Inspection on 25/06/07 for Gallions View Nursing Home

This inspection was carried out on 25th June 2007.

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

Other inspections for this house

Gallions View Nursing Home 19/08/08

Gallions View Nursing Home 24/07/06

Gallions View Nursing Home 13/02/06

Gallions View Nursing Home 25/07/05

Gallions View Nursing Home 21/12/04

Gallions View Nursing Home 05/08/04

Gallions View Nursing Home 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Gallions View Nursing Home 20 Pier Way Thamesmead London SE28 OEU Lead Inspector Maria Kinson Unannounced Inspection 25th June 2007 09:40 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 Gallions View Nursing Home DS0000006761.V339187.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. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gallions View Nursing Home Address 20 Pier Way Thamesmead London SE28 OEU 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 8316 1079 020 8854 5331 condonc@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited ***Post Vacant*** Care Home 120 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (90) of places Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 90 beds for general nursing care of people aged 50 years 30 beds for people with dementia aged 50 years Date of last inspection 24th July 2006 Brief Description of the Service: Gallions View is a Nursing Home for 120 residents, run by BUPA Care Homes. It is situated in spacious grounds in West Thamesmead, but is within striking distance of the town centres of Plumstead and Woolwich with their thriving and varied range of shops and markets. The Home consists of four purpose built bungalows, each accommodating thirty residents, and a central two-storey building housing the administrative staff, the laundry, kitchen and hairdressing salon. The Bevan Unit, an NHS Intermediate Care Unit, shares the site and the service functions with the Home but is exempt from registration. Each unit has its own Statement of Purpose, and one unit offers specialist nursing care for people suffering from dementia. All the rooms are single occupancy, with hand washbasins and there are shared bathroom and toilet facilities. The site is attractively landscaped, with gardens adjacent to each unit, and secure fencing around the perimeter, including gates that are locked at night. There is car parking to the front of the building. The fees charged by the home range from £551.57 - £750 per week. This does not include additional charges such as chiropody, hairdressing, newspapers and toiletries. This information was supplied to the commission on 25.06.07. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 25th June 2007 and was unannounced. Two inspectors spent over nine hours in the home. Most of the time was spent talking to residents, staff and visitors on Squires, Duncan and Hutton units. All of the communal areas and a selection of bedrooms on these units were viewed and various records were examined. A random sample of residents, relatives and health care professionals were asked to provide written feedback about the service. The commission received nine comment cards back from relatives, three from health care professionals and twenty- two from people that live in the home. The information provided by residents, relatives, staff and other professionals forms part of this report. The commission has visited this home on one occasion since the last key inspection to undertake a random inspection. The reports from this visit are available from the office listed at the back of this report. What the service does well: The arrangements for admitting new people into the home were satisfactory and some changes had been made in recent months to make it easier for people to view the home. The home had established good links with local health care professionals and was able to obtain advice and guidance from various professionals if required. Relatives said they were able to visit the home when they wanted and were able to spend as much time as they wanted with their family member in the home. Most residents said they liked living in the home although a few people said they hated it when they first moved in because they had to leave their family home. One person said “I am very happy here and well looked after” and another resident said he was happy all the while that staff let him sit in a comfortable chair to watch television. Residents said that staff maintained their privacy and treated them with “kindness” and respect. Residents confirmed that they were able to choose what they ate and said the food was usually good. On one unit residents were given a pot of tea so that they could serve it just how they liked it and have as much or as little as they wanted. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 6 Complaints were recorded in a logbook. All of the issues recorded were investigated and a prompt response was provided for the complainant. Care was taken when recruiting new staff to ensure that they were suitable for the job, were permitted to work in the UK and did not have any criminal convictions. Access to training was good and staff were supported to obtain relevant qualifications. During the past year the manager had to make some difficult decisions and has undertaken a significant amount of work to improve the standard of care provided in this home. The atmosphere in the home has improved. What has improved since the last inspection? What they could do better: Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 7 Some of the information that was obtained before a person moved into the home was rather basic. Staff did not have access to information about the person’s usual routine and personal preferences. Medicines were stored appropriately but were sometimes left unattended. The remaining balance of some medicines was not correct. This is likely to be due to record keeping errors. One unit did not have an adequate supply of homely remedy medicines. Regular activities were taking place but a number of residents said they wanted to go out on trips or would like to sit in the garden when the weather was good. Some of the furniture and fittings looked old and worn in parts. In particular some of the commodes, dining tables and stroke chairs on Squires looked neglected and some of the flooring in bath and shower rooms was coming away from the wall. Some residents did not have access to a call bell in their rooms and there were not adequate facilities for people to summon help if they were using a sensor pad. A number of staff had attended bedrail safety training. This equipment was usually monitored closely but in one instance staff had not followed the recommended guidance. Some health care professionals and relatives said that some members of staff did not communicate effectively or have a good understanding of the needs of older people. The manager said that communication had improved but was aware that further work was required to address this issue. Recruitment checks for new staff were good and plans were in place to introduce further checks and safeguards to protect residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written information about the service was provided and prospective residents were able to view the facilities before making a decision to move into the home. Staff carried out a care needs assessment before confirming if the home could meet a person’s needs. EVIDENCE: A copy of the ‘Service User Guide’, an information booklet for residents was seen in some of the rooms visited and some of the people spoken with confirmed receipt of this document. The manager or a senior member of staff assessed people that were referred to the service. Since the last inspection the company had introduced new documentation. This includes a form for recording information obtained during the pre admission assessment. The pre- admission assessments seen on Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 10 Squires were good but some of the information recorded on some of the other units was quite basic and provided very little information about the person as an individual. See recommendation 1. Staff used the assessment record and information that was provided by the funding authority to decide if the service would be able to meet the person’s needs. After the assessment staff wrote to the prospective resident to advise them if the home was able to meet their needs. Residents were encouraged to view the home prior to making a decision to move in but were often too frail or unwell to do this. Some residents said that their family members looked at several homes before choosing Gallions View. The manager said that visitors were able to visit the home at anytime and did not require an appointment. Most residents were satisfied with the information that they received about the service before they moved in. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care records had improved but one of the plans seen did not provide adequate information for staff about the management of a wound. Staff worked in partnership with other professionals to ensure that resident’s health care needs were met and their privacy and dignity was maintained. The management of medication was mostly satisfactory but some record keeping issues were identified and some medicines were left unattended. EVIDENCE: A new recording system called ‘Quest’ had recently been introduced. Most of the nursing staff had attended training about the new documentation and the manager said that care staff would also be expected to complete this training in 2007. A number of audits had taken place to ensure that staff were using the new records correctly and a guidance log was provided for staff to refer to. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 12 Four sets of care records were assessed. Three out of the four care plans seen were satisfactory but one person did not have a wound care plan. The staff on duty had received some information from the night staff about the wound but were not aware of the grade of the wound or the current treatment. See requirement 1. The other care plans that were viewed provided good information for staff about the action they should take to meet people’s needs and maintain their safety. For instance one care plan stated that a person who was assessed to be at high risk of developing pressure sores must sit on the green pressure cushion, use a pressure relief mattress when in bed and should be repositioned every four hours during the night. Care plans were reviewed monthly or more frequently if required and some of the plans seen were agreed and signed by the resident or their relative. A new form for recording discussions with residents and relatives about the care plan had been introduced but was not in use on all of the units visited. Access to community health care services was satisfactory. Records indicated that some residents had seen a GP, Chiropodist and specialist nurse in recent months. Appointments were recorded in the diary and outcomes noted in the persons care notes. Residents said they usually received the medical support they required. Three health care professionals that were in regular contact with the home provided written feedback about the service. The responses provided were variable but all of the respondents said that staff usually obtained advice about health care issues if required and were usually able to meet people’s health care needs. Some of the respondents indicated that some members of staff did not have adequate experience or knowledge about caring for older people and did not always communicate effectively. See standard 30. One person said there had been an “improvement in the general management of the home in recent months” and this had resulted in “a better quality of service for residents”. Relatives said that staff were usually able to meet their family members needs and usually kept them informed about significant issues. Two relatives said staff had not told them about or given them adequate notice about hospital appointments. The manager should address this issue with staff. A number of relatives said they were made to feel welcome by staff when visiting and said staff spoke to the people living in the home in a polite and respectful manner. Some relatives indicated that communication between staff and residents and staff and relatives could be improved. See standard 30. The management of medication was assessed on Hutton and Duncan. The home had recently changed to a new pharmacy supplier. Staff had received training about the new system and documentation. Medicines were stored appropriately but the medication room was left open on one of the units. Medication that was supplied in blister packs was well managed but a few discrepancies were noted with medicines that were supplied in packets and Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 13 boxes. Records of receipt and administration of medicines were satisfactory but some handwritten entries on the medication administration charts were not checked and countersigned by a second person. On some of the units where there were a lot of medicines in packets and bottles the medication trolley was rather congested, this made it difficult for staff to locate medicines quickly. See recommendation 2. Some staff were unsure about the procedure for obtaining supplies of homely remedies. Supplies of these medicines were rather low on one unit. See requirement 2. Several staff members were observed carrying out their duties throughout the inspection. Staff responded to residents in a caring and professional manner. Residents said staff were kind and maintained their privacy. Residents were appropriately dressed for the weather and assistance to eat was provided where necessary. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a regular programme of activities but residents did not have an opportunity to go out. Relatives said they were able to visit at anytime and could spend as long as they liked with their family member. Most people said they were satisfied with the choice and quality of food provided and enjoyed their meals. EVIDENCE: A schedule of planned activities was displayed in the lounge. The programme included reminiscence, arts and crafts, sing-along, beauty therapies, bingo, floor and board games. In addition residents could attend the cinema club on Fridays and a sing along and church service on Tuesdays. During the inspection some of the residents took part in a quiz and were playing a ball game. Residents said that the home usually arranged activities but a number of people said that more activities and outings were required “ to keep residents alert and active”. One person said that all he wanted to do was to sit in a comfortable chair and watch the television and another resident said he Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 15 did not want to take part in group activities but staff always told him what was planned and invited him. People’s social history and personal interests were recorded on a ‘map of life’ and ‘activity profile’. It was noted that one resident liked to mix in small groups, did not like group activities or outings and liked listening to classical music in her room. The resident was listening to classical music when the inspector arrived and the care notes stated that she was occasionally persuaded, with agreement, to go to the lounge to socialise with some of the other people living in the home. There was a monthly record sheet to record activities in resident’s files. The records seen indicated that some residents were supported to take part in some of the sessions listed on the programme, attended entertainment or social events and had ‘one to one’ time with the activities coordinator. The home did not have any transport and staff indicated that it was difficult to find transport for lots of people in wheelchairs. See recommendation 3. Relatives said they were able to visit their family member at anytime and were able to spend as long as they liked in the home. One relative told the inspector he usually visited during the day, other family members visited during the evening and he often took his wife home for the weekend. There was evidence that people were able to make decisions about how and where they spent their time and were offered choices about where they sat and what they ate. One person told the inspector “I have the freedom to do what I want”. Records indicated that some residents had declined support with hygiene and had refused to take part in group activities. Most of the residents took their lunch in the dining room but a few people ate in their rooms through choice or because they were unwell. Food that was transferred to resident’s rooms was covered to keep the meal hot and fresh. Residents said they were able to choose what they wanted to eat from the menu and staff were familiar with residents preferences. Some residents were assisted to eat by staff. Residents said there was “always plenty to eat” and they enjoyed the food provided. In the kitchen there was a colourful poster advertising the ‘Night Bite Menu’. Staff said the items listed were delivered to each unit once a day and were offered to residents if they wanted a snack or could not sleep. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place for investigating concerns, complaints and allegations. EVIDENCE: The complaints procedure was displayed in the main reception area and in the entrance area on each of the units. The procedure provides information for residents and relatives about who they should speak to if they have any concerns and how long it will take the home to investigate their complaint and provide a response. Relatives and residents were familiar with the complaints procedure and said they would speak to the manager or staff if they had any concerns. The complaints file was examined. Five complaints had been received by the home since the last inspection. Two complaints were upheld, two were not upheld and one was inconclusive. One member of staff was disciplined and received retraining as a result of one investigation. Complaints were investigated and dealt with appropriately and the commission was notified about significant events. Staff had a good understanding of abuse and knew what they should do if they witnessed or were told about an allegation of abuse. Some members of staff Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 17 had attended abuse training or had covered this topic when completing vocational qualifications. The manager notified the commission and social services about allegations of abuse or neglect. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and maintained to a satisfactory standard. Some work must be undertaken to repair or replace damaged furniture and to ensure that residents have access to a call bell. EVIDENCE: All of the communal areas and a selection of bedrooms on Hutton, Duncan and Squires were inspected. All parts of the home were clean, tidy and odour free. Residents indicated the home was almost always clean and fresh. Since the last inspection some of the bedrooms had been redecorated and a new standing hoist and hot food trolley had been purchased. The grounds and gardens at the front of the home were well maintained. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 19 Toilets and bathrooms were fitted with appropriate aids to assist residents with poor mobility. Since the last inspection the blinds in the bathrooms had been replaced, the extractor fans were cleaned and some old equipment was removed to make it easier for residents and staff to gain access to these rooms. The home employs a full time maintenance employee. There were good systems in place for reporting or requesting work or repairs. Some of the built in units and bedside cabinets in bedrooms were chipped and worn. The manager said that funding had been obtained from the Department of Health to replace some of the bedroom and dining room furniture. A number of the commodes on Squires looked old and stained and two of the dining tables were very unstable. The covers on two “stroke’ chairs” were damaged and the padding was coming out. See requirement 3. Some of the repairs identified during the previous inspection had not been addressed. This included the loose flooring in the bathroom on Benn house, the stained floor covering in room (32) and the loose flooring in the ‘walk in’ shower (19) on Duncan. The manager said that the company were not satisfied with the work that was undertaken by another company to address these problems and had now appointed a new company to undertake the work. See requirement 4 and 5. Hand washing facilities were provided where clinical waste or infected material was handled. Protective equipment was provided for staff. Domestic staff had received training about the use of hazardous chemicals and cleaning materials were stored securely. There were call bell leads in all of the bathrooms and toilets but some residents did not have access to this facility in their bedroom. Although the residents in these rooms were in the lounge it was not clear how they would summon help once they returned to their rooms. One person said she did not receive a response when she pressed the call bell during the night. It was later discovered that this was because staff attached a sensor pad to the call bell socket during the night to reduce the risk of falls. Where staff assess that it would not be in the residents best interests to have access to a call bell a risk assessment should be completed and alternative strategies implemented to maintain the persons safety and well being. See requirement 6. Action had been taken to improve the ventilation in the smoking room on Duncan House. The manager said that a door would be fitted to this room to comply with the new smoke-free legislation. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Work was in progress to improve continuity of care for residents by recruiting more permanent staff. Staff were supported to attend relevant training sessions and to obtain recognised qualifications. Thorough checks were undertaken when recruiting new staff but references were not always verified to ensure that they were genuine. EVIDENCE: Staffing levels on the day of the inspection were satisfactory and most residents said that staff were usually available when they required assistance. Five residents said there were periods when there were not “enough staff on hand, to help out when you need something”. The manager should obtain regular feedback from residents and relatives about this issue. A number of new staff had been recruited and pre employment checks were in progress. The manager was working hard to reduce the use of agency staff and provide better continuity of care for residents. Forty percent of care staff were working towards achieving a vocational qualification in care at level 2 or above. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 21 The personnel files for four recently recruited staff members were examined. The files were well organised and indexed. This made it easy to locate information quickly. Records indicated that there were sound recruitment procedures in place to protect the people living in the home, but a few shortfalls were noted. One file did not contain a current photograph of the employee and it was not clear if one reference was genuine as it was not on headed paper or company stamped. The manager had identified this issue and was planning to implement a system of telephone checks to verify references for new employees. See recommendation 4. Each member of staff had a personal training record. A varied and relevant programme of training had been provided for staff since the last key inspection. Some members of staff had attended fire safety, supervision, moving and handling, risk assessment, peg feeding, bedrail safety and record keeping training. The feedback from some health care professionals and relatives indicated that some members of staff did not always communicate effectively and did not have adequate knowledge or experience about caring for older people. The training programme includes ‘care of the older person’ and a customer care course called ‘personal best’. Staff should be encouraged to attend these sessions. See recommendation 5. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 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 home was well managed and led. There were systems in place to monitor and improve the standard of care provided in the home and to safeguard people’s money. Health and safety issues were monitored closely to provide a safe environment for residents and staff. EVIDENCE: The manager is a registered nurse and has experience of managing care homes for older people. The manager had submitted an application to become the registered manager for the service but the application could not be processed, as it was incomplete. It is a requirement that a home has a registered Manager. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 23 Since the last inspection a deputy manager had been appointed. This post will provide additional support for the manager and staff. Staff said that the manager and deputy manager visited the units regularly to support staff and monitor care practices. The home had a comprehensive quality assurance system. The system included monthly audits of specific topics such as medication, record keeping and health and safety. The quality manager checked the findings from audits to ensure that they were accurate and that appropriate action was taken to improve the service. The home obtained feedback from residents and relatives during meetings and a satisfaction survey was sent out to relatives once a year. Residents and relatives meetings were held on some of the units in May and June 2007. BUPA care homes were assessed by the commission in 2007 and were found to have suitable accounting and financial procedures in place to demonstrate that the company was financially viable. The system for dealing with people’s money was examined and was found to be satisfactory. Residents’ money was stored in a shared bank account but interest was paid proportionately to each resident. Records of money deposited or withdrawn from the residents account was maintained on the computer but paper records were also made available to residents or their relatives, on request. Printed copies were retained in the administrative office with accompanying receipts to evidence any credits or debits. A separate list of valuable items such as jewellery and certificates was maintained and these items were stored securely. Most residents received assistance from their relatives to manage their finances and relatives were encouraged to take on this role where possible. When necessary, the home does provide the above service with help from social services, solicitors or friends. The Inspector examined the money records for one resident chosen at random. Credits and debits tallied with the receipts and the balance. The Inspector was informed that a financial audit had recently taken place and no concerns were identified. Maintenance reports for gas appliances, portable electrical appliances, lifting and hoisting equipment and some of the in house safety and security checks such as hot water temperatures were examined. All of the records seen were satisfactory. Fire safety records were comprehensive and included regular checks to ensure that the alarm, emergency lights, extinguishers and fire doors were in place and working properly and that fire exits were clear. The fire risk assessment had been updated and staff received fire safety training updates. Staff were assessed during fire drills to ensure that they were familiar with the fire procedure. The manager should increase the frequency of Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 24 the fire drills on Benn and Hutton so that all staff can practice what they had learnt during the training sessions. See recommendation 6. Accidents were recorded on a monthly audit sheet, which was discussed at heads of departments and health and safety meetings. Accident records were examined for all of the units. Most of the forms provided a factual account of the event if witnessed or stated the location and position of the resident when staff found them. Senior staff monitored the forms and provided extra information when the accident required further investigation. Moving and handling assessments identified potential risks when moving or handling residents and provided information for staff about the number of staff and type of equipment that was required to move a person safely. For instance one of the assessments seen stated that an oxford hoist was to be used for all transfers and a wheelchair was used for mobility. Residents that were using bedrails had a bed rail assessment and covers were used to protect the resident. One person that was using bedrails had one bedrail fitted to the bed. The other side of the bed was placed against the wall. If the person was to push the bed away from the wall they could become trapped or fall down the side of the bed. Staff said additional sets of bedrails were on order. See requirement 7. Some staff had attended bedrail training in the period since the last inspection. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 25 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 X X 3 Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 12 Requirement Timescale for action 22/08/07 2. OP9 13 3. OP19 23 The Registered Person must ensure that care plans include specific information about the care of wounds and pressure sores. The Registered Person must 22/08/07 ensure that: • Medicines are stored securely • That handwritten entries on the MAR chart are checked and countersigned by a second person • That the home maintains an adequate supply of homely remedy medicines • That accurate records are maintained about medicines administered in the home The Registered Person must 17/10/07 address the following issues on squires: • Repair or replace the tables that are unsteady • Clean or replace the commodes that are stained • Upholster or replace the covers on the ‘stroke’ DS0000006761.V339187.R01.S.doc Version 5.2 Gallions View Nursing Home Page 27 4. OP19 23 5. OP19 23 6. 7. OP22 OP38 23 13 chairs The Registered Person must: Replace the flooring in the shower room (29) on Benn House (The previous timescales of 08/12/06 and 11/05/07 were not met). The Registered Person must ensure that the following issues are repaired: the stained floor covering in room (32) and the loose flooring in the ‘walk in’ shower (19) on Duncan. (The previous timescale of 11/05/07 was not met). The Registered Person must ensure that all residents have access to a call bell. The Registered Person must ensure that bedrails are used in accordance with the guidance issued by the Department of Health. 17/10/07 17/10/07 22/08/07 22/08/07 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. 3. 4. 5. Refer to Standard OP3 OP9 OP12 OP29 OP30 Good Practice Recommendations The Registered Person should ensure that staff obtain and record information about each person’s individual needs and preferences. The Registered Person should consider purchasing an additional medication trolley for each unit. The Registered Person should consider providing suitable transport for local homes to use for outings. The Registered Person should ensure that references that are not stamped or on headed paper are verified. The Registered Person should encourage staff to attend ‘personal best’ and ‘care of the older person’ training sessions. DS0000006761.V339187.R01.S.doc Version 5.2 Page 28 Gallions View Nursing Home 6. OP38 The Registered Person should ensure that the frequency of fire drills is increased on Benn and Hutton. Gallions View Nursing Home DS0000006761.V339187.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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