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Inspection on 26/11/07 for Denham Manor Nursing Home

Also see our care home review for Denham Manor Nursing Home for more information

This inspection was carried out on 26th November 2007.

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.

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

The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. Their funding arrangements are clear. The assessment document prompts staff to ask potential residents about their spiritual and cultural needs, which were recorded. There is good support from the local general practice and residents see the doctor or specialist nurse on a regular basis. Resident`s autonomy and lifestyles are respected and there are a wide variety of activities on offer to bring interest and diversion to their day. There is an enthusiastic activities coordinator who has worked with residents to identify their preferences and provides a lively programme of entertainment and outings on an individual and group basis. The environment is attractive and welcoming. The gardens are well maintained and there is access and seating areas for people who have disabilities. Residents said that the staff were kind and helpful, although `busy`. There is an experienced manager and the organisation has its own quality assurance and clinical governance monitoring systems, to monitor the quality of care offered.

What has improved since the last inspection?

The standard of care planning has improved since the last inspection and the manager has introduced some new documentation to make it easier for staff to identify, plan for and meet residents health and personal care needs. There has been an improvement in identifying residents who are at risk of losing weight and in the steps taken to address this. Resident`s personal care needs had been met and they were supported to meet their own needs where this was possible. Residents moving and handling needs had been reviewed and some new equipment had been bought to ensure that these could be met safely. Two new conservatories and a dining room have been built enhancing the communal areas for residents. The top floor bathroom has been refurbished to become a shower room. Five new height adjustable, profiling beds have been bought.

What the care home could do better:

The improvement in care planning must be maintained. Care plans musts be reviewed and evaluated regularly, changing care needs must be identified, assessed and a plan of care must be developed and evaluated. All entries should be signed and dated. Risk assessments should be undertaken to ensure that those residents whose divan bed is raised on blocks, are safe when using them. Height adjustable beds should be provided for all residents who require nursing care to ensure that they can be safely cared for without injury to themselves or to staff. Residents should not share hoist slings. Residents whose are at risk of developing pressure damage must be given the appropriate mattresses and cushions to prevent pressure damage occurring. Two nurses must sign the medicines administration record if medication is transcribed from the pharmacy box or the prescription. They are signing to say that it is an accurate transcription. Residents must be helped with their meals in a timely way and aids, for instance plate guards, must be provided for those who are able to eat themselves but may need some additional support. Residents should be helped to choose their main meal and have a menu to remind them of the day`s menu. The seating arrangements for those who remain in their wheelchairs at lunch should be reviewed. Hot food should not be allowed to go cold during the time it takes to serve everyone. Accurate records of complaints and the outcomes for residents should be kept at the home, to ensure that they are resolved in a timely way.Two references must be sought for all employees before they commence work. One should be from the staff member`s last employer. The requirements identified by Buckinghamshire Fire and Rescue service and those identified in the home`s own fire risk assessment must be addressed in full if residents are to live in a safe environment. An improvement plan to address the requirements made in this report must be written. The plan must describe the steps that will be taken to address the requirements and the timescale by which they will be met. The improvement plan must be sent to The Commission for Social Care Inspection within one month of the request being made.

CARE HOMES FOR OLDER PEOPLE Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ Lead Inspector Christine Sidwell Unannounced Inspection 26th November 2007 10:30 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 Denham Manor Nursing Home DS0000019195.V353606.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. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Denham Manor Nursing Home Address Halings Lane Denham Bucks UB9 5DQ 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) 01895 834470 01895 832845 denham@caringhomes.org County & Suburban Care Ltd vacant post Care Home 53 Category(ies) of Dementia - over 65 years of age (53), Old age, registration, with number not falling within any other category (53) of places Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users may be admitted from the age of 60 years. 43 Beds are registered for nursing care. The total number of people accommodated must not exceed 53 at any one time. 11th July 2007 Date of last inspection Brief Description of the Service: Denham Manor is a care home providing nursing and residential care for up to 53 residents. The home is situated in a pleasant, but relatively isolated country lane, on the outskirts of Denham. Public transport and other amenities are not easily accessible. The home was registered in 1988 and consists of a two-storey building, with three conservatories. The home has forty single and three shared bedrooms. Some bedrooms have en suite facilities. There is a passenger lift. The home has extensive gardens, which are well maintained. The current scale of charges at the time of writing this report range from £450.00 to £950.00. Additional costs are incurred for hairdressing, newspapers, transport and personal items. Information about the home in the form of a statement of purpose, a service user’s guide and brochures can be obtained from the home. Copies of previous inspection reports are also available at the home. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of four days and included a one day unannounced visit to the home by two inspectors. The key standards for older people’s services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. This was the second key inspection of Denham Manor this year and the manager was not asked to complete another annual quality assurance selfassessment. Questionnaires were sent to the home for distribution to residents and their families although none were returned on this occasion. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the Operations Director, Manager, nursing, care and ancillary staff. Care practice was observed and the care of six residents followed through. A tour of the building and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well: The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. Their funding arrangements are clear. The assessment document prompts staff to ask potential residents about their spiritual and cultural needs, which were recorded. There is good support from the local general practice and residents see the doctor or specialist nurse on a regular basis. Resident’s autonomy and lifestyles are respected and there are a wide variety of activities on offer to bring interest and diversion to their day. There is an enthusiastic activities coordinator who has worked with residents to identify their preferences and provides a lively programme of entertainment and outings on an individual and group basis. The environment is attractive and welcoming. The gardens are well maintained and there is access and seating areas for people who have disabilities. Residents said that the staff were kind and helpful, although ‘busy’. There is an experienced manager and the organisation has its own quality assurance and clinical governance monitoring systems, to monitor the quality of care offered. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The improvement in care planning must be maintained. Care plans musts be reviewed and evaluated regularly, changing care needs must be identified, assessed and a plan of care must be developed and evaluated. All entries should be signed and dated. Risk assessments should be undertaken to ensure that those residents whose divan bed is raised on blocks, are safe when using them. Height adjustable beds should be provided for all residents who require nursing care to ensure that they can be safely cared for without injury to themselves or to staff. Residents should not share hoist slings. Residents whose are at risk of developing pressure damage must be given the appropriate mattresses and cushions to prevent pressure damage occurring. Two nurses must sign the medicines administration record if medication is transcribed from the pharmacy box or the prescription. They are signing to say that it is an accurate transcription. Residents must be helped with their meals in a timely way and aids, for instance plate guards, must be provided for those who are able to eat themselves but may need some additional support. Residents should be helped to choose their main meal and have a menu to remind them of the day’s menu. The seating arrangements for those who remain in their wheelchairs at lunch should be reviewed. Hot food should not be allowed to go cold during the time it takes to serve everyone. Accurate records of complaints and the outcomes for residents should be kept at the home, to ensure that they are resolved in a timely way. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 7 Two references must be sought for all employees before they commence work. One should be from the staff member’s last employer. The requirements identified by Buckinghamshire Fire and Rescue service and those identified in the home’s own fire risk assessment must be addressed in full if residents are to live in a safe environment. An improvement plan to address the requirements made in this report must be written. The plan must describe the steps that will be taken to address the requirements and the timescale by which they will be met. The improvement plan must be sent to The Commission for Social Care Inspection within one month of the request being made. 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. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents have contracts, which describe the service that they should expect, and the responsibilities of both parties. EVIDENCE: The files of four residents who had moved to the home since the last inspection were examined. All had evidence that the manager had visited them prior to their move to the home and that their needs had been assessed. There was evidence in the files that care manager’s assessments have been sought where appropriate. The documentation used to guide the assessment of potential residents who are self funding is comprehensive. Care plans are drawn up following assessment and the family of one resident spoken to confirmed that they had been involved in this. Resident’s cultural and religious needs are identified and recorded as part of the assessment. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 10 The files contained copies of resident’s contracts and terms and conditions, which were explicit as to their individual funding arrangements. There were also records to show that notice of fee increases is given. The home does not offer intermediate care. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There has been an improvement in the level to which resident’s personal care needs are identified and met. There is a need to ensure that resident’s changing healthcare needs are responded to promptly and that medication is managed safely if resident’s healthcare and medication needs are to be met in full. EVIDENCE: The care plans of the six residents whose care was followed in detail were examined. The content of the care plans had improved since the last inspection. The files were in order and the manager has introduced new documentation to make it easier for staff to identify, plan for and meet resident’s needs. There was also evidence that care managers assessments had been sought and some care plans were signed by the resident or their family to indicate that they had been involved in the development of the care plan. The extent to which the care plan had been evaluated regularly varied. One resident had had a fall. This was noted in the records of the general practitioner’s visit but a care plan had not been developed to monitor or addresses this. Some entries were undated. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 12 Residents had been helped to maintain their personal care needs. One resident said that the ‘carers are very good but very busy, they always help me and I can have a bath when I wish’. There were records in the files to show that residents are assessed as to their risk of developing pressure damage, losing weight or falling. Their moving and handling needs are also assessed. Of the six residents whose care was tracked all had been weighed and all but one had maintained their weight since moving to the home. The manager has introduced new procedures to ensure that action is taken if a resident is found to be losing weight. The prevention and management of pressure damage was variable. Of the six residents whose care was followed through, two had pressure damage. One had pressure damage on moving to the home. His risk had been assessed as high and he had been provided with the appropriate pressure relieving mattress and cushion. The tissue viability nurse specialist from the local Primary Care Trust (PCT) had seen him. The records showed that the damage was healing. The second resident developed pressure damage in the home. The care plan shows that she was assessed on the 28/09/07 as having no pressure damage. A risk assessment was undertaken on the 30/09/07, which stated that she had a moderate risk of developing pressure damage. Redness was noted on the 5/11/07 and a dressing applied. Care plan entries were made on the 11/1107, 14/11/07 and 16/11/07. On the 18/11/07 the entry states ‘sloughy wound’. On the 19/11/07 a phone call is made to the organisation’s head office requesting a height adjustable bed and a specialist pressure-relieving mattress. The bed and specialist pressure-relieving mattress were delivered on the 23/11/07. A wound care plan was in place, although no measurements of the wound were undertaken. Two photographs were taken one on the 5/11/07 and one on the 18/11/07, which showed the deterioration. There is a need to ensure that resident’s risk of developing pressure damage is assessed on a regular basis and when their health changes. There is also a need to ensure that residents who are identified as having a moderate or high risk of developing pressure damage are provided with the correct pressure relieving mattresses and cushions before they develop damage. There is also a need to ensure that wound healing is monitored carefully should damage occur. Residents are registered with the general practitioner of their choice or with the local general practice. There was evidence in the files that the general practitioners visit regularly and one resident spoken to spoke highly of the doctor and said that the staff always called him if she asked. Residents had had ‘flu’ vaccinations. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 13 Two residents on the top floor were spoken to and both indicated that they were happy there. One was still in bed and her bed linen was in some disarray. The manager said that she liked it that way. One was dressing herself and the carer was seen to return to check that she was all right and could manage. At the last inspection a number of resident’s moving and handling needs could not be met safely as the hoist did not go under the divan beds that they were nursed on. The manager stated that five new height adjustable beds had been purchased since the last inspection. Several divan beds however were seen to be on temporary blocks to raise them from the floor. Risk assessments must be undertaken to ensure that these are safe for residents. Height adjustable beds should be provided for residents who require nursing care. There are medication policies and procedures in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. There were no gaps seen on the medication administration records. At the last inspection it was noted that two members of staff sign handwritten entries to the medication administration record. This was not the case at this inspection and one medication record contained an entry, which had not been countersigned by the general practitioner, and where the dose had been inaccurately transcribed from the prescription/dispensed box. The nurses administering the medication had noted the error and had been administering the correct dose but the transcription had not been changed to reflect the correct dose. The manager and operations director said that the normal practice was for the chemist to send a second printed medication chart when additional medications were prescribed. The error was addressed as soon as it was brought to the manager’s attention by the inspector. Controlled drugs were stored in a satisfactory manner and all entries to the controlled register were signed. The controlled drug register was in poor condition and the manager said that a new one had been ordered. A notification had been made to the Commission for Social Care Inspection that a small number of sleeping tablets had been reported missing. The police had been notified and the matter investigated. The procedures for checking and recording controlled drugs between shifts have been reinforced. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Resident’s autonomy and lifestyles are respected and there is a wide variety of activities on offer to bring interest and diversion to their day. There are insufficient staff available at meal times to help residents eat their main meal and to assist in making mealtimes a sociable occasion. EVIDENCE: There is an activities organiser in post who arranges a number of activities which residents are assisted to participate in if they wish. A musical afternoon was being held on the day of the unannounced visit. On most days there is a ‘pick and choose’ afternoon in the lounge when games are played. Coffee mornings, sherry mornings, cream teas and quizzes are featured. The activities organiser said that he also meets with residents on a one to one to basis if they do not wish to participate in communal activities. Funding to support activities is raised through raffles and fetes. An autumn programme of activities has been developed, leading up to a variety of Christmas celebrations. Residents also have the opportunity to go out, either as individuals or in groups. Tea dances and musical entertainments are held. The residents spoken to said that they enjoyed the entertainments and that it ‘livened up the day’. One said that the ‘activities chap is wonderful, he makes me laugh’. The activities coordinator is to be congratulated on developing individual care plans, which describe individual’s life histories and hobbies and Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 15 interests and how they would like to spend their day. Activities are then tailored to individual’s interests and wishes. The residents spoken to said that they had a choice as to how they spent their day and as to when they got up or went to bed. One qualified this by saying that I sometimes get up early, as ‘I know if I say, not yet, I will have to wait a long time’. Two visitors were spoken to and both said that they were made welcome at any time and one said that she was often able to have tea with her friend. The service user’s guide states that visitors are welcome at any time. The permanent chef left sometime ago. A part time chef has been appointed and chefs from other homes in the group have covered the catering service. A new chef was undergoing a part of her induction on the day of the unannounced visit. There is a rotating menu plan, which showed that the menus are varied and that a choice is available. The menu for the day was on display in the main entrance hall but not in the dining room or on the dining tables. There is a new dining room and conservatory, which is bright and pleasantly decorated. Residents were taken to the dining room from about 12.15 to wait for lunch. There was no supervision in the dining room during this time. The inspector had to seek a carer for one resident who wished to go to the toilet and some residents were seen to be irritated with each other. Tables were laid with paper napkins. The arms of the wheelchairs do not allow residents who stay in their wheelchairs to sit close to the table. The practice of residents remaining in their wheelchairs for meals should be reviewed and residents be given the opportunity to sit at a higher table if they stay in their wheelchair or to sit on a dining chair. The meal was served from about 1pm by the chef, a registered nurse and a carer. The meal on the day was Toad in the Hole with onion gravy, mashed potatoes and mixed vegetables, followed by a pink sponge and pink custard sauce. A vegetable pancake was offered as an alternative to the main course. There were insufficient staff available in the dining room to assist residents. One lady dropped her spoon and was trying to eat with a knife. Residents did not have plate guards when needed. Most residents did not finish their meal. The manager said that the care staff who were not in the dining room would be helping residents who wished to eat in their rooms and helping those who could not eat unaided. Two residents were spoken to, one who was eating in the dining room and one who was eating in her room. One said that he had been here ‘over a year now and the food leaves a lot to be desired’. He also said that the food was often cold. The other said that she never knew what the meal would be until it was served although she was satisfied with standard of food. The meal service should be reviewed. Residents must be helped with their main meal in a timely way and aids, for instance plate guards, must be provided for those who are able to eat themselves but may need some additional support. Residents should be helped to choose their main meal and have a menu to remind them of the day’s menu. The seating arrangements for those who remain in their wheelchairs at lunch should be reviewed. Hot Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 16 food should not be allowed to go cold during the time it takes to serve everyone. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The complaints policies and procedures are in place to consider residents concerns although accurate records must be kept at the home to ensure that they are dealt with in a timely way. EVIDENCE: There are complaints policies and procedures in place. A complaints log has not been kept up in the home since the last inspection although the manager said that copies of all complaints would be held at head office. She was aware of the need to ensure that the homes complaint’s log was maintained and had plans to so. From the paperwork available it appeared that the home has received three complaints since the last inspection and has investigated or is in the process of investigating these. The manager said that the Clinical Director for Caring Homes would be investigating one complaint and undertaking a dependency analysis in the home. The home had a copy of the local multi-agency strategy for the Protection of Vulnerable Adults and 89 of staff have now had training in this topic. The Commission for Social Care Inspection (CSCI) has been notified of two complaints about care since the last full inspection and has received two anonymous complaints, one in writing and one on the telephone. The Commission is also aware of one complaint, which was followed up by the Local Authority. The information from these complaints was recorded on the CSCI’s records and used in the planning of this inspection. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 18 The Commission has not been notified of any allegations made to the local authority under the safeguarding procedures. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents live in an attractive home, which is subject to ongoing improvements to improve the communal areas and resident’s rooms. There is a need to ensure that individual specialised equipment and height adjustable beds are available for residents who need nursing care in order that their care needs can be met safely. EVIDENCE: The home is an older, elegant building, which is situated in attractive, wellmaintained gardens. People with disabilities can access outside sitting areas. The rooms vary in size and there has been significant investment in improving the communal areas in the home. Two new conservatories and a new dining room have been built. A requirement was made at the last inspection that the home address the issues identified in their own fire risk assessment. These have not been addressed in full and are discussed in the management section of this report. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 20 The bathrooms have been improved since the last inspection. The bathroom on the top floor has been refurbished to create a shower room and was awaiting new flooring. The ground floor bathrooms were tidy and were not being used for storage. There is still limited space in the bathroom, which contains the Parker bath, for a hoist, which limits the use that can be made of that bathroom. Resident’s rooms very in size. They are encouraged to bring personal items and many had chosen to do so. Their rooms reflected their diverse lives and interests and were homely. The manager said that rooms are decorated when they become vacant. The colours are neutral. A requirement was made at the last inspection that all residents who require nursing care have a height adjustable bed. The manager said that five new height adjustable beds had been bought. Other divan beds had been put on temporary blocks to raise them and to accommodate the hoist. Risk assessments should be undertaken for these beds to ensure that they are safe for residents to use. There was still an odour of urine in a small number of rooms. There are control of infection policies and procedures in place and the manager stated that these have been updated since the Department of Health issued updated guidance to care homes in June 2006. There is liquid soap and hand towels in resident’s rooms and evidence that alcohol hand rub is available. It was not possible to inspect the laundry on the day of the unannounced visit as all washing machines were out of order and the laundry had built up. This was being addressed as a matter of urgency. A requirement was made at the last inspection that residents do not share hoist slings, as this is contrary to the latest guidance from the Department of Health, which was issued in June 2006. This has not yet been fully implemented although the manager said that she had been allocated a budget to do so. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is a training programme to give staff the necessary skills to care for residents with complex needs although the staffing levels are insufficient to meet residents’ needs in a timely manner and must be reviewed. In general recruitment procedures are thorough although the provider must ensure that references are obtained from the employee’s previous employer if residents are to be fully protected. EVIDENCE: The home has three floors. The workload is arranged such that the staff who are allocated to the ground floor also cover the five residents on the top floor. There are two qualified nurses on duty throughout the day and one at night, supported by six carers between 8.am and 2pm, four between 2pm and 8pm and three between 8 pm and 8am. A requirement was made at the last inspection that the staffing levels were kept under review and the manager stated that she had been allocated funding to increase the staffing levels in the evenings. She also stated that the Clinical Director for Caring Homes was to undertake a dependency analysis to ensure that the staffing levels met the needs of residents. Additional housekeeping support had also been agreed, to enable the care team to focus on caring. The call bells were not ringing continuously throughout this visit as had been noted at the last inspection. The manager had introduced a monitoring system whereby the qualified nurses checked residents on a regular basis throughout the day when the carers were busy and she felt that this anticipated problems better and reduced the need for residents to call to ask for assistance. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 22 Nine of the twenty-four carers hold the National Vocational Qualifications in Care at Level 2 and four are working towards it. The home does not yet meet the standard that 50 of care staff hold this qualification. The recruitment files of three staff members were examined. All contained application forms, evidence of the staff member’s identity and a photograph. A Criminal Records Bureau disclosure had been received prior to the staff member commencing work. A requirement was made at the last inspection that two references must be sought before a new staff member starts work and that one reference should be from the person’s last employer. Of the two staff members recruited since the last inspection one file had evidence that this had been complied with although the other did not. The work history was inconsistent and both references were from colleagues and had been sent to private addresses. This requirement will be repeated and a new timescale set. The home must review its recruitment procedures to ensure that an accurate work history is obtained from applicants and references are obtained from previous employers. This requirement will be repeated and a new timescale set. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The provider has a quality assurance programme and has taken steps to improve the quality of care offered to residents. There has been an improvement in the equipment and facilities available to meet resident’s needs safely. The requirements of the fire safety authority must be met, for residents to live in a safe environment. EVIDENCE: A new manager has been appointed since the last inspection. She has experience in managing care homes and is a registered nurse. She holds the National Vocational Qualifications in Management at level 4. She has not yet applied for registration with the Commission for Social Care Inspection and states that she will do so within the next three to six months. The staff spoken to said that she was approachable and has made some positive changes to the Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 24 home. The residents spoken to said that they felt confident that she would deal with any issues that they had. Caring Homes has a quality assurance system in place and regularly audits the service. Weekly reports and clinical governance updates are sent to the head office and action plans are developed to address the issues. A monthly management report is also submitted. An operational manager visits the service regularly and a record of her visits is kept within the home. The organisation undertook a residents and staff questionnaire in January 2007 and an action plan is being developed to address issues arising from this. The home does not manage any residents’ money on their behalf. There is a procedure for the safekeeping of small amounts of money on behalf of residents. Each resident has a transaction sheet and receipts are given for money deposited and expenditure incurred on behalf of residents. There are health and safety procedures in place and risk assessments have been undertaken. COSHH data sheets are available for hazardous substances. A requirement to update the moving and handling assessments of residents and to provide appropriate aids was made at the last inspection. This has been addressed and assessments had been updated. A new hoist and some height adjustable beds have been purchased. The infection control policies and procedures have been updated in line with the Department of Health guidance issued in 2006 although hoist slings are still shared between residents, which is contrary to this guidance and may put residents at risk of cross infection. This was a requirement of the previous inspection, which has not yet been implemented in full and will be repeated in this inspection. A fire risk assessment was undertaken on the 14th December 2006. The recommendations of this fire risk assessment had not been addressed by the last inspection undertaken in July 2007 and a requirement to address this was made. The Buckinghamshire and Milton Keynes Fire Authority inspected the home on the 3rd September 2007 and identified two deficiencies including that inadequate action had been taken following the completion of the Fire Risk Assessment in 2006. The actions had not been addressed in full by the time of this inspection. The manager said that this was being dealt with by the organisation’s head office. This must be addressed and the provider must address all fire safety recommendations to ensure that residents are not put at risk. Thirteen requirements were made following the last key inspection in June 2007, although the organisation did not accept them all and wrote disagreeing with the outcome. The Commission for Social Care Inspection requested an improvement plan at this time but the organisation failed to submit one. However action has been taken or is in the process of being taken to address Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 25 most of the requirements made at the last inspection. A number of the requirements made following the previous inspection, which had not been met in full at this inspection, have been repeated and a new timescale for completion has been set. An improvement plan will be requested when this report is finalised and a requirement to prepare this and send it to the Commission for Social Care Inspection has been made in this report. Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 2 X 3 X 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 1 Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 27 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. 2 Standard OP8 Regulation 12(1)a Requirement Residents must be assessed as to their risk of developing pressure damage on a regular basis and if their health changes Residents whose risk assessment shows that they are at moderate or high risk of developing pressure damage must be provided with the appropriate pressure relieving mattress and seat cushions, to minimise the development of pressure damage, which is painful and inhibiting for them. The progress of wound healing must be monitored carefully and accurate records kept. Two nurses must sign the medicines administration record if medication is transcribed from the pharmacy box or the prescription. They are signing to say that it is an accurate transcription. Residents must be assisted with their meals. Aids must be provided for those who need them and food should not be allowed to go cold whilst it is DS0000019195.V353606.R01.S.doc Timescale for action 31/12/07 3. OP8 12(1)a 31/12/07 4 5 OP8 OP9 12(1)a 13 (2) 31/12/07 31/12/07 6 OP15 12(1) a 31/01/08 Denham Manor Nursing Home Version 5.2 Page 28 7 OP19 23(4A)b 8 OP24 13(4) 9 OP26 13(3) 10 OP28 19(1)b and Schedule 2 11 OP33 24A (1) and (2) being served. The requirements identified by Buckinghamshire Fire and Rescue service and those identified in the home’s own fire risk assessment must be addressed in full. This is an unmet requirement of the previous report and a new timescale has been set. Risk assessments must be undertaken where residents have divan beds, which are raised on temporary blocks to ensure that they are safe for residents to use. Residents must not share hoist slings to reduce the risk of cross infection. This is an unmet requirement of the previous report and a new timescale has been set. Two references must be sought for all employees before they commence work. One should be from the staff member’s last employer. This is an unmet requirement of the previous report and a new timescale has been set. An improvement plan to address the requirements made in this report must be written. The plan must describe the steps that will be taken to address the requirements and the timescale by which they will be met. The improvement plan must be sent to The Commission for Social Care Inspection within one month of the request being made. 31/03/08 31/12/07 31/03/08 31/03/08 29/02/08 Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations The improvement in care planning should be maintained and all residents should have up to date care plans, which accurately reflect their needs and the care that they require to meet those needs. The seating arrangements for residents who stay in the dining room in their wheelchairs should be reviewed. Menus should be reviewed to ensure everyone is aware that there is a choice of main meal and has a menu to remind them as to what the meal of the day is. Accurate records of complaints and the outcomes for residents should be kept at the home, to ensure that they are resolved in a timely way. All residents requiring nursing care should be provided with height adjustable beds. The offensive odours in some rooms should be eliminated. 2 3 4 5 6 OP15 OP15 OP16 OP24 OP26 Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI Denham Manor Nursing Home DS0000019195.V353606.R01.S.doc Version 5.2 Page 31 - 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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