Inspection on 19/07/05 for Georgian House Nursing Home

This inspection was carried out on 19th July 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.

Other inspections for this house

Georgian House Nursing Home 07/09/06

Georgian House Nursing Home 02/11/05

Georgian House Nursing Home 20/01/05

Georgian House Nursing Home 19/07/04

Georgian House Nursing Home 23/12/03

Georgian House Nursing Home 03/06/03

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

CARE HOMES FOR OLDER PEOPLE Georgian House Nursing Home 20 Lyncroft Gardens Ealing London W13 9PU Lead Inspector Robert Bond Unannounced 19th and 25th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Georgian House Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Georgian House Nursing Home Address 20 Lyncroft Gardens, Ealing, London W13 9PU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8567 6232 020 8567 1955 Mr & Mrs Hopley Mrs Margaret Hopley Care Home 28 Category(ies) of Physical Disability - over 65 years of age (0), registration, with number Old age not falling within any other category of places (0), Terminally ill (0) Georgian House Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 28 medical beds for the elderly of which 4 patients may be received for palliative care. Date of last inspection 20th January 2005. Brief Description of the Service: Georgian House Nursing home is registered with the CSCI as a care home with nursing for 28 older people, four of whom may receive palliative care. The building comprises two semi-detached houses combined into one detached property, with parking at the front and a large landscaped garden and patio to the rear. There are twelve single and eight double rooms. Communal facilities include a large lounge and a separate dining room. The property is on a quiet residential street, not very far from central Ealing. Georgian House Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector arrived at 9.30am to undertake this unannounced inspection on 19th July 2005 and spent five hours in the home. As the Registered Manager was not able to be present, the Inspector arranged with her to visit again on the 25th July 2005, at which time he met both Registered Providers. The Inspector talked to all the staff he met on his tour of the home, and spoke to six service users. There were six vacancies on the day of the inspection, and the home was fully staffed. Agency staff are not used. The inspector examined in detail the care files of three service users, and saw most parts of the building including three service users’ bedrooms. The inspector examined the workings of the home against 29 of the National Minimum Standards for care homes for older people. He found that 11 Standards were fully met, 13 Standards were partly or almost met, and 5 Standards were not met. The Inspector made 13 requirements, of which 1 is restated from the last inspection as it had not been met within the timescale for action supplied. The inspector also made 12 recommendations. What the service does well: What has improved since the last inspection? Most of the requirements from the previous CSCI inspection have been carried out. The standard of administration of medicines has improved and the process is now being audited by the home’s senior staff on a monthly basis. Reviews of service users plans are now more often signed and agreed by service users or Georgian House Nursing Home Version 1.10 Page 6 their representatives. Where service users have to share a double room, there written agreement to do so is now obtained. Additional mandatory staff training has been undertaken. More regular activities and more choice of activities are now available. Several divan beds have been replaced by hospital-type beds. As a result of all of the above, the senior nurse believed that the standard of care being received by service users have improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Georgian House Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Georgian House Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, and 3 The outcome for Standard One is not fully met, as the home’s brochure is out of date. The outcome for Standard Two is not fully met as the contract examined had not been signed by anyone representing the home. The outcome for Standard Three is not fully met as the assessment of a prospective service user’s needs had not been signed or dated. EVIDENCE: The Inspector examined the home’s Statement of Purpose and Service Users’ Guide, both of which were satisfactory. The home’s brochure however is out of date as it refers to the home being registered with the Health Authority and also states that day care is available in the home. A contract between the home and a service user was also examined. It was satisfactory but had not been signed by anyone on behalf of the home. The Inspector also examined the assessment records of the latest service user to move into the home. This file contained a full assessment by a London Borough of Ealing care manager, and an additional assessment of whether the home could meet the service user’s needs, by a senior nurse employed in the home. This later document however was not signed or dated by the nurse. Georgian House Nursing Home Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, and 11. The outcome for Standard 7 is not met as the social needs of a service user were not recorded, and there was no evidence of him or his family being consulted on or agreeing to the service user plan. The outcome for Standard 8 is almost but not fully met due to inadequate consideration of the possible needs for physiotherapy, occupational therapy of speech therapy for a service user with stroke. The outcome for Standard 9 is almost but not fully met due to an error in the medication administration record, and the confusing reuse of MAR sheets. The outcome for Standard 10 is not fully met due to staff entering service user’s rooms without their express permission, the location of a central heating boiler within a bedroom, and the presence of clinical waste paladins immediately outside of a bedroom window. The outcome for Standard 11 is not met as death and dying are not generally covered in service user plans. EVIDENCE: Although the last service user to move in had been resident in the home for nearly three weeks, the service user plan did not consider his social, emotional, leisure or religious needs. There was no evidence that he or his relatives had been consulted when drawing up the plan, or that they had Georgian House Nursing Home Version 1.10 Page 10 agreed to it. The plan did not consider therapeutic or rehabilitative strategies for the service user. Service users are able to choose from a number of General Practitioners. Reflexology, physiotherapy, dentistry, community psychiatric nurses, MacMillan nurses, and the services of an occupational therapist and of a psychogeriatrician can all be arranged. Three care plans were examined and they were seen to record health needs, and how to meet them. Waterlow assessments, cot-rail assessments, and moving and handling assessments were all seen to be undertaken. Medication storage and recording systems were inspected. One error was discovered in the administration of medication. In addition, when one MAR sheet had been completed for the weeks it covered, rather than start a new sheet, entries had been continued at the bottom of the sheet which leads to confusion and should be avoided. Controlled medication was appropriately stored and its administration recorded. The Inspector was shown into a service user’s bedroom without the service user’s prior permission. A central heating boiler is also kept in this room, therefore the service user’s privacy is in danger of being invaded whenever the boiler requires attention as it did on the day of the inspector’s visit. The same bedroom had two large yellow paladins for the storage of clinical waste placed in the garden immediately outside of the window. The service user plans seen did not cover the service users’ wishes concerning death and dying, funeral arrangements and wills. It is recommended that this information is obtained via the care manager before a service user moves in. Georgian House Nursing Home Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. The outcome for Standard 12 is not fully met as religious and recreational interests are not always recorded in the service user plan. The outcome for Standard 13 is met. The friends of Georgian House are commended for their efforts. The outcome for Standard 15 is met. EVIDENCE: A list of activities available in the home was located on the wall of the ‘nurses’ station’ but it was a short list and said by the senior nurse to be out of date. She agreed to update it. A record of service users’ involvement in activities is now kept, but it does not indicate what activity the service user engaged in, hence the recording system must be improved. Service users are given a menu choice, and records are now kept by room number as to which meal has actually been eaten. As 8 rooms are double rooms, the record keeping system will have to be changed so that the service users are named individually. The service user plans seen by the Inspector did not record religious needs and how to meet them. A visitors’ book is kept in the foyer of the home, but either there are very few visitors to the home, or few of them sign in as up to five days would go by without a signature appearing. Visitors must be encouraged to sign in and out. The senior nurse reported that there is a ‘Friends of Georgian House’ in Georgian House Nursing Home Version 1.10 Page 12 existence whose members visit service users who might otherwise receive few visitors. The Inspector observed the midday meal being served and eaten. The meal appeared to be appetising. All service users spoken to said they were ‘happy with the meals’. Georgian House Nursing Home Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The outcome for Standard 16 is met. The outcome for Standard 18 is partially met as the home’s procedure must be amended to take account of the London Borough of Ealing’s adult abuse reporting procedure. EVIDENCE: No complaints were made to the Inspector by service users and none were recorded in the home’s complaints book since before the previous CSCI inspection. The home’s complaints policy and procedure meets the required Standard. The senior nurse reported that all staff had been trained in ‘abuse protection’. The Inspector examined the home’s adult protection procedure and found that it did not inform staff how and to whom suspicions of abuse should be reported. There was no mention of The London Borough of Ealing’s Adult Protection Procedure and the use of strategy meetings, although a copy of the Ealing Procedure was produced by the Registered Manager at the Inspector’s second visit. The home must amend their own procedure to take account of Ealing’s procedure and reporting arrangements, and arrange for all management, nurse and care staff to be trained in the new procedure. Georgian House Nursing Home Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, and 26. The outcomes for Standard 19 and 25 were not met due to the Health and Safety concerns identified below and that no hot water was available in a large part of the home on the day of the inspection. The outcome for Standard 20 is almost met, but dining room tables and table clothes require attention. The outcome Standard 26 is almost met, but communal carpets need more frequent cleaning. The outcomes for Standards 21 to 23 are met. The outcome for Standard 24 is not fully met due to the damaged furniture and unlocked boiler cupboard in a service user’s bedroom. EVIDENCE: The location and layout of the home were seen by the Inspector to be suitable for the home’s purposes. The premises were homely, well decorated and mostly adequately furnished. Under Health and Safety however are detailed four instances were the home is not totally safe due to the presence of cleaning agents in areas that were unlocked and which could in theory be accessed by service users. Immediate Georgian House Nursing Home Version 1.10 Page 15 requirements were issued to address these shortcomings, and the registered manager and provider report that they have dealt with the issues raised. In addition there were a number of maintenance concerns in that on the day of the initial inspection, four electric lights were not functioning, the upstairs bedpan sluicing machine was out of order, and no hot water was available in bedrooms, toilets and bathrooms on the ground floor. Communal areas were generally adequately furnished with the exception of the dining room where new tables and tablecloths are recommended. Bedrooms were generally adequately furnished but in one room a damaged chair and table were seen. Some beds are yet to be replaced with adjustable hospital type beds. Double rooms have privacy screens provided and evidence was seen that service users who have to share, do sign their agreement to this arrangement. A bedroom contained in an unlocked cupboard a central heating boiler. This must be kept locked but consideration should be given to relocating the boiler. This room also contained an easy chair and adjustable table that were damaged and worn. Some bedrooms are en-suite. Communal bathrooms and toilets are adequate. Special equipment seen is adequate. Heating, lighting and ventilation are generally adequate. The laundry room however was very hot and it was not clear how to turn on the extractor fan. The Inspector did not detect any unpleasant smells in the home which was clean throughout except for hall carpets which should be shampooed for frequently. Georgian House Nursing Home Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The outcome for Standard 27 is fully met. The staffing level exceeds that laid down in the Staffing Notice for 28 service users. Currently there are six vacancies. The outcome for Standard 29 is almost but not full met as a member of staff does not have a Criminal records Bureau disclosure certificate obtaining by Georgian House. The outcome for Standard 30 is met on the basis of training records examined. EVIDENCE: The Inspector examined a rota for staff working the week of the inspection. It demonstrated that two registered nurses were on duty at all times, except that an enrolled nurse acted up sometimes. Also 5 ancilliary nurses or care assistants were on duty every day except Sundays when there were four. The home’s procedure and policy manual contains a signed list of staff who have read its contents but it was not uptodate. There are training records on each member of staff, and a training plan for the home overall. Georgian House Nursing Home Version 1.10 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, Outcomes for Standards 31,32 and 36 are fully met on the basis of what the inspector noted in terms of records and atmosphere within the home. The outcome for Standard 33 is not fully met as customer surveys are not formally analysed and the findings reported back to service users. The outcome for Standard 38 is not met due the serious Health and Safety concerns identified. EVIDENCE: Minutes of staff meetings were seen, and on the Inspector’s second visit staff training, supervision and appraisal records were examined. The Registered Manager is appropriately qualified and experienced. Service user questionnaires received back were seen. The senior nurse said she analysed these and looked for any shortfall in the service that could be identified and would then take the appropriate remedial action. This is as it should be, however the National Minimum Standards require that the results of service user surveys are published and lead to an annual development plan. Georgian House Nursing Home Version 1.10 Page 18 The following Health and Safety concerns were discovered. Each floor of the home has a walk-in cupboard that contains a machine for sluicing bed pans. The chemical that is used for this purpose is fed by pipe from a plastic jar standing just inside the door. As the cupboard doors are not locked, or fitted with locks, a service user could easily access the sodium hydroxide chemical container which is marked as being hazardous due to its corrosive nature. A food store is located in the home’s garden which is intended for service users’ use. The store was locked and had its door propped open by a container of cleaning agent. Further containers of cleaning agents were stored with the food. This is contrary to Health and Safety regulations and must cease. The food store must be kept secure. A garden shed was also found to be unlocked and here were stored items such as white spirit. Again it must be kept locked. All of the above were subject to an Immediate Requirement by the Inspector which the Registered Manager has confirmed in writing have all now been addressed and put right. The door to the laundry room, which is a fire door, does not close tightly as required, and its self-closer is broken. The extractor fan may not be working. These issues must also be urgently addressed. The Inspector examined risk assessment on the home. A annual assessment is done and recorded on each bedroom but many other parts of the building were not considered. The risk assessment process must cover every area within the home including the car park and garden. Risk assessments must also be undertaken on generic hazards such as chemical storage, and gas, electricity and water supplies. The assessments should be reviewed monthly. In summary, Health and Safety must be given a higher priority in the home, with updated risk assessments and more self-auditing by the management. Georgian House Nursing Home Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 2 3 3 3 2 1 2 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 2 x x 3 x 1 Georgian House Nursing Home Version 1.10 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 2 3 7 Regulation 5 14 15 Requirement Contracts or statements of terms and conditions must be signed. Assessments must be signed by the person undertaking the assessment, and dated The service user plan must set out in detail how the social care needs of service users are to be met Evidence is required to demonstrate that service user plans have been drawn up and agreed by the service user and/or their representatives. The registered person must enable service users to have access to specialist therapeutic services according to need. The recording of the administration of medication must be clear and accurate The home must be conducted in a manner which respects the privacy and dignity of service users (see Recommendations 2 and 3) Service user plans must record service users spiritual needs and wishes concerning terminal care and arrangements after death. (see Recommendation 4) Version 1.10 Timescale for action 010905 010905 010905 4. 7 15 010905 5. 8 15 010905 6. 7. 9 10 13 (2) 12 (4) (a) 010905 010905 8. 11 12 (2) 011005 Georgian House Nursing Home Page 21 9. 12 15 (1) 10. 18 and 30 13 (6) 11. 12. 13. 19 24 38.6 13 (4) 23 12 (1) (a) Care plans for each service users social, leisure and spiritual interests must be formulated to reflect their individual needs and identify clearly how these are to be met. THIS IS PARTIALLY RESTATED FROM THE LAST INSPECTION. THE TIMESCALE FOR ACTION WAS NOT MET. The homes adult abuse procedure must take account of the reporting procedure in the Local Authority Adult Abuse Policy, and staff must be trained in its application. (see Recommendation 9) Keep locked central heating cupboard in service users bedroom Replace damaged bedroom furniture . The registered manager must ensure that risk assessments are carried out for safe working practice topics and for all areas of the property. 011005 011005 010905 011005 011005 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 1 10 10 11 12 Good Practice Recommendations Update the homes brochure Relocate the central heating boiler so it is not within a service users bedroom. Relocate the homes clinical waste paladins so that they are not immediately outside the window of a service users bedroom. Social workers should be asked to provide details of service users wishes concerning terminal care and arrangements after death, at the time of referrral. That service users spiritual wishes are reviewed to ascertain if anyone wishes to go to religious services outside of the home, and then to make the necessary Version 1.10 Page 22 Georgian House Nursing Home 6. 7. 8. 9. 10. 11. 12. 12 15 13 18 and 30 20 26 30 arrangements. The record of activities should show exactly which activity has been undertaken by named service users. The record of meals taken should show exactly what food has been eaten by named service users. Visitors should be reminded to always sign and and out. Contact Ealings Adult Protection section to request they undertake the training required. Refurbish or replace dining room tables and replace table clothes. Shampoo corridor carpets more frequently. All staff must read the procedure manual and sign that they have done so. Georgian House Nursing Home Version 1.10 Page 23 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST 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 Georgian House Nursing Home Version 1.10 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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