and thereafter kept in good working order The registered person must ensure that staff working at the home has qualifications suitable to the work they are to perform and the skills and experience necessary for that work. DS0000018768.V289999.R01.S.doc 8 OP16 22 30/06/06 9 OP19 23 30/06/06 10 11 12 13 14 15 OP19 OP22 OP22 OP23 OP26 OP26 23 16 16 16 23 23 30/08/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 16 OP28 18 30/08/06 Daneside Court Nursing Home Version 5.1 Page 28 17 OP30 18 18 OP31 8 19 20 21 OP33 OP36 OP38 35 18 13 The registered person must ensure that all staff receive training appropriate to the work they are to perform including moving and handling training. The registered person must appoint an individual with appropriate skills and qualification to manage the care home The registered person must review the quality assurance systems in the home. Staff working at the home must be appropriately supervised. Timescale 24/12/05 not met The door to the loft must be kept locked at all times. 30/07/06 30/08/06 30/08/06 18/05/06 25/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP18 OP29 OP30 Good Practice Recommendations All nursing staff should be reminded of their responsibilities under the NMC codes of practice. Training on adult protection should be provided for all members of staff. The registered person should ensure that a reference from the applicants previous employer is obtained as part of the employment process All members of staff should receive induction training to national Training Organisation workforce training targets within 6 weeks of appointment to their posts. Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Daneside Court Nursing Home DS0000018768.V289999.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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