Inspection on 02/06/05 for Denham Manor Nursing Home

This inspection was carried out on 2nd June 2005.

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

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

Other inspections for this house

Denham Manor Nursing Home 27/10/08

Denham Manor Nursing Home 26/11/07

Denham Manor Nursing Home 11/07/07

Denham Manor Nursing Home 04/04/06

Denham Manor Nursing Home 05/09/05

Denham Manor Nursing Home 27/09/04

Denham Manor Nursing Home 28/04/04

Denham Manor Nursing Home 27/04/04

Denham Manor Nursing Home 23/11/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ Lead Inspector Joan Browne Unannounced 2nd June 2005 09:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Denham Manor Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Denham Manor Nursing Home Address Halings Lane, Denham, Bucks, UB9 5DQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01895 834470 County and Suburban Care Limited Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Denham Manor Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2004 Brief Description of the Service: Denham Manor is a care home providing nursing and accommodation for 40 older people and 6 people who need help with personal care. County and Suburban Care Limited owns the home, which is a private limited company. The home is situated in a pleasant but relatively isolated country lane on the outskirts of Denham. Public transport is not easily accessible. The home was originally registered in 1988 and consists of a two-storey building, with three conservatories. The home has 38 single bedrooms and 6 double bedrooms. 35 of the single bedrooms and all the double rooms have en suite facilities. There is a passenger lift. The home has extensive gardens, which are well maintained. Denham Manor Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 2nd June 2005 with a follow up visit on 9th June 2005. The lead inspector was Ms Joan Browne who was accompanied by Mr Mike Murphy (Inspector) and Mrs Rosemarie James (Regulatory Manager). The inspection consisted of meeting with residents and staff, examination of care documentation and records. A tour of the building was carried out. Feedback was given to the manager, area manager, clinical director and regulatory manager of the out-come of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home’s statement of purpose and service users’ contract require reviewing. Further training for staff in care planning and report writing is required. Written consent from service users or their representatives to have photographs taken should be obtained. Medication processes need to be developed further. Improvement in the home’s telephone facilities is required. Maintenance work identified as needing attention must be carried out. The roof needs to be overhauled to prevent water damaging the homes structure. Door holding devices such as dor-gards should be fitted to those service users’ bedroom doors who wish to keep doors open. Swing top bins must be replaced with foot pedal bins. Where the organisation wishes to allow an employee, including those appointed overseas, to take up employment before an Enhanced CRB certificate has been obtained, a satisfactory ‘POVA First’ check must first be obtained and the member of staff appointed working under supervision until a satisfactory enhanced CRB certificate has been received. Mandatory training for staff must be regularly updated. A supervision Denham Manor Nursing Home Version 1.10 Page 6 framework needs to be developed. Improved food stock control measures need to be in place. Wheelchairs and window restrictors must be checked monthly. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Denham Manor Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Denham Manor Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3, & 5 The home’s Statement of Purpose and Service User’s Guide contain a lot of relevant information but lack some of the detail to enable service users to be fully aware of the services the home provides to meet their needs. Each service user has a written contract. However, some clauses within the document are ambiguous having the potential to confuse service users. The home has an effective assessment procedure to ensure that prospective service users needs are identified. Prospective service users and/or their representatives have the opportunity to visit the home to ascertain its suitability. EVIDENCE: The Statement of Purpose was revised in May 2005. The document includes the name and registered offices of the registered provider, County and Suburban Care Ltd. It states that the present manager is the registered manager. This was not the case at the time of this unannounced inspection. The organisational structure is shown as 7 boxes, each Denham Manor Nursing Home Version 1.10 Page 9 representing an individual or group of staff employed in the home. The number of RN’s (registered nurses), activities co-ordinators, chefs, and receptionists is given. There is one manager and one senior RGN. The number of carers is not stated but the number of care staff on duty in the morning, evening and at night is given. A useful summary of the staff induction, training and development programme is provided. The document makes it clear that the home is a nursing home for older people and that it does not provide care for people ‘whose mental health difficulties are so marked as to require specialised psychiatric support’, (i.e. persons with diagnosed dementia prior to admission). The statement says that ‘regular service user meetings take place to which relatives may be invited’ and that ‘Service users’ questionnaires are sent out annually to enable closer monitoring of service delivery and standards of care’ and that ‘The Home also invites comments on feedback forms, which are available in the reception area’. With regard to recreation it says that ‘The home’s policy on Recreational Therapy takes into account Service Users’ interest, skills, experiences, personalities and medical conditions’. The number of rooms is given but not room sizes. There is no refere nce to arrangements for respecting the privacy and dignity of service users. Other aspects of Schedule 1 regarding complaints and fire procedures are met. The service users guide is written in a straightforward style. It includes a brief description of the accommodation, the names and titles of staff, the number of places and a statement that the home specialises in the care of older people and also provides rehabilitation, respite and terminal care’. Contact details for a local advocacy service are given, the complaints procedure is outlined (and includes the addresses of the Commission for Social Care Inspection and Social Services in Aylesbury) and the document states that the dates of residents’ meetings are posted on notice boards and on a weekly activities sheet. It says that minutes of meetings are available on request and a copy of the annual service user’s satisfaction survey can also be requested. The ‘Contract of Residence’ was revised in March 2005. The contract includes the number of the room to be occupied, a summary of what fees include and of what is not covered, a breakdown of the contribution towards fees, the terms and conditions of occupancy and the circumstances in which the contract may be terminated. While it is implied that the services listed in the contract which are not included in the fees may be available at additional cost, an explicit statement to this effect would be desirable. Some sections may need further review and clarification. On the first page it is stated that ‘Fees do not include any expenses relating to Service User’s pets’ while on the third page it is stated that ‘The Home regrets they cannot accept animals into the home’. A paragraph on property is also ambiguous ‘The Home will not be held responsible for loss of Service Users property. On admission a Service User property list will be completed. Any new items brought into the Home must be added to this list. No responsibility will be taken for possessions not itemised Denham Manor Nursing Home Version 1.10 Page 10 on the property list. No responsibility will be taken for lost or broken If the home is not accepting spectacles, dentures or hearing aids’. responsibility for service users’ property then this raises questions of the need for such a list and on the feasibility or desirability of maintaining it as a routine practice over time. It is not clear whether the statement on ‘no responsibility being accepted for lost or broken spectacles etc’. extends to losses incurred through the actions of staff employed by Caring Homes. On receiving an enquiry the manager completes an inquiry form. Some referrals may be excluded at this stage – at the time of the inspection these include where a person suffers from dementia (where formally diagnosed), those with pressure sores or people exhibiting behaviour problems. Where the enquiry progresses to referral the manager conducts an assessment in the person’s present place of residence. The assessment sections of three care plans were examined. Files had satisfactory documentation. Pre-admission assessment documentation covered assessment of allergies, past medical history, speech, hearing, sight, mobility, elimination, personal hygiene, tissue viability, nutrition, pain and comfort, sleeping and rest, breathing, circulation and ‘recreational and spiritual’. On completing the assessment the assessing manager was required to record the answer to the question ‘Can the home meet needs ‘Yes’ or ‘No’’. Information from referring professionals is also available prior to admission. Assessment of needs on admission is well structured and files contained a range of assessment and care planning documents including manual handling, nutrition, falls, social interaction, continence and pressure sore. Examination of files showed some variation in the level of detail recorded and there is a need to obtain a greater degree of consistency in practice. It was difficult to assess the extent to which informal carers (e.g. a family member) were involved in the assessment process. National Health Service (NHS) registered nurses are involved in assessment and treatment processes for service users referred for NHS services (such as tissue viability nurses or GP practice nurses in the case of pressure ulcers). The contract includes the statement ‘The first four weeks of admission shall be regarded as a trial period for the benefit of the service user and the home, after which a care review will take place’. Although prospective service users are offered the opportunity to visit the home before assessment the manager said that many are too frail to assess the home for themselves and in such circumstances the home liaises with the person’s family and the referring care manager (if involved). The home does not accept emergency admissions. Respite admission can be offered when a room is free. Denham Manor Nursing Home Version 1.10 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Those care plans examined did not contain all of the information necessary to enable staff to meet service users care needs. The home’s staff have developed better working relationships with the general practitioner and staff from the Primary Care Trust to ensure that the health care needs of the service users are met. The medication administration practices demonstrated by staff need to reflect the home’s medication policy. This will ensure that service users health and well being are not put at risk. Service users commented that staff respect their privacy and dignity. However, telephone facilities in the home need further consideration to ensure service user privacy. EVIDENCE: Four service users’ plans were examined. The name of the primary nurse and key worker was recorded at the front of the care plan. Care Plans contained assessment information aimed at identifying needs and a plan of care to meet needs. Some variation in the quality of information was noted. For example, Denham Manor Nursing Home Version 1.10 Page 12 although depression was noted in one care plan there did not appear to be any exploration of this with the resident in subsequent records. Daily reports focussed on physical care given and contained few references to psychological and social aspects of care. A photograph of a wound was on file in one case although written consent for taking the photograph did not appear to have been obtained as evidenced by that section of the relevant consent form not being completed. Weights were regularly recorded. Not all of the care plans examined had been reviewed monthly as stated in the National Minimum Standards. Care staff assist service users to maintain their personal and oral hygiene. The trained staff with support from the tissue viability nurse, assess service users’ tissue viability. It was noted that there were several service users who were suffering from pressure ulcers. Some had acquired the damage on admission to the home. Each service user had a waterlow chart in place, which is reviewed regularly. The home is expected to provide appropriate equipment such as pressure relieving mattresses and cushions where required. The home’s staff are expected to assess those service users with incontinence problems. Providing they meet the criteria they are supplied with the necessary equipment to aid their incontinence from the Primary Care Trust continence adviser, who also offers support and advice to the home’s staff. In the period leading up to this inspection the Commission ahd been informed that the home had run out on incontienence supplies. An investigation was carried out that established this was because assessments of service users by staff had not taken place. The management of continence supplies was followed up at this inspection and the manager gave reassurance that the issue had been resolved. This was because assessments of service users by staff had not taken place. The management gave reassurance that the issue had been resolved. It is the practice in the home for service users with poor appetites to be monitored closely and advice would be sought from the general practitioner who may consider prescribing supplements if indicated. All service users are registered with a general practitioner (GP) who visits the home weekly. The relationship between the GP practice and the home was good. The home uses the Boots monitored dosage system. The medication administration record (MAR) sheets were examined. Some gaps were noted and there was no reason documented for omission. Eye drops in use did not record the date opened. Some entries had been scribbled over. It was noted that a service user was prescribed for Warfarin medication however, the instructions on the daily administration doses were not kept in the medication record book. As a good practice it is being recommended that the instructions on daily dosage be kept in the medication folder. An individual protocol should Denham Manor Nursing Home Version 1.10 Page 13 be developed for Warfarin administration. It is also being recommended that an individual PRN protocol be developed for those service users who are in receipt of Paracetamol, Co Dydramol and Fosamax medication. It was noted that medication for a particular service user was written as ‘take as directed’. This is not a good practice and should cease. Handwritten entries were recorded on MARS without evidence that a second member of staff checked the information. As a good practice all handwritten entries recorded on MARS should be checked, dated and signed by two staff members. When antibiotic treatment has been completed or other medication discontinued. The person making the entry should record a short note for example, ‘course completed, stopped by GP’ and date and sign the entry. As a good practice staff should be consistent and record their signatures instead of recording a tick when creams and lotions have been administered. Service users spoken to on the day of the inspection confirmed that staff respected their privacy and dignity. Service users are addressed by their preferred term of address, which is recorded in individuals’ care plans. Staff were observed serving afternoon tea to service users who were on bed rest. It was noted that drinks were left on lockers and service users were not able to access drinks. Some service users’ call bells were also not accessible. Staff are reminded of their duty to ensure that drinks and call bells are accessible to service users at all times. It was recommended at the last inspection that the telephone facility in the home should be reviewed to ensure that those service users who do not have their own personal telephone can have access to a telephone in private. The recommendation had not been responded to. Denham Manor Nursing Home Version 1.10 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Since the appointment of the new chef the presentation and quality of the food is high and meets the nutritional needs of service users. EVIDENCE: The lunchtime period was observed, which was a relaxed and social occasion. The menu choice was shepherd’s pie, creamed potatoes and carrots. Dessert was fresh fruit salad with cream. Lunch was well presented and tasty. Staff assisted those service users who needed assistance in a discreet and sensitive manner. Service users confirmed that since the appointment of the new chef there had been an improvement in the quality of the food. Denham Manor Nursing Home Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The arrangements for protecting service users are satisfactory and ensure that they are not placed at risk of harm or abuse. EVIDENCE: The home has a complaints policy and procedure in place, which service users and relatives are made aware of. Since the last inspection the Commission has received several complaints from relatives who have raised concerns regarding the food and the provision of care. The complaints were referred on to the home’s manager to be addressed. It is pleasing to be able to report that the home has recruited a new chef and there has been a marked improvement in the preparation and presentation of food since they took up their position. The home has a vulnerable adult policy and a whistle blowing policy in which all staff are made aware of. The inspectors were told that the would respond promptly to any suspicion or evidence of abuse. It was that training in adult protection and abuse awareness for staff was arranged. place, home noted being Denham Manor Nursing Home Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25, & 26 Issues relating to the environment which have been highlighted in this report and in a letter to the Responsible Individual need attention to ensure that service users’ health and welfare is not compromised. Some of the systems in place to control the spread of infection were not robust enough to ensure the health and safety of service users and staff. EVIDENCE: The home is situated in a pleasant, but relatively isolated location on the outskirts of Denham. The grounds were tidy, attractive and accessible to service users. The maintenance and renewal programme of the fabric and decoration of the premises was not available on the day of the inspection. A considerable amount of maintenance work to the premises was identified as needing attention during the inspection and 83 requirements to address the problem areas identified were made via letter to the Responsible Individual. Included in these requirements were the repair of 8 radiator covers which posed a health and safety risk and the replacement of 5 window frames 4 of which were in Denham Manor Nursing Home Version 1.10 Page 17 service users bedrooms. These requirements were made because the existing windows were in such a bad state of repair that their weather proof ability was doubtful. In addition to this it was noted that the guttering appeared blocked in places and it was strongly recommended that the area of brickwork near to the front entrance where ivy has recently been removed should be cleaned to give the home a more pleasing look to anyone visiting it. There was evidence to indicate that when it rains heavily water was entering the property and causing damage to the ceilings and associated structures. It has been made a requirement of this report that a survey of the roof is undertaken by a recognised roofing contractor and an action plan to address any problems identified sent to the Commission. It was evident that some maintenance work from the previous inspection relating to the physical environment of the building had not been complied with. It was noted that windowsills had been painted but the paint was peeling because the woodwork underneath was not sound. The home employs a full time maintenance man. It was noted that the environmental health officer recently carried out an inspection of the kitchen and some requirements were made. The inspectors were told that work was in progress to comply with the requirements. The home has adequate toilets, washing and bathing facilities. Service users have access to the communal areas and their bedrooms with the provision of the passenger lift. Handrails are fitted in the corridors; grab rails in the bathrooms and some bedrooms. Hoists are installed in bathrooms to assist with bathing and moving and handling. Some bedrooms were personalised and reflected the individual characters of service users. It was noted that chests of drawers and vanity units were in need of replacing in some bedrooms. Some bedrooms had a strong smell of urine and carpets were heavily soiled and stained. It is acknowledged that some carpets had recently been replaced and there were plans to replace more. It has been made a requirement of this report that those carpets that appear to be the cause of unpleasant odours are included in this programme of carpet replacement. En suite facilities were in need of decorating and some floor coverings required replacing. It was noted that in one particular bedroom faeces was observed on the wall and on the bed rails. This was reported to staff at the time. On resuming the inspection one week later this had not been cleaned. Curtains in some bedrooms required re-hanging. Denham Manor Nursing Home Version 1.10 Page 18 Lighting in bedrooms was satisfactory however, the light bulb in one particular en suite required replacing. The hot water temperature in one particular bedroom registered 60 degrees Celsius. The hot tap in bathroom 120 was running cold. A requirement has been made in this report for restrictor valves to be replaced or adjusted. In the interim the manager must develop a risk assessment. Service Users were spoken to some of whom were not happy because they were requested to keep their bedroom doors closed during the inspection. Senior managers are reminded that bedroom doors can only be kept open providing the appropriate door holding devices or dor-gards are fitted to the doors. A requirement has been made in this report that the appropriate door holding devices or dor-gards must be fitted to those service users’ bedroom doors who wish to keep their doors open. Consultation with the fire safety office regarding this will need to take place before any work commences. The systems in place to control the spread of infection were not robust enough as evidenced by: the sluice room floor on the first floor having faeces on it; general waste bins with swing top lids, pedal bins are preferable and the clinical waste bin was not fitted with a lock. On the positive side the laundry room is situated away from where food is prepared and soiled linen was placed in red alginate bags. Denham Manor Nursing Home Version 1.10 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The numbers and skill mix of staff are appropriate for the needs of the service user group. Some recruitment files lacked evidence that the necessary checks had been undertaken before commencing employment, having the potential to put service users at risk. It is acknowledged that a considerable amount of training has taken place. However, some additional training is required to ensure full competence amongst the staff team. EVIDENCE: The staffing establishment for the home has not changed since the last announced inspection. This allows 2 registered nurses (RN’s) and 7 healthcare assistants (HCA’s) in the morning, 2 RN’s and 5 HCA’s in the evening and 1 RN and 3 HCA’s at night. There are two activities co-ordinators – one working 30 hours a week, the other 6 hours a week. Other staff include a chef (a new appointment for whom there was much praise for improvements in the quality of food), two kitchen assistants, a laundry assistant, three domestic staff, one housekeeper, one full-time handyman and two receptionists. The manager was appointed in January 2005. At the time of this inspection the home was about to appoint to the vacant head of care position. A full-time administrator post was vacant (The home is currently supported by an administrator from another area). Staff under the age of 18 do not provide personal care to service users. A registered nurse is always in charge in the absence of the manager. Denham Manor Nursing Home Version 1.10 Page 20 According to the summary training sheets submitted with papers for the inspection 5 care staff have obtained National Vocational Qualification (NVQ) in direct care at level 2 and two care staff are registered for such training. The home has one NVQ assessor. The manager stated that she is currently pursuing NVQ 4, the Manager’s Award. Two care staff are intending to undertake nurse training and the home receives student nurses on placement from Buckinghamshire Chilterns University. Information on the NVQ status of agency staff was not available. The only member of staff who was under 18 years of age was not employed in a care capacity. A copy of the summary training form was made available for inspection purposes. This provided information on the training received by 45 staff under 16 subject headings between February 2004 and May 2005. On acquiring the home in 2004 Caring Homes Ltd established a comprehensive internal staff training programme in order to bring staff training up to the organisation’s standard. This continued throughout 2004 and by the time of this inspection in June 2005 almost all care staff had received training in fire safety, moving & handling and food hygiene. A smaller majority had received training in first aid and on the protection of vulnerable adults. Smaller numbers had received training in ‘Care Assessing and planning’ and other subjects. All staff undertake the organisation’s induction programme. Individual files examined contained certificates of attendance on courses attended. The majority of training conducted to date focussed on mandatory training (fire, first aid, moving & handling, health & safety, and food hygiene). It was noted that many individual summaries were not being regularly updated. A training programme for the next 12 to 18 months was not available at the time of this inspection (the manager had only been in post six months). The home has experienced considerable change over the last 18 months and an ongoing programme of staff training and development is essential in addressing weaknesses in the quality of service delivery. The manager stated that she intends to take advantage of training opportunities offered by local health and social services as well as those available within the organisation. Some staff have attended courses in catherisation, wound care, care assessing and planning, and one care assistant has attended a course on ‘Dementia Awareness’. Given that the home now has a permanent manager and is looking at the team structure below this position, it is important to carry out a thorough review of training needs (to include good practice in nursing and social care, drawing on the organisation’s experience since acquiring the home as well as its own policy on training, the views of staff as expressed in supervision, appraisal and meetings, and the views of residents, relatives and of local health and social services practitioners with whom it is in contact). This should form the basis of a programme of staff training addressing ‘mandatory’ training, NVQ (at levels 2 and 3), and training in specific care subjects to meet Denham Manor Nursing Home Version 1.10 Page 21 the training needs of registered nurses, and support identified strengths and address weaknesses. The manager and the administrator set out policy and practice. Applicants are required to complete an application form and to provide two referees. The appointment of overseas staff is managed through the company’s head office. The appointment of staff locally is managed by the home. Staff should not start employment before a Protection of Vulnerable Adult ( ‘POVA first’) check is obtained. All new care staff are provided with a copy of the General Social Care Council (GSCC) codes of conduct by the administrator on starting employment. Staff receive a statement of terms and conditions, a signed copy of which is retained on file. The terms and conditions are set out in detail in the staff handbook (‘Issue 1 March 2005’ a copy of which was given to the inspectors). The home does not employ volunteers at present. Four staff files were examined. The organisation of files was generally good although some papers relating to recent appointments were loose filed and photocopied documents did not have a note to indicate whether the original document had been seen. For staff working more than 48 hours a week a European Working Time Directive waiver form was on file. Performance on ‘POVA first’ in the files examined varied. One file had a police clearance from the employee’s own home country. Reference to ‘POVA first’ was not on file. A CRB certificate was obtained two months after taking up employment. The terms and conditions for this post included a deduction of an amount which was to be refunded after one year in post – this condition was not noted in other contracts. In a second file an open reference did not have evidence of verification by the appointing manager and a ‘POVA first’ was obtained one month after starting employment. The copy of terms and conditions on file had not been signed. Other files examined appeared in order. Denham Manor Nursing Home Version 1.10 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 38 A structured framework of supervision needs to be developed to ensure that service users benefit from a staff team who are appropriately supervised. The home needs to be pro-active in ensuring that records relating to health and safety are kept up to date. This would ensure that service users safety and health is not compromised. EVIDENCE: All employees should receive a copy of ‘Caring Homes ‘Employee Handbook’ (Issue 1 March 2005 submitted with other papers for this inspection). Although the handbook does not have a section on staff supervision it does state that staff can expect (among others) ‘Full support and commitment for your development and to meet your job related needs’ and ‘ongoing career development, subject to opportunities within the company’ and ‘A culture where quality and care are our fundamental principals’. The organisation’s own quality audit includes a standard on supervision. Denham Manor Nursing Home Version 1.10 Page 23 At the time of this inspection in June 2005 one to one supervision had not been established. The explanation given for this was due to the ‘fluid environment’ related to changes in managers over the past twelve months, turnover of other staff and the key head of care position being vacant. Inspectors were assured that this matter is now being addressed. Training records examined indicated that not all staff had received training updates in safe moving and handling procedures, fire training and first aid. It was noted that personal food belonging to service users such as prawn sauce and crab legs were stored in the general kitchen refrigerator. This practice should be reviewed. Opened mint sauces stored in the refrigerator were not labelled and dated. Fire records examined indicated that the fire panel is checked weekly and the emergency lighting monthly. However, there was no record in place of staff who had undertaken fire drills. Evidence was in place to substantiate that the hot water system had been chlorinated to prevent the risk of Legionella. There was no evidence available to substantiate that the kitchen gas appliances are regularly service. There was no record to indicate that wheelchairs and window restrictors are checked monthly. It was noted that the COSHH health and safety check list was not fully completed. Denham Manor Nursing Home Version 1.10 Page 24 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 2 x 2 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x 1 x 2 Denham Manor Nursing Home Version 1.10 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(1)(c ) Schedule 1 Schedule 4 (8) 18(1) (c ) (i) 13(2) 16(2)(b) Requirement The manager must ensure that the Statement of Purpose includes all of the information required under Schedule 1 Regulation 4(1)(c ). The manager must review service users contracts to ensure that it states explicitly services covered by fees. The manager must ensure that all staff undergo further training in care planning and report writing. The manager must enure that staff administer and record medication appropriately. The proprietor must provide telephone facilities and make arrangements for service users to use such facilities in private. The organisation are to provide the Commission with a survey on the state of the roof carried out by a recognised roofing contractor and an action plan on how they are to rectify any problem areas identified. The proprietor must ensure that maintenance work outlined in letter of 10.06.05 is carried out. The proprietor and manager Version 1.10 Timescale for action 30.09.05 2. 2 30.09.05 3. 7 09.0605 and ongoing 09.06.05 and ongoing 31.10.05 4. 5. 9 10 6. 19 23(2)(b) 14.8.2005 7. 8. 19,21,22, 24, 24 23(2)(b) 23(4)(a) 10.06.05 and ongoing 09.06.05 Page 26 Denham Manor Nursing Home 9. 26 13(3) 10. 11. 26 29 13(3) 19 Schedule 2 18(1) (c ) (i) 18(2) 13(3) 12. 13. 14. 30 36 38 15. 16. 38 38 Schedule 4 (14) 13(4) must ensure that those service users who wish to keep their bedroom doors open should have the appropriate door holding devices or dor-gards fitted following consultation with a Fire Safety Officer. The manager must ensure that swing top bins are replaced with pedal foot bins to control the spread of cross infection. The manager must ensure that the clinical waste bin is fitted with a lock. The manager must ensure that the homes recruitment procedure conforms to Schedule 2 Regulation 9 of the Care Homes Regulations. The manager must ensure that mandatory training for staff is regularly updated. The manager must ensure that all staff receive a minimum of six supervision sessions yearly. The manager must ensure that opened sauces stored in the refrigerator should be labelled and dated. The manager must ensure that a record is kept of staff names who attended fire practice drills The manager must ensure that that wheelchairs and window restrictors are checked and recorded monthly. COSHH health and safety check list must be completed fully. and ongoing 30.09.05 09.06.05 and ongoing 09.06.05 and ongoing 09.06.05 and ongoing 09.06.05 and ongoing 09.06.05 and ongoing 09.06.05 and ongoing 09.06.05 and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Version 1.10 Page 27 Denham Manor Nursing Home 1. 2. 3. 4. 5. 7 9 9 9 38 It is recommended that the manager should obtain written consent from service users or their representatives to have photographs taken. It is recommended that the manager should ensure that individual protocols for Warfarin, Forsamax and PRN medication be developed. It is recommended that the manager should ensure that handwritten entries on MAR sheets are checked, dated and signed by two staff members. It is recommended that the manager should ensure that staff are consistent and record their signatures when creams and lotions have been administered. It is recommended that the manager should review the practice of storing service users personal food items in the refrigerator in the main kitchen. Denham Manor Nursing Home Version 1.10 Page 28 Commission for Social Care Inspection Cambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire HP19 8JR 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 Denham Manor Nursing Home Version 1.10 Page 29 - 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. 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