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Inspection on 17/11/05 for Euroclydon Nursing Home

Also see our care home review for Euroclydon Nursing Home for more information

This inspection was carried out on 17th November 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

Most of the residents spoken with were contented in the home and felt that the staff were kind and looked after them well. All stated that they enjoyed the food, one saying he had too much to eat. Staff spoken with, are all keen to learn and are enthusiastic about undertaking an NVQ qualification. The home does have close links with the multidisciplinary team within the community.

What has improved since the last inspection?

There are some signs that care records should improve once the new documentation has been introduced and there are uniform records in place for every resident.

What the care home could do better:

Recruitment procedures still have gaps in checks and required documentation that must be addressed. Some residents and staff feel that issues raised/requests made either go unanswered or actions take a long time to initiate. Better communications between the provider and the home and regular visits to the home should overcome this feeling and there are plans to introduce a regular newsletter to hopefully address this problem. There is a need for the stability of a registered manager in the home to set and maintain the standards of care expected. Falling standards of care indicate either a lack of awareness from care staff or lack or supervision by the qualified nurses. The home is actively looking for a manager and since the inspection each registered nurse and senior carer have been given responsibilities for different areas of care to hopefully improve the standards overall. The help of an external expert has also been enlisted on a consultancy basis.

CARE HOMES FOR OLDER PEOPLE Euroclydon Nursing Home Drybrook Glos GL17 9BW Lead Inspector Mrs Janet Griffiths Unannounced Inspection 17th November 2005 09:30 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 Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 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. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Euroclydon Nursing Home Address Drybrook Glos GL17 9BW 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) 01594 543982 01594 544352 Chantry Retirement Homes Ltd To be appointed Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate 5 (five) named service users under the age of 65 years - Service User Category PD. The home will revert to the original service user category when these service users no longer reside at the home or reach the age of 65 years. To accommodate 1 (one) service user under 65yrs of age on respite care. This bed to be used for respite care only of a period no longer than 1 month unless prior agreement with CSCI. Not to be used for a permanent resident under 65yrs of age. 9th June 2005 2. Date of last inspection Brief Description of the Service: Euroclydon Care home is located in the Forest of Dean on the outskirts of Drybrook and is registered to provide both nursing and personal care. The accommodation comprises of three areas referred to as the original Main House, the single storey extension and the link extension, which joined the two previously separated areas in 1996. Residents are accommodated on two floors in the Main House and the link. Two shaft lifts facilitate access to the upper levels, although one has been out of order for some time. The home offers thirty-eight single and five double rooms. Twenty-eight rooms offer en suite facilities. In addition, there are a number of assisted bathrooms and toilets on each floor and in each extension. Communal areas include a lounge and large dining room with an adjoining conservatory and small smoke room in the Main House; a smaller lounge in the link extension and another large lounge and sun lounge currently used as a dining room, in the single storey extension. The home is positioned on high ground and most upper floor rooms offer a magnificent view of the surrounding countryside. The gardens are well maintained and accessible to all residents and a summerhouse was built last year to provide shelter from the elements. The home has its own tail-lift minibus. A new Company- Chantry Retirement Home took over the business from the previous registered owner earlier this year. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours on one day in November 2005. An anonymous complaint, recently received by the CSCI was also investigated during the inspection. A tour of the premises was undertaken and a number of residents spoken with to include one newly admitted resident and one on respite care. A number of staff were also spoken with to include nursing and care staff, the laundry assistant, cleaning, catering, maintenance and administrative staff. A selection of care files was looked at in detail and other records to include personnel files of three newly appointed staff were also checked. As a result of some of the findings an immediate requirement notice was served in relation to a lift being out of action for some months and causing some distress to the residents and inadequate staffing levels. What the service does well: What has improved since the last inspection? There are some signs that care records should improve once the new documentation has been introduced and there are uniform records in place for every resident. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 6 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. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 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 Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 The homes Statement of Purpose and Service Users Guide does not provide accurate and up to date information for prospective service users to be clear about the services the homes provides to meet their needs. The admission process is managed satisfactorily to ensure that residents needs can be met. EVIDENCE: The home has a copy of the Statement of Purpose on the back of the door in each room and a service users guide in a file in reception. Although a few minor changes have been made to this, much of the information was compiled by the previous manager and must be reviewed to reflect the home as it is now. Service users should actually all have a copy of the Service Users Guide rather than the Statement of Purpose and when this has been updated this must be addressed. Since the inspection draft copies of the revised Statement of Purpose and Service Users Guide have been seen and are to be printed and distributed shortly, with copies sent to CSCI. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 9 It was reported that there have been a number of new admissions since the last inspection and records of some of these were seen and some of the residents spoken with. The home also has one room mainly used for those on respite care and was currently occupied by a gentleman who had come in for a short period of time as his wife had been unwell. He said that he thought the home was very nice, the staff were kind and he was well looked after. There was evidence seen of assessments being completed on each resident, although some of these were brief. Some files also had Social Services assessments and care plans and evidence of recent reviews. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 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 The home has a care planning system in place but this is not always consistent and may not clearly provide staff with the information they need to satisfactorily meet service users needs. Although there is evidence of good multidisciplinary working taking place on a regular basis, the health needs of the residents are not always fully identified and met which could potentially place residents a risk. EVIDENCE: A selection of care files were looked at in detail. All had assessments completed and from these care plans were in place and showed evidence of review, although some did not reflect the current needs of the service users and reviews were overdue. There is currently a mixture of old and new documentation as each care file is in the process of being updated. This is sometimes quite confusing to follow. Most residents had moving and handling and pressure sore risk assessments, but again these did not always reflect current needs and equipment being used for those at high risk of pressure sores not always clearly identified. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 11 One gentleman said that he was unable to have his weekly bath today because the staff on-duty were too small to being able to manage him. The manager reported that this was not totally accurate but as he was unreliable in his ability to transfer and had refused a moving and handling aid this procedure was difficult. This had not been identified in the risk assessment. It was noted that a number of residents have bed rails fitted but no bumper pads are in place to protect the residents from injury or entrapment. Risk assessments must be completed for use of bed rails to consider whether this is the safest option for each resident. It was reported that in one instant recently bed rails had been removed and an adjustable height bed and crash mattress used. Since the inspection more bumper pads have been ordered. One resident who has been identified as at high risk of pressure sores for at least the last three months, now has a broken area on her sacrum and a high risk pressure relieving mattress was being fitted during the inspection. It was suggested that this is being ‘reactive’ rather than ‘proactive’. It was also recorded that barrier cream had been applied to the broken area, which was not considered appropriate. It was later reported that this resident had been admitted to hospital and had returned with a pressure sore. The weight records of this same resident state that she has gained 1 stone 4 pounds in the last couple of months. This was questioned as to its accuracy, although on checking the records later the manager reported that it was an accurate recording. The weight increase was as a result of the service users’ physical condition and resulted in admission to hospital. One recording had been deleted using ‘tippex. A further resident who is also very frail had a very dry mouth and tongue. According to her fluid chart she had received two hot drinks during the morning but all the fluid charts seen were not being completed consistently indicating that residents are not receiving regular fluids. The manager did report that they do not have enough jugs to go round every room (more have since been ordered and action has been taken subsequently to ensure that fluid carts are kept up to date). The use of supplements for those nutritionally at risk was seen. Although a number of the residents spoken with said that they were very happy with the home and were well looked after, the above evidence does not indicate a consistently high standard of care. However, the manager has been able to look at alternative methods of continence management for a number of residents who previously had indwelling catheters. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 12 Since May a total of 55 accidents have been recorded. One recently resulted in a resident having a fractured hip and they had returned to the home the previous day following surgery. One accident to a member of staff was as a result of slipping on a wet carpet caused by a leak in the roof. It was reported that this is being addressed. There was no evidence seen to suggest that accidents were not being reported/recorded, as suggested within the complaint. Within the records is evidence of multidisciplinary input through regular doctors visits (visiting during the inspection), district nurses visiting those residents admitted for personal care only, the continence advisor, wound care specialist, chiropodist and optician. The doctor who visits the home regularly was spoken with following the inspection and felt that the care in the home was satisfactory. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 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 The home does aim to provide as stimulating and varied a life at the home as possible but some residents experience limitations with this programme. EVIDENCE: The home only has one very part-time activities organiser since the second one left a while ago. There was no one organising activities in the home during the inspection but evidence of some craft activities taking place, with a recent collage representing Remembrance Day. Although it was reported that an extensive range of activities are organised regularly and the home is actively seeking a second activities organiser, some of the residents spoken with felt there was little organised activities, and resorted to reading their newspapers or retiring to their rooms to watch television. This was also reflected in the comments made at residents meetings. The home has experienced difficulties in recruiting activities organisers for some time, but continues to advertise the post. It is felt that new recruits loose interest quickly if they are unable to motivate service users. However a visit to the home following the inspection showed a full Christmas programme and school children were at the home singing Christmas carols at the time of this visit. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 14 The home has five younger adults accommodated and again there appears to be little to provide a stimulating environment for them. One spends her days in the smoking room but it was reported that she does have three visits a week from her support worker and is regularly taken to the shops and home. Most of the others remain in their rooms or in one of the lounges and none of them attend day centres or any community facilities, but a variety of activities have been offered to them but they decline these and they prefer to pursue their own interests. One couple have however become engaged and are apparently planning to marry next year. Staff related that they had an engagement party recently. Other recent events have included a firework display, a harvest festival and earlier in the year Strawberry cream teas. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 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 Arrangements for responding to residents concerns are not totally satisfactory and residents are not confident that their concerns although listened to, will be acted upon. EVIDENCE: The home has a complaints procedure in place, displayed in the main hallway of the home, but this needs to be updated as it refers to the previous owner of the home and to the NCSC. An updated version is reportedly in place in the procedures file and the one on display is now being updated. It was reported that there had been no complaints since the last inspection. However, speaking to a number of residents to include two who represented the resident on the residents committee, they were very unhappy that one of the upper floor lifts had been out of order for some months resulting in residents having to walk long distances to the other lift and manoeuvring through two doors with walking frames or wheelchairs, which was extremely difficult. They felt that they had raised this matter on a number of occasions with the proprietor and manager but nothing appeared to be happening. A new structure of responsibility has been introduced since the inspection, which will enable a timely response to concerns raised. Since the inspection steps have been taken to repair the lift so that it can be used provided staff accompany service users. One service user who was particularly upset had been asked if he would like to move to a ground floor room, but he declined the offer. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 16 The general impression also coming from the staff was that it took some time for any action to occur. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 17 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): 19,26 The standard of the environment within this home is satisfactory providing service users with an attractive and comfortable place to live in, however, shortfalls in infection control and continence care may be detrimental to the environment if not addressed satisfactorily. Not all aids to promote independence are in full working order. EVIDENCE: A tour of most of the rooms in the home took place. The maintenance man was on leave during the inspection but back-up arrangements had been made for emergency cover. Generally, the standard of maintenance and décor in the home was satisfactory, and all areas appeared comfortably furnished. However, several residents were quite distressed by one shaft lift being out of order for some time, which hampered their independence in leaving the first floor to go to the ground floor. It was reported that this is being addressed but because of the age of the lift there is a problem in replacing parts and it may result in a new lift being fitted (see standard 16 above). Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 18 A former office is currently being converted into an en suite bedroom. It is anticipated that this will be ready for occupation in a few weeks. A fire check and check from CSCI are necessary prior to the room being occupied. This room will not alter the registration numbers of the home as some double rooms are currently occupied singly (room has been completed since the inspection) The following areas were noted as requiring attention: Room 1 the door is difficult to open. Room 31 needs redecorating (the home reported that it is unable to do this at present not wishing to disturb the resident in the room who is unwell). The standard of cleanliness in the home is also generally high and the cleaners spoken with take pride in and enjoy their work, but there was a slight odour on entering the home and several rooms (identified during the inspection) with a strong odour noted. It was also noted that there were several heavily stained plastic urinals laying on the floor in one the toilets together with a plastic bedpan holder. One member of staff asked the inspector what precautions should be taken for a resident with MRSA and was told that provided good hygiene practices were followed no special procedures were required. The manager reported that the home did have a policy on MRSA and that all staff are made aware of MRSA so felt that there should have been no need for concern. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27,29,30 The numbers of staff recently available is not sufficient to meet the high dependency needs of the residents. The procedures for the recruitment of staff continue to be less than robust and thus do not provide safeguards to offer protection to people living in the home. Staff have been trained to do the job but are not altogether competent. EVIDENCE: On arrival the inspector was told the manager was on an admin day’ and that there were two RGN’s on-duty. The manager reported however that she was working ‘on the floor’ and one RGN was working as a care assistant. All of the staff on-duty were working 12-hour shifts with the exception of the manager. In addition to the above there were three senior care assistants and four other care assistants on-duty. On night-duty there would be one qualified nurse and three care assistants. Although this appeared to be adequate staff on this occasion, it was apparent from care issues identified above that the numbers of staff on-duty are unable to fully meet the needs of the residents and at weekends they currently have to complete the laundry as well. It was reported and a months rotas provided, confirmed that they had been short of staff recently because of people having to take holidays before the end of December and no agency were used to cover shortfalls. Four care staff; a qualified nurse and an activities co-ordinator have all left since the last inspection. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 20 An advertisement has just been placed for care staff and a laundry assistant. Two new care assistants have recently been appointed and another was due to start the week following the inspection. It was later reported that the staffing shortages recently experienced are now under control with the recent appointments made. The dependency levels within the home are very high with 5 residents under 65 with physical disabilities, all who need two staff to attend most of their care needs, and forty elderly residents, many of whom require nursing care. It is therefore vital that adequate staffing levels are in place and are constantly monitored against the dependency levels to ensure that each residents needs are met in full. It was reported that the staffing levels provided are always 25 above the minimum requirements. A number of staff were spoken with and the care staff all appeared to enjoy their work and were able to relate how they met the needs of individual residents. It was noted that staff wear an assortment of uniforms; many from previous jobs and this can be confusing for both visitors and residents to identify who is who. Having been used to a proprietor always on the premises, some staff find it difficult that the new proprietor is not continually in the home although he is always available. The home is committed to staff training and it was reported that there are two staff with NVQ 3, one with NVQ 2, two currently doing NVQ 2 and three more commencing NVQ 2 and one NVQ 3 in January. There are also three overseas carers who are qualified nurses in their own countries and are therefore classed as having an equivalent to an NVQ qualification. The home currently does not have any NVQ assessors although one nurse has D32/33 but is planning to update to the A1 qualification now required. One senior carer is also doing an assessors course. One overseas carer is also waiting to be accepted for adaptation training. In addition to this the qualified nurses recently attended a study day on pressure area care and are to attend another on wound care. A continence workshop is also being set up. A number of staff have completed a distancelearning course on basic food hygiene and are about to commence one on infection control. Three staff files were checked on this occasion, two on staff recently appointed and one on a member of staff about to commence. The first seen had all the required checks and documentation to include POVA/CRB, two references, one from the last employer, an application form completed with a full career history and confirmation of mental and physical fitness and documents to confirm ID such as passport, birth and marriage certificates; the second had completed an application form but this did not confirm mental and physical fitness; there was no photograph or other proof of identity, two references were given, one being Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 21 from the last employer but the CRB/POVA was completed with her previous employer and is not transferable; it was reported that she is working under constant supervision and this must continue until a new POVA check has been completed; the third file seen had an application completed with a full career history and CV; two references were given but neither were from the last or even a previous employer; as this employee was from overseas, the reference required was also from an employer abroad and management took a risk and appointed this member of staff working at all times under full supervision of two senior care staff. It was reported that the POVA check was satisfactory and a CRB had been sent for but there was no documentation to confirm satisfactory POVA. Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38 With no permanent manager in post there continues to be little leadership, guidance and direction to the staff to ensure residents receive consistent quality care. This results in some practices that do not promote and safeguard the health, safety and welfare of the people using the service. Service users views are sought from time to time but they do not perceive them as having much effect in changing how the home is run. Residents’ financial interests are safeguarded. Service users rights and best interests are not always safeguarded by the homes’ record keeping policies. EVIDENCE: Since the last inspection and changing personal circumstances the acting manager has withdrawn her application to become registered manager of the home. The position has already been advertised once unsuccessfully and a second advert is about to be placed. It is vitally important for the continuity and Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 23 development of the home that this position is filled as soon as possible. It was later reported that the home is actively trying to recruit a manager and alternative interim arrangements have been made to ensure the needs of the residents are always fully met. Written details of the interim management arrangements are required to be sent to CSCI. There have been no quality assurance surveys given to residents or their relatives to audit their views of the home since the new proprietor took over. It was later reported that a full quality assurance programme is being introduced. Service user/relatives questionnaires have been developed and a newsletter will be developed to give feedback. This will be seen at the next inspection. The proprietor who is not in day to day running of the home is also required to complete Regulation 26 inspections and reports, but none have been received to date. This is to be addressed. Residents meetings have been held, the last minuted in June, but there was no evidence to suggest that their views had been considered. Again resident and staff views suggested that any concerns raised took a long time to action. The home does not act as appointee for any residents pensions, this is dealt with themselves or by their families. Small amounts of personal money/valuables are held securely at the request of residents/their families and a record and receipt is kept of any transaction undertaken and is available for them to see if they wish. Not all of the required records are well maintained (see standards 7 and 29). It was also noted that although menus are kept, a record of all the food provided is not. This should include any alternatives served, vegetables and sandwich fillings. This record is to commence from now. There were no windows noted as unrestricted on this occasion. The only health and safety risk noted was a partly opened lift door to the lift, which is out of order. This could be a risk to anyone who may attempt to go in the lift unaccompanied and should be secured until repaired. Since the inspection this has been repaired and full refurbishment is planned for the first quarter of the next year (see standard 16 above). Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The registered person shall keep under review the Statement of Purpose and Service Users Guide and shall supply a copy of the revised service users guide to each resident/ their representative and the CSCI (timescale of 9/9/05 not met). The registered person shall prepare a written plan of care for each service user, in consultation with the service user or their representative where possible ensuring that they reflect the current needs of the service user (timescale of 9/7/05 not met in full). The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated (timescale of 9/7/05 not met in full). Attend to areas of maintenance as identified in the report The registered provider must ensure that suitable adaptations including passenger lifts are provided and kept maintained. DS0000063477.V260435.R01.S.doc Timescale for action 17/01/06 2. OP7 15 17/12/05 3. OP8 13 17/12/05 4. 5. OP19 OP22 23 23 17/01/06 31/01/06 Euroclydon Nursing Home Version 5.0 Page 26 6. 7 OP26 OP27 23 18 8 OP29 19 9 OP31 8 10 OP33 24 11 OP32 26 12 OP37 17 13 OP38 13 Ensure that the premises are kept clean, hygienic and free from any offensive odours. Ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of service users. All required documentation as identified in Schedule 4; Regulation 17(2) of the Care Homes Regulations be held in staff files (timescale of 9/7/05 not met) The registered provider shall appoint an individual to manager the home and submit an application to CSCI for them to be approved as registered manager. A system must be put in place and be maintained to review and improve the quality of care provided in the home The registered provider shall visit the home unannounced at least once a month, interview staff and service users, inspect the premises and submit a report to the CSCI The registered person shall maintain in the home all the records specified in Schedule 4 of the Care Homes Regulations 2001. The registered person shall ensure that all parts of the home to which service users have access, are so far as reasonably practicable free from hazards to their safety to include the provision of bumper pad protection when bedrails have been considered appropriate for a service user as determined by a risk assessment (timescale of 9/7/05 not met). DS0000063477.V260435.R01.S.doc 17/12/05 30/11/05 17/12/05 30/06/06 31/05/06 31/12/05 30/11/05 30/11/05 Euroclydon Nursing Home Version 5.0 Page 27 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 OP7 OP8 Good Practice Recommendations Avoid use of tippex on records, which could be interpreted as falsifying records. Service users are assessed by a person trained to do so, to identify those service users who have developed or are at risk of developing, pressure sores and appropriate intervention is recorded in the plan of care. The incidence of pressure sores, their treatment and outcome, are recorded in the service users individual care plan and reviewed on a continuing basis. Equipment necessary for the promotion of tissue viability and prevention and treatment of pressure sores is provided. Review complaints procedure to ensure that information within it is accurate and up to date. 3. 4. 5 OP8 OP8 OP16 Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Euroclydon Nursing Home DS0000063477.V260435.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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