Inspection on 09/10/06 for Ealing Manor Nursing Home

This inspection was carried out on 9th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ealing Manor Nursing Home 05/12/05

Ealing Manor Nursing Home 21/06/05

Ealing Manor Nursing Home 17/01/05

Ealing Manor Nursing Home 19/07/04

Ealing Manor Nursing Home 12/08/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Ealing Manor Nursing Home 5/6 Grange Park Ealing London W5 3PL Lead Inspector Mrs Rekha Bhardwa Key Unannounced Inspection 10:35 9 and 11th October 2006 th 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 Ealing Manor Nursing Home DS0000010963.V313871.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. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ealing Manor Nursing Home Address 5/6 Grange Park Ealing London W5 3PL 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) 020 8840 3490 020 8579 4595 Messrs Narain and Rajesh Mittal Mrs Lydia Ngusoron Kur Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0), Terminally ill (0) Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 6 TI and up to 35 in total All Service Users to be over the age of 40 Date of last inspection 5th December 2005 Brief Description of the Service: Ealing Manor Nursing Home is a converted detached house in a residential area of Ealing. It can be accessed by bus, underground and main line train services. The accommodation consists of 27 single and 3 double bedrooms. The main day room has three areas for service users to utilise, plus there is a separate quiet lounge available. There are local shops within 10 minutes walk and the Ealing Broadway Shopping Centre is accessible by bus or a longer walk. Local transport facilities are available in the form of buses and Ealing Broadway underground and mainline station. The home offers a good social and leisure activities programme. The home has a designated information board for visitors and this information is comprehensive. At the time of the inspection there were 31 service users accommodated at the home. The fees charged range from £525 to £575, dependent on the assessed needs. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 12 hours was spent on the inspection process. A tour of the home was carried out, and service user plans, medication records, staff records, financial records, management records, administration records, maintenance and servicing records were viewed. 10 service users, 5 visitors and 8 staff were spoken with as part of the inspection process. The preinspection questionnaire, given to the home at the time of inspection, has also been used to inform this report. What the service does well: What has improved since the last inspection? What they could do better: Shortfalls identified in the detail of fire drill records should be easy to address. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 6 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. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written contracts are in place, thus ensuring information regarding the homes terms and conditions are understood. Service users are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. Prospective service users and their representatives are encouraged to visit the home in order to allow them to make an informed choice. EVIDENCE: There is a written contract/agreement with the Primary Care Trust and local Social Services for service users being funded by these departments. Contracts were available for service users funded privately. The home has a pre-admission assessment that is carried out for all routine admissions to the home. These were seen in some of the service user plan documentation viewed and were comprehensive, giving a clear picture of the service user and their needs. Copies of Social Services and Primary Care Trust assessments, plus hospital discharge information were also available. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 9 One representative of a service user confirmed that they had been able to visit the home prior to the service user being admitted. Where possible service users who are able to make a pre-admission visit to the home are encouraged to do so. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user plans were generally up to date and identified the needs of the service users, thus providing staff with clear information of how the service users needs are to be met. Medications are being well managed at the home, thus safeguarding service users. Staff care for the service users in a gentle and courteous manner, thus respecting their privacy and dignity. EVIDENCE: Three service user plans were examined during the course of the inspection. Generally these were comprehensive and reflected the needs of the service users. There was evidence that care plans were being reviewed monthly or sooner. A care plan agreement form had been signed either by the service user or their representative. Nutritional assessments had been carried out and monthly weights had been recorded. Where service users had a marked weight loss there was evidence that a referral to the Dietician had been made. Moving and handling risk assessments had been carried out and the need to ensure Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 11 that details of the handling equipment to be used were recorded was discussed with the Registered Manager. Pressure sore risk assessments had been carried out, where service users had a skin break this had been identified in the assessment. Those viewed were being reviewed monthly. Continence assessments had been carried out and associated plans had been formulated. Risk assessments for falls had been completed. It was recommended at the time of the inspection that the Registered Manager alongside the accident audits maintain an audit tool for the number of falls. Improvements were noted in wound care documentation. Where a service user had more than one wound a separate wound care plan was available for each wound with details of the wound dressing regime. Details of when dressings are renewed were clearly recorded. Wound assessment documentation is reviewed monthly. Wound photographs with the consent of the service user were available. One Registered Nurse has completed the post-graduate Tissue Viability course. The specific pressure relieving equipment in use had been clearly identified. Pain control had been identified under the medication usage care plan. Regular wound audits take place. Risk assessments for the use of bedrails had been carried out and for two service users written consent had been obtained. For one service user with bedrails the consent form had been signed by the Registered Manager as no service user representative was available. The Inspector recommended that the service users Social Worker or GP also sign this consent. There was evidence of input from the GP and other healthcare professionals recorded in the service user plan. The home uses the Boots Monitored Dosage System. The clinical room was clean and tidy. Medications are securely stored in the home. The room temperature had been recorded as 25˚ centigrade or below. Since the last inspection air conditioning has been installed. The medication fridge temperatures were within safe range. Liquid medications had been dated when opened. A stock check was carried out for a sample of medications and stocks and records were accurate and up to date. All receipts, administration and disposal of medications are recorded. Medication administered via a Percutaneous Endoscopic Gastronomy tube had been clearly recorded and administration of feeds had been signed for on the Medication Administration Record. The home has several GPs that prescribe medication on a monthly cycle. One GP refuses to prescribe monthly and will only prescribe two monthly. This had raised some concerns with the overall medication management of these service users, these concerns had been raised with the GP who still continues to prescribe two monthly. Staff were seen speaking to service users in a gentle and courteous manner. Service users spoken with confirmed that staff were caring towards them, and visitors spoken with during the inspection confirmed that staff always make them welcome at the home. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 12 Several staff members have received training in the care of the dying, and were seen caring for service users in a gentle and sensitive manner. Visitors can stay with their loved ones, and comfortable seating and refreshments are available. For service users who require palliative nursing care support the home has good support from the Macmillan nursing service. Specific care plans on death and dying were not available, however there was evidence of service users wishes recorded in the admission documentation. The Registered Manager stated that this was an area, which some service users and their representatives found difficult to discuss. Pain control and social support are addressed through care plans regarding medication management and social needs. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities provision is generally good and service users have a choice of whether they wish to participate, thus respecting their wishes. The home has an open visiting policy, thus encouraging service users to maintain contact with family and friends. Information regarding advocacy services is freely available, thus ensuring the service users right to independent representation is respected. The food provision in the home is good, offering variety and choice, to meet the service users needs. EVIDENCE: The home employs a part-time activities coordinator. A range of activities take place and a programme is displayed in the main lounge area. The activities coordinator informed the Inspector that participation in the activities provided varies dependent on the wishes of the service user. Care plans for social needs were available. The home has an open visiting policy and visitors spoken with said that they were made to feel welcome at the home. Service users can choose whom they wish to see and their wishes are recorded. Some service users at the time of the inspection chose to stay in their bedrooms rather than the lounge area. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 14 Two members of St Mary’s Church were visiting at the time of the inspection and both stated that they always found the staff very friendly and helpful. Information regarding advocacy services is available in the home. The Registered Manager stated that where a service user required advocacy services this would be arranged. Since the last inspection the menus have been reviewed and changed. The menus viewed detailed a choice of meal. A cooked breakfast option is available. Service users spoken with confirmed that they had a choice and that they enjoyed the meals provided. Water jugs and drinking glasses were available in each bedroom and on the service users over knee tables. The Inspector spoke with the cook on the second day of the inspection. She said that all service users are asked the night before what they would like to eat for their meal the next day. As some service users have some memory loss this exercise is also carried out in the morning by the care staff. The kitchen was clean and tidy and all the cleaning and temperature records were up to date. Risk assessments for the kitchen and staff handling food had received food hygiene training. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by service users and their visitors. The system in place for protection of vulnerable adults is robust, thus safeguarding service users. EVIDENCE: The home has a clear complaints procedure, which provides the contact details of the CSCI. The last recorded complaint received by the home was dated 18/3/06. This had been, investigated, recorded with details of the outcomes evidenced. Visitors spoke with at the time of the inspection confirmed that they would raise any concerns with the Registered Manager. No Protection of Vulnerable Adults (POVA) concerns have been received by the home and the CSCI since the last inspection. The Registered Manager was clear about the POVA procedures to be followed in the event of an allegation. Staff had received POVA training. The Registered Manager stated that she fosters an atmosphere of openness and honesty within the staff team. The training matrix provided by the home indicated that staff had received training in POVA. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, thus providing a clean and homely environment for service users to live in. Equipment in the home is available to meet the service users needs, thus providing for the service users needs. Clear infection control procedures are in place and being adhered to, thus safeguarding service users. EVIDENCE: The Inspector undertook a tour of the home on the first day of the inspection. The service users are accommodated across three floors. Since the last inspection the building work and redecoration to individual bedrooms has been completed. Future plans are in place to redecorate and recarpet the lounge/dining room and corridor areas. On the second day of the inspection a Fire Officer from the LFEPA was undertaking a fire inspection. There is a large garden to the rear of the building, which can be accessed through the lounge. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 17 There is a large lounge on the ground floor, which is in three areas. Furnishings viewed in the communal area were of good quality and met the needs of the service users. Bedrooms viewed were well furnished and had been personalised by the service users and their representatives. Bedroom doors are lockable. At the time of the inspection no service user had requested a key. Where service users chose to keep their bedroom doors open these had been fitted with a Dorgard mechanism. Suitable bathing and toilet facilities are available on each floor. Toilets are located close to communal areas. Height adjustable beds, moving and handling equipment and corridor rails were available throughout the home. All radiators are guarded and can be controlled individually. Lighting was satisfactory and the home has in place an emergency lighting system. There was evidence of the hot water temperatures and the emergency lighting being regularly checked by the maintenance man. Call bells were available in the bedrooms viewed and the toilet and bathroom areas. The laundry room is located on the ground floor. The laundry assistant stated that family members label individual clothing. An infection control procedure was available, along with protective clothing, gloves, soap and paper towels. The laundry assistant confirmed that she had received training in infection control. Liquid gel is also available in the main entrance of the home and all visitors are asked to wash their hands when they enter and leave the home. Four sluice rooms are available and these are separate from service user toilet areas. The home was clean throughout and smelled fresh. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was adequately staffed and staff are employed in such numbers as are necessary to meet the needs of the service users at all times. Staff had received training to enable them to meet the general care needs of service users. Robust recruitment and vetting procedures are in place, thus safeguarding service users. EVIDENCE: The staffing levels were appropriate to meet the needs of the service users. The Registered Manager stated that when service users dependency levels are high extra care staff are deployed. Ancillary and domestic staff are employed in numbers that meet the needs of the service users. The home employs a full time maintenance man. The Registered Manager stated that the home has very little staff turnover and that most staff have been at the home for several years. Some members of staff who had completed their supervised practice placements had obtained employment in other nursing fields. There was evidence that the induction training undertaken by staff met the Skills for Care Common Induction Standards and foundation training. The home has 12 care staff with NVQ 2 in care or equivalent. The Registered Manager is a Moving and Handling Instructor. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 19 Two sets of staff employment records were viewed. These contained the information required under the Care Homes Regulations 2001. Training records were available. Staff spoken with confirmed that they had been receiving training. Specialist training in topics to include skin & wound care, malnutrition, palliative care training and other relevant subjects had been undertaken both by trained nurses and care staff. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the qualifications and experience to manage the home. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Service users monies are well managed and securely stored. Systems for the management of health and safety throughout the home are good, thus safeguarding service users, staff and visitors. Shortfalls identified should be easy to address. EVIDENCE: The Registered Manager is a first level registered nurse. She has also completed the Registered Managers Award, equivalent to NVQ level 4 in management. There was evidence that she had been undertaking periodic training in topics relevant to the needs of the service users. Staff who spoke with the Inspector said that the Registered Manager is supportive and listens Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 21 to any points raised. Service users and their representatives who spoke with the Inspector also confirmed that the Registered Manager is approachable and professional in her approach. Regulation 26 visits take place and the reports of these visits are forwarded to the Commission. Feedback questionnaires had been distributed in March 2006 and the results had been collated and forwarded to CSCI. Audits for service user plans, medications, wound care and the environment are carried out monthly. Small amounts of personal monies are managed by the home. Clear records of income and expenditure with receipts are maintained. Training records viewed confirmed that staff had received health & safety training to include fire safety, moving & handling and food hygiene. The Registered Manager is a Moving and Handling trainer. Risk assessments for safe working practices and equipment are in place. Servicing records were viewed at random and those viewed were up to date. Fire drills and fire alarm tests had been taking place. Both day and night staff had undertaken fire drill training. The Inspector noted that the fire drills were not always recorded clearly. This was discussed with the Registered Manager and the maintenance man at the time of the inspection. Hot water temperatures were being taken and records available confirmed this. Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 22 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no 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 OP38 Regulation 23(4) Requirement The fire drill records must clearly record the time and the names of staff attending the drill. Timescale for action 16/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ealing Manor Nursing Home DS0000010963.V313871.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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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