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Inspection on 05/09/05 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 5th September 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.

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 home employs a full time activity organiser. The home has a flexible visiting policy. At the time of the inspection staff were co-operative, polite and professional. The relationship between the home`s staff and the visiting general practitioner is good. The home receives good support from the Primary Care Tissue Viability nurse. The home has student nurses on placement from the local college. The home employs an excellent chef. The gardens and grounds are well maintained.

What has improved since the last inspection?

The home has employed an appointed to the home. Floor four bedrooms refurbished. cared for in bed are now kept assistant chef. A new area manager has been covering in ten bedrooms had been replaced and Care plans belonging to frail residents who are in their bedrooms.

What the care home could do better:

Care planning needs to improve and risk assessments kept under review. Improvement in medication recording and practice is required. The cleaning schedule in the laundry room must be adhered to. Staffing numbers must be reviewed taking into account residents` dependency levels using an appropriate tool. The home`s recruitment procedure must conform to Schedule 2 and Regulation 19 of the Care Homes Regulations. A supervision framework needs to be developed. The fire risk assessment for the building and generic risk assessments need to be kept under review. The practice of residents sitting in wheelchairs for the entire day without the appropriate pressure relieving cushions in place should be reviewed. Information held in the home relating to agency staff members should conform to guidelines issued by the Aylesbury office of The Commission for Social Care Inspection. Staff meetings need to take place regularly and should be a regular occurrence thereafter.

CARE HOMES FOR OLDER PEOPLE Denham Manor Nursing Home Hailings Lane Denham Bucks UB9 5DQ Lead Inspector Joan Browne Mike Murphy Announced 5 Spetember 2005 at 9:45 am 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 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Denham Manor Nursing Home Address Hailings 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 01895 832 845 County and Suburban Care Ltd Care Home 53 Category(ies) of Old age, not failling within any other category registration, with number (53) of places Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 2005 Brief Description of the Service: Denham Manor is a care home providing nursing and accommodation for forty older people and six 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 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. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place on the 5th and 6th September 2005. The lead inspector was Ms Joan Browne who was accompanied by Mr Mike Murphy (Inspector). Records, policies and procedures were examined and staff’s practices were observed. Residents, relatives and staff were spoken to. Some residents’ bedrooms were inspected. A pre-inspection questionnaire and comment cards were forwarded to the home in advance of the inspection. It was noted that the pre-inspection questionnaire was partly completed and returned on the second day of the inspection. The manager stated that she did not have the time to complete the questionnaire prior to the inspection. She also stated that comment cards had been distributed to residents and relatives three days prior to the inspection. As a result residents did not complete comment cards. Two comment cards were received from relatives and some were spoken to during the inspection. Relatives stated that an improvement in the provision of care had been made but was not sustained. Further concerns raised were the poor standard of hygiene in residents’ bedrooms, the high turn over of staff, the vacant deputy manager’s position, the lack of team spirit and low moral amongst the staff team. 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: The home employs a full time activity organiser. The home has a flexible visiting policy. At the time of the inspection staff were co-operative, polite and professional. The relationship between the home’s staff and the visiting general practitioner is good. The home receives good support from the Primary Care Tissue Viability nurse. The home has student nurses on placement from the local college. The home employs an excellent chef. The gardens and grounds are well maintained. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 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 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 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) 3 Pre-admission assessments are taking place. However, a consistent approach by staff to complete information fully is needed to ensure that residents’ needs will be met. EVIDENCE: Documentation relating to two residents pre-admission assessments were examined. 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’. In one plan the sections relating to sleep pattern and also likes and dislikes were not completed. In the second plan examined information recorded under the heading past medical history read as follows: Dementia, Incontinence. This information appeared contrary and could be misleading. Files examined contained a range of assessment and care planning documents including manual handling, nutrition, falls, social interaction, continence and pressure damage. There was some variation in the level of information recorded and there is a need to obtain consistency in practice. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 9 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) Care plans are in place however, they need to be more detailed, kept under review and to be working documents to ensure that residents’ identified needs are known to staff to enable them to provide the appropriate care. Shortfalls identified in this report relating to residents’ health have the potential to put residents at risk. Poor practice in the administration of medication identified in the body of this report has the potential to put residents at risk. Further guidance in staff’s care practice is needed to ensure that residents’ privacy and dignity is respected. EVIDENCE: Four residents’ care plans were examined. Presentation of folders was not good. Sheets needed numbering and reinforcing. Care plans contained assessment information aimed at identifying needs and a plan of care to meet needs. The quality of information recorded varied and depended on which member of staff was completing the plan. Not all needs identified were supported by a plan of care. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 10 It was noted that a particular resident displayed challenging behaviour at times, which resulted in the individual dressing and undressing. However, there was not a management plan in place to guide staff in managing this behaviour. It was recorded in a particular resident’s care plan that the level of his cognitive deficit should be regularly assessed using the ‘mini mental state examination as a tool’. There was no evidence available to substantiate that the assessments were taking place. Two moving and handling care plans examined indicated that they were updated monthly. However, staff appeared to be doing themselves a dis-service by not incorporating their good practice in action plans examined. The daily report writing focussed on physical care given and did not record on the progress of needs identified. It was noted that care plan folders for those residents who were being nursed in bed had been left in their bedrooms. The manager stated that this system had been developed to ensure that staff record in detail the care that was being provided. Details relating to individuals’ personal care needs were recorded in the daily log. Oral hygiene care plans were in place for some individuals but there was no evidence to substantiate that they were being maintained. It was noted that six residents were suffering from pressure ulcers. Waterlow charts examined for some individuals were not reviewed monthly and records were not adequately maintained. The turning chart for a particular resident was not always followed. It was noted that a resident who was prone to tissue damage had been put on a turning chart. The information recorded in the care plan stated that the resident should sit out for lunch then return to bed. However, it was noted that the plan was not being followed. Records indicated that there were times when the resident was not put back to bed. On two consecutive days it was noted that the resident remained in the chair between 1.00 pm to 8.00 pm and 12.00 pm to 9 00 pm. It was noted that some residents expressed a wish to remain in their wheelchairs. However, this was not reflected in their care plans and not all chairs had the appropriate pressure relieving cushions in place. The manager is required to ensure that information relating to residents’ choice is reflected in the care plan. Appropriate pressure relieving cushions should be placed in individual wheelchairs to prevent tissue damage. It was noted that the information sheet relating to a particular resident’s indwelling catheter was not adequately maintained. Staff were not always recording when the catheter had been changed. Staff should ensure that the information on the sheet is kept up to date. Eight residents’ weight charts were examined. It was noted that four residents had lost a considerable amount of weight since admission and four had gained weight. Nutritional charts were in place for individuals. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 11 The home uses the Boots Manrex monitored dosage system. The medication Six gaps were noted on administration record (MAR) sheets were examined. individuals’ MAR sheets. These related to creams and analgesics. Staff did not use the code recorded on the MAR sheets to denote if medication was given or reason for omission. It was noted that the general practitioner countersigned handwritten entries on MAR sheets. One resident self-administers her medication. A risk assessment was in place but it had not been reviewed since it was implemented. It was noted that Madapor 125mg medication prescribed for a particular resident was given to another resident. The manager confirmed that the individual’s medication had run out over the weekend and she had sought permission from the on call doctor to use the other person’s medication. However, there was no written permission from the on call doctor authorising staff to do so. The manager explained that she had taken corrective action and had approached the general practitioner (GP) on the Monday for a prescription, which the home obtained on the Tuesday. She was not able to explain why the medication had run out. The home uses the monitored dose system. The manager must ensure that residents’ medications are issued in sufficient numbers to avoid this incident reoccurring. Regular monitoring of MAR sheets must take place. All trained staff must have their competencies in medication administration regularly assessed. Copies of assessments undertaken should be kept for inspection purposes. Staff were observed providing personal care to residents who were being nursed in bed behind closed doors. There were times noted when residents’ call bells took more than eight minutes to be answered. Relatives spoken to stated that there were times when residents’ dignity was compromised. They stated that residents were not toileted regularly and nail care was not provided. There were times when residents would have jugs of water left in their bedrooms but there would be no drinking glasses left. Residents were observed seated in the lounge for long periods unsupervised. It was noted that staff appeared rushed off their feet and were not able to spend quality time interacting with residents. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 12 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) 12, 14 & 15 In the absence of the activity organiser consideration should be made to ensure that residents’ social and recreational needs are met. Residents are given the opportunity to be supported by an advocate this would ensure that they exercise their own choice and have full control over their lives. The presentation and quality of the food was of a high standard this would ensure that residents’ dietary needs are catered for. However, lunchtime need to be better managed. EVIDENCE: The home employs a full time activity organiser. However, it was stated that the activity organiser was off sick for. The hairdresser visited the home on the first day of the inspection. Over the course of the two days there were no further organised activities. Staff stated that they do not have time to do any social activities and that “working there is like working in a factory – just processing people and carrying out tasks”. Relatives report “no stimulation of residents in the activity organiser’s absence” – “Even the VE day celebrations weren’t shown on TV”. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 13 Relatives and residents are made aware that they can access the services of an advocate if they wish to. Information relating to the advocacy service was displayed on the notice board. It was pleasing to note that some residents were using the service of the advocate and were finding it to be of invaluable help and support. Lunch was observed. This was a relaxed occasion. Tables were covered with tablecloths and each table had a vase with fresh carnations displayed. The appropriate cutlery, napkins and condiments were available. The menu choices were braised liver and bacon casserole, cheese omelette, mashed potatoes, beans and carrots. Lunch was well presented and tasty. Dessert was sponge and custard, fruit salad, yoghurt and ice cream. Staff assisted those residents who needed assistance in a discreet and sensitive manner. Positive interaction between staff and residents was noted. Relatives and residents were complimentary about the improvement in the quality and presentation of the food. It was noted that some residents were served with their desserts before they had finished their main course. Staff said that this was not the normal practice. This resulted in some residents eating the main course and dessert at the same time. It was noted that staff were supervising residents’ meals in the dining room as well as those residents who remained in their bedrooms. It was noted that some residents became distracted when they were requested to take their medication whilst eating lunch. It is recommended that the practice of administering medication during lunch should be reviewed. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 14 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 home has a clear complaints policy in place this should ensure that residents and relatives are being listened to. Policies and procedures are in place to protect residents. However, the home’s recruitment procedure is not robust and could potentially place residents at risk of harm or abuse. EVIDENCE: The home has a complaints policy and procedure. According to the manager, residents or relatives raising a complaint are given a form ‘Customer Compliment Suggestion Complaint Form’ to complete. Where they are unable to complete it themselves staff will record the complaint for them. The manager investigates complaints. The conclusion of the investigation leads to a ‘not substantiated’, ‘partially substantiated’ or ‘substantiated’ grading. The complaints file containing completed forms and related correspondence was examined. A sample of complaints was examined. This showed that complaints are investigated by the manager and, in the case of written complaints, a letter outlining the findings sent to the complainant on conclusion. Investigations appeared thorough in the sample reviewed and in many instances an apology was given. A summary of complaints received is completed twice yearly. This should facilitate analysis, identify weaknesses in the quality of the service and the corrective action to be carried out by managers. Arrangements for the protection of vulnerable adults (POVA) are in place. Staff have received training by Buckinghamshire Social Services. Managers have Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 15 responded promptly to an allegation of abuse. The organisation advertises a confidential reporting system (to the Clinical Director) on the notice board on the ground floor. It did not advertise details of the local independent confidential reporting system – CARELINE (0800 137915) or to other agencies such as the Commission for Social Care Inspection. The home did not have a copy of the most recent edition of Buckinghamshire joint agency guidelines on POVA. Weaknesses in recruitment procedures (see below) pose a potential risk to residents. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 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 & 26 Ongoing investment to improve the appearance of the premises should create a comfortable and safe environment for residents living there. 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. Some maintenance work to the premises identified as needing attention at the last inspection had been addressed and work was in progress to complete the remainder. The Commission has been informed that a full structural survey of the entire roof had been carried out. However, at the time of the inspection a copy of the report was not available. Some bedrooms on the ground floor and first floor were examined. In two bedrooms on the ground floor faeces was noted on the bedrails and on the walls in the en suite. Skirting boards were covered with dust. This was pointed out to the domestic staff who responded immediately and cleaned the rooms. It was noted that floor coverings in some bedrooms had been replaced and that the odour in the bedroom with the wooden floor had subsided. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 17 It was disappointing to note that the walls in the laundry room were covered with cobwebs and dust. There was a build up of dust behind the machines and it was evident that the cleaning schedule was not being followed. There were several items of clothing belonging to residents left in the laundry room that were not marked and needed to be identified. It was noted that some swing top bins had been replaced with the foot pedal type to prevent the spread of cross infection. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 18 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 Staffing levels and staff deployment on the day of the inspection was insufficient, this has the potential to indicate that not all residents’ needs are met. Staff recruitment files indicated that staff commenced employment without the necessary checks having been undertaken, this has the potential to put residents 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: At the time of this inspection the home accommodated 37 residents. The staffing allows for two registered general nurses (RGN’s) and six care assistants in the morning, two RGN’s and four care assistants in the afternoon and evening, and one RGN and three care assistants in the evening. In addition to nursing and care staff there is one chef, a part-time assistant chef and three part-time kitchen assistants, one housekeeper (post vacant at time of inspection but appointment imminent), one full-time laundry assistant, one full-time handyman, a part-time gardener, a full-time administrator, a parttime receptionist, an activities co-ordinator, and three full-time domestic staff. Staff were under stress at the time of this inspection. The organisation had not succeeded in making an appointment to the deputy manager’s post. One team Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 19 leader was on maternity leave. The second team leader was on sick leave and had handed in her notice. Overall staff numbers had been adjusted downwards in line with a temporary reduction in resident places from 46 to 37. The manager was not supernumerary but was working ‘on the floor’. Managers said that the ‘Department of Health Residential Forum’ staffing tool had informed the calculation of staff hours. The Clinical Director said that the organisation had found an outcome-based approach to such a calculation to be more reliable. Details of the latter were not supplied for inspection but a copy of the home’s calculation using the Residential Forum formula was provided. It was evident that there were strong and disparate views on the staffing of the home. On the one hand was a view that staff numbers were inadequate, that the adjustment in line with resident places did not take account of the dependency of residents, that care staff were now expected to undertake duties in relation to meals which had formerly been carried out by housekeeping or kitchen staff, and that the number of care assistants had been reduced in real terms. It was said that each of these was contributing towards a reduction in the quality of care to residents, was having a significant adverse effect upon staff morale and was leading to increasing dissatisfaction with the quality of care on the part of relatives. On the other hand was the view of managers that any adjustment to duties had not been unreasonable, that contrary to being short of staff the home was in fact overstaffed for the present number of residents, and that the solution to any stresses lay more in organisation and management than in increasing staff numbers. Both points of view were strongly expressed by their respective proponents. Evidence from the inspection process such as the time taken to answer call bells (eight minutes), comments from staff “working here is like working in a factory” and unsatisfactory maintenance of care records, and criticisms from relatives’ comment cards indicate staff shortages. Whether this would be better addressed by providing more ‘hands on carers’ or looking at organisation and management is up to the provider. What cannot happen is for the current state of operation to continue as it has been. Further welfare visits will be carried out and an improvement in direct care provision and maintenance of care records is expected. Nine of nineteen care assistants were either already considered to have a qualification equivalent to NVQ 3 by virtue of being a qualified nurse in their own country, had acquired NVQ 2 or were currently pursuing NVQ 2. The home expects to meet the requirement for 50 of staff to be qualified to NVQ level 2 or equivalent by the end of 2005. In considering recruitment practice four staff files were examined – one registered general nurse, (RGN) one senior care assistant (a qualified nurse from Poland), one care assistant and one assistant chef. Files were well organised. The file of the RGN had been examined on a previous inspection Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 20 and comments had already been communicated to managers. All four files had a photograph of the employee. None of the other three files had an application form. The explanation given for this was that the staff had either been recruited in Poland or through a UK agency. Two of the three files did not contain verification of photocopied references. The references were not addressed to the organisation. In one file the references were not signed and did not have the official stamp of the organisation even though the reference stated that this was required. In two cases interviews appeared to have been conducted over the telephone – one with an overseas applicant, the other with a UK applicant in London. In two files a ‘POVA first’ check had correctly been obtained prior to commencing employment and in advance of receipt of an enhanced CRB. In one file the ‘POVA first’ was obtained two months after the person commenced employment. Files of care staff had a copy of the terms and conditions of employment and in accordance with the requirements of the European Working Time Directive a separate agreement was signed where staff wished to work in excess of their contracted basic hours of 48 hours a week. A separate form recorded receipt of the General Social Care Council (GSCC) codes of practice. Full details of supervision arrangements during induction were not available so it was not possible to confirm whether it complied with the requirements in annex C to Department Of Health (DOH) guidance on POVA (effective from July 26 2004). It was noted that information relating to agency members of staff did not conform to guidelines issued by the Aylesbury Office of the Commission for Social Care Inspection. A copy of the training programme was provided for the inspection. This documented actual or planned training in mandatory or foundation training. Each member of staff has an individual folder containing details of their induction, basic and other training. NVQ training is conducted through ‘Care in the Shires’ training agency. Gaps were noted in induction records and it was not possible to assess the consistency of induction processes for new staff. The home’s present induction does not conform to NTO (‘Skills for Care’ (formerly TOPSS)) requirements. Other training consists of a combination of in-house video based training, training events organised by head office, and training opportunities offered by local health and social services. At the time of this inspection the home did not have a position on supporting the continuing professional development needs of qualified nurses. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 21 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) 31, 32 & 36 The deputy manager’s position needs to be recruited to, this would allow the manager to look at areas in which the home needs to improve. The systems for resident, relatives and staff consultation are poor with little evidence that their views are sought or acted upon. The home needs to develop a robust supervision framework to ensure that staff are supported and supervised in providing quality care to residents. Overall systems are in place to protect residents’ safety. However, fire risk assessments and generic risk assessments need to be reviewed. EVIDENCE: The manager is an experienced registered nurse with two years experience in home management. The manager had been in post seven months at the time of this inspection. The manager is not responsible for any other establishment. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 22 The manager is familiar with the specialty having previously worked as a deputy manager in a nursing home for older people. Lines of accountability are clear, both within the home and to senior managers, and the manager reported regular contact with the regional manager. Due to maternity leave, sickness and vacancies key support staff were not in post at the time of this inspection. The manager said that she endeavours to maintain an open style of management and to support staff in their work. The post of deputy manager is to be re-advertised following a failure to appoint in the last round of recruitment. The manager said that residents are encouraged to read their care plans and to be involved in care planning. More recently the home has invited an advocate from Age Concern to meet with residents and two meetings have been held to date. Staff meetings, with the exception of a heads of department meeting, are not being held on a regular basis at present because of pressure on staff time. The manager stated that she has held one meeting with relatives but there are no plans to hold further regular meetings. Some criticism of senior managers was expressed. It was felt that there was an emphasis on tasks at the expense of doing things at the residents pace or in spending time with them. Senior managers were described as “abrasive” and lacking sensitivity to the views of staff and relatives. An effective form of supervision, conducted on a regular basis, was not in place at the time of this inspection. Kitchen records relating to food temperatures were examined and in good order. Food and sauces stored in the refrigerator were dated and labelled. The kitchen storeroom was tidy and opened packets of food were stored in airtight containers. Records indicated that the fire panel is checked weekly. It was noted that the fire risk assessment for the building and generic risk assessments needed to be reviewed. A valid hard wiring electrical certificate for the building was in place. Records indicated that the nurse call bell system is checked monthly and the passenger lift is service regularly. Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 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 3 x 2 2 2 x x x 1 x 2 Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 24 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 7 Regulation 12(1)(b) Requirement Timescale for action 30.11.05 2. 7 12(1)(b) 3. 9 13(2) 4. 26 23(2)(d) The manager must ensure that care plans are detailed and reflect identified needs with clear actions. Risk assessments and Waterlow assessments must be reviewed regularly and changes noted should be reflected in the care plans. An audit system must be put in place to support the content of the care plans. The manager must develop care 31.10.05 plans for residents who present anti social and challenging behaviour. Daily report writing should reflect care given. 30.11.05 The manager must ensure that medication administered is signed for. Trained nurses must use the appropriate code if medication is refused or not administered. There must be an adequate stock of medication for residents. The practice of sharing medication must cease. The proprietor and manager must ensure that all trained nurses working in the home have their competencies in medication administration regularly assessed. The cleaning schedule in the 05.09.05 Version 1.40 Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Page 25 5. 27 18(1)(a) 6. 29 19 Schedule 2 7. 36 18(2) 8. 38 13(4) laundry room must be adhered to The manager and proprietor must review staffing numbers taking into account residents dependency levels using an appropriate tool. The proprietor and manager must ensure that the homes recruitment procedure conforms to Schedule 2 Regulation 19 of the Care Homes Regulation. (Previous timescale of 09.06.05 not met) The manager must ensure that all staff receive a minimum of six supervision sessions yearly. (Previous timescale of 09.06.05 not met) The manager must ensure that the fire risk assessment and generic risk assessments are reviewed. and ongoing 31.10.05 31.10.05 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. 1. 2. Refer to Standard 8 29 Good Practice Recommendations It is recommended that the manager review the practice of residents sitting in wheelchair for the entire day without appropriate pressure relieving cushions in place. It is recommended that the manager and proprietor should ensure that information held on agency staff members working in the home conform to guidelines issued by the Aylesbury office It is recommended that the manager should ensure that regular staff meetings are held. 3. 32 Denham Manor Nursing Home 20050509 Denham Manor X00015 AI Stage 5 S19195 V237676 H53.doc Version 1.40 Page 26 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 01296 737550 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. 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