Inspection on 08/05/06 for Harefield Nursing Centre

This inspection was carried out on 8th May 2006.

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

Harefield Nursing Centre 25/06/07

Harefield Nursing Centre 11/09/06

Harefield Nursing Centre 14/11/05

Harefield Nursing Centre 25/04/05

Harefield Nursing Centre 05/10/04

Harefield Nursing Centre 15/04/04

Harefield Nursing Centre 10/09/03

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

CARE HOMES FOR OLDER PEOPLE Harefield Nursing Centre Hill End Road Harefield Middlesex UB9 6UX Lead Inspector Mrs Rekha Bhardwa Unannounced Inspection 8th May 2006 10:00 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 Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 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. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Harefield Nursing Centre Address Hill End Road Harefield Middlesex UB9 6UX 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) 01895 825 750 01895 825 760 ANS Homes Limited Miss Eileen Louise Ward Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 40 ELDERLY FRAIL NURSING MINIMUM STAFFING NOTICE One service user, date of birth 16th August 1945 can be accommodated at the home, as agreed on 2nd April 2004. 14th November 2005 Date of last inspection Brief Description of the Service: The Harefield Nursing Centre is a purpose built home to accommodate 40 service users. It is situated in a semi-rural setting close to Harefield Hospital and Harefield Village and is served by public transport. The home was built in 1995 and all bedrooms are single occupancy with en suite facilities. The home consists of two floors with a lift. The first floor houses the kitchen, laundry and staff facilities and the ground floor is the living area for the service users. There are two spacious communal lounges and a dining room. The gardens are well maintained. Public transport in the form of Bus services are available in Harefield village and there are shops available in the village also. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 27 hours was spent on the inspection process. One Inspector carried out a tour of the home, and service user plans, medication records, staff records, financial records, management records, administration records, maintenance and servicing records were viewed. 10 service users, 10 staff, 6 visitors and 3 visiting healthcare professionals were spoken with as part of the inspection process. Due to the Registered Manager being on annual leave she was not available on the first day of inspection. She however made arrangements to meet the Inspectors on the second day of inspection. What the service does well: What has improved since the last inspection? What they could do better: Significant shortfalls were identified in the completion of service user plans, staff employment records and staffing levels within the home. An immediate requirement was set in respect of staffing at the time of inspection and correspondence has taken place between the Responsible Individual and CSCI on this matter. Pre-admission assessments had not always been completed in full to ensure that all the service users needs had been identified. Staff training in relation to dementia care must be in place. Service user plans must be completed promptly following the service users admission to the home. Risk of falling assessments must be reviewed following a fall. Food choice options are not offered to service users. Mealtimes also need to be reviewed in conjunction with service user consultation. Care staff serve the evening meal, and catering staff need to be in place for this purpose. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 6 A programme of redecoration and refurbishment had not been formulated. Bathrooms and sluice rooms were being used as storage areas. Staffing levels were not sufficient to meet the needs of service users and this needs to be reviewed in line with service user dependencies. Standards of cleanliness and odour management were poor as a result of inadequate staffing in these areas. The Registered Manager was on leave and there were no clear management arrangements to cover in her absence. Staff need to be clear about their roles and responsibilities. Evidence of induction and foundation training to meet the Skills for Care core standards was not available. Systems for monitoring the quality of care and management are in place but there is no evidence of the follow-up action taken where a shortfall has been identified. There was no business and financial plan available to view. Maintenance records did not always record the action taken where equipment had been identified as faulty. Several of the shortfalls have been repeated from the last inspection and it is disappointing that these have not been addressed. 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. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 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 Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 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): 3 & 4. The home does not provide intermediate care. Pre-admission information is obtained for prospective service users, but in some cases the information is incomplete, thus not providing the staff with a full picture of the service users needs. Where the home is caring for service users with specialist care needs, further training is required to ensure staff have the skills and knowledge to care for these service users appropriately. EVIDENCE: The homes pre-admission assessment document currently in use is quite brief and those viewed had not always been fully completed. Copies of the Social Services needs led assessments or assessment summaries are also obtained. Where service users are admitted to hospital, the home does carry out a reassessment prior to the service user returning to the home. During the tour of the home it was clear that several of the service users have dementia care needs. The Responsible Individual has applied to the CSCI for a major variation to convert one section of the home into a dementia care unit. This is still in progress. Although staff have received some training in dementia care, further training would be necessary to provide staff with the skills and knowledge to care for service users with such a diagnosis. One service user Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 9 with a mental health diagnosis had been admitted to the home, and the home is not registered to care for service users with mental disorder. There was no evidence of staff training in this area. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The information in the service user plans did not always provide staff with a clear picture of the service users, and delays in completing some documentation contributes to this. Medications are generally well managed at the home and shortfalls identified should be easily addressed. Staff treat service users with courtesy and respect. EVIDENCE: Service user plans were sampled on each unit. Service user plans are not always being completed within 5 days of the service users admission, and in some instances care plans for activities of daily living had not been completed until some weeks following admission. For one service user the information in one section of the service user plan was inaccurate and did not tally with other information. For another service user with a mental health diagnosis, the mental ability assessment had not been completed. The service user plans had been reviewed monthly, but it was clear that a full review had not taken place, as discrepancies such as those exampled here had not been identified and corrected. There was a marked delay following admission on the completion of several of the falls risk assessments. Also, these had not always been updated following a fall, or on a routine monthly basis. For a service user who had fallen on 08/05/06, this had not been identified in the registered nurses daily Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 11 record entry. These findings are concerning and need to be addressed promptly and processes put in place to maintain service user plans accurately and effectively. Seven service users had wounds, 6 of which have pressure sores. Wound care documentation was viewed and in one service user plan viewed the information was not concise and therefore difficult to follow. This had been reviewed and updated with clear care plans by the second day of inspection. On occasions records identified that the recommended dressing was out of stock so an alternative had been used. The need to ensure that adequate stocks of the dressings in use for each service user are maintained was discussed. For one service user who required 2 hourly turns as part of their pressure area care, this had not been documented for 5 days. The photographic record of wounds was, in some instances, out of focus, and this needs to be addressed. There was evidence of input from the Tissue Viability Nurse specialist, and one Inspector met with two Nurse Specialists on the second day of inspection. Pressure relieving equipment was seen in use in the home. Bedrail assessments and written consents for use were available. Continence assessments and care plans for continence care needs had been completed. Nutritional screening had taken place and care plans for eating & drinking formulated. In one instance the care plan identified that following weight loss a service user was to be weighed weekly, but this had not always been done. Moving & handling assessments had been carried out. It was noted that as with the care plans, several of the assessments had been formulated some weeks after admission. The medication records and management was viewed. Generally the records were up to date. Receipts and disposals had been recorded, and apart from 2 omissions, all administration records were complete. Some of the liquid medications had not been dated when opened. For service users on warfarin therapy the varying daily doses had been clearly recorded and results of the latest blood test results were available. Prescriptions creams and ointments are now stored in the medication trolleys. For one service user on a percutaneous endoscopic gastrostomy (PEG) feed, clear instructions were recorded and each feed had been signed for. Where allergies are known these are recorded on the medication administration record (MAR) chart. There were some gaps noted, and it is recommended this is discussed with the pharmacist to ensure this section is completed for all service users, including those with no known allergies. For medications prescribed with a variable dose, the actual dose administered had not always been recorded and this was discussed. Controlled drugs records were up to date and accurate, and a daily stock check is carried out for all controlled drugs held at the home. The minimum and actual temperatures recorded for the drugs fridge are regularly below 2° centigrade, and this needs to be addressed to ensure refrigerated medications are stored at between 2°– 8° centigrade. In the medical store room on the first floor, medications to be sent for disposal were stored correctly, plus yellow bags containing various items were seen, to Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 12 include empty medication containers. It was unclear why these were being kept and not disposed of in the household waste. The floor was very sticky and it appeared that a waste medication had leaked onto the floor. This is a repeat finding. Staff were seen caring for service users in a gentle and courteous manner. Service users spoken with said that the staff are very caring. Bedrooms viewed were personalised. Service users clothing is labelled and service users were well groomed. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 The activity provision in the home considers service users interests and keeps them active. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. The food provision is good, however service users are not offered choices, which is limiting. EVIDENCE: The home has a new activities co-ordinator, and activities were taking place on both days of inspection. The activities co-ordinator had formulated care plans for each service user to identify their interests and hobbies. A ‘Map of Life’ document had been completed for each service user, providing a good social and life history, from which information can be gained to help provide activities suited to each individuals needs. The possibility of undertaking activities training was discussed, for both service users with physical disabilities and also those with dementia, who require specialist input. On both days of the inspection visitors attended the home. Service users are able to receive visitors in private or in the communal areas, depending on their wishes. Two work experience students were working with the activities coordinator and were joining in with activities. The lunch and suppertime meals were observed. Several of the service users require assistance with feeding, and each mealtime is split into two sittings. At Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 14 the first sitting, 9 service users required feeding, and 4 service users had their meals on trays in their bedrooms, some of whom needed assistance. Staff were seen to give assistance in a courteous manner, but several were needing to feed two service users at once in order to provide the assistance necessary. Some service users eat very slowly, and meals therefore can get cold. The home has a 4 week menu. Service users spoken with said that breakfast meal is good, with a cooked option always available. The cook said that she does go around each morning to inform the service users what main meal is being provided at lunchtime. If a service user does not want the main meal, then an alternative is offered. Actual option choices are not presented to service users, and no record of the meal partaken of is kept. The menus are not displayed for each meal in a format that service users can easily read, for example, on the notice board in the dining room. Liquidised diets are provided and all the food viewed was attractively presented. The menu records soup & sandwiches and a hot option, but the latter is not usually provided. The lunchtime meal finishes at 1.30pm and the evening meal starts at 4.30pm, thus not allowing much of a gap between lunch and supper. This is due in part to the staff shift pattern, and this needs to be reviewed to ensure mealtimes are at appropriate intervals apart. The kitchen was viewed and this was clean and tidy. Foodstuffs were being appropriately stored with evidence of stock rotation. The kitchen records for May 2006 were viewed and these were up to date. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 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 & 18 The home has a satisfactory complaints system with evidence that service users and representatives concerns are listened to and acted upon. Staff have knowledge and understanding of adult protection issues which protect service users from abuse. EVIDENCE: The home has a clear complaints procedure and a record of all complaints is kept, with letters of outcomes sent to the complainant. There have been four complaints since the last inspection, and these have been appropriately managed. There have been no adult protection issues since the last inspection. Staff have received POVA training and are aware to report any concerns. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Shortfalls noted to include odours, cluttered facilities and issues arising from staff shortages detract from the overall homely environment and could potentially place service users at risk. EVIDENCE: One Inspector carried out a tour of the home. Redecoration is carried out as rooms become vacant. A redecoration and refurbishment programme with timescales for completion needs to be formulated. A copy of a room checklist carried out in July 2005 had previously been forwarded to the CSCI. At the last inspection shortfalls in the provision of adjustable beds and a lack of heating in the en suite facilities were identified, and a full environmental audit with an action plan with timescales to address issues identified was required. This has not been received and further discussion has taken place with the Registered Manager following this inspection. The grounds are well maintained and there were splashes of colour in the garden, which can be seen and accessed from several of the service users rooms and from the lounges. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 17 The home has two communal lounges and one dining room. One of the lounges is not in regular use, and would be a communal room for the proposed dementia care unit. Service users have access to the garden. The home has assisted bath and shower facilities. Some of these rooms were cluttered and being used for storage. There are two sluice rooms, and both were being used as storage areas and needed tidying out. The flooring in several of the en suite facilities was very marked and in some cases coming away from the wall. The Registered Manager said that £8000 has been budgeted for the replacement of flooring in these areas. All the service user bedrooms are on the ground floor. There are a variety of hoists available to assist service users with their moving & handling needs. There are rails in the corridors and where required in the bath, shower and toilet facilities. Bedrails were seen in use in the home. In one instance the bedrail clamps in use did not fit the bed frame properly, and the records showed that the service user had fallen out of bed and landed on the rail. The Registered Manager said that she would take action to address this. All the bedrooms are single with en suite facilities. There are still several divan beds in use in the home, some of which are quite high. There is a call bell system throughout the home. Delays in the answering of the bells on occasion were noted, and some comments about this were also received. The home was pleasantly warm. Hot water temperatures were being recorded. Legionella testing took place on the day of inspection. The lighting throughout was satisfactory and emergency lighting tests are carried out. The laundry room was viewed. Laundering procedures were being followed. Information about infection control was available. Any unlabelled items of personal laundry are kept for service users or their representatives to identify. The laundry equipment was all in working order. Malodours were noted in several of the bedrooms and corridor areas, and these were worse on the second day of inspection. At the time of inspection the Housekeeper was also doing the laundry in the absence of the laundry assistant. There were no other cleaners in the home. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 There were not sufficient numbers of staff on duty to ensure that the needs of the service users were being fully met. Shortfalls in the staff employment records could potentially place service users at risk. The arrangements for the Induction and foundation training are not in place and staff potentially do not have a clear understanding of their roles. EVIDENCE: Duty rotas viewed at the inspection indicated that there were two Registered Nurses and six care staff on duty for the morning shift on the first day of the inspection. For the afternoon shift there were two Registered Nurses and five care staff on duty. It was clear from observations made at the time of the inspection that additional care staff are required in the morning to address the peak time activity of the day. It was noted that on both days of the inspection two service users did not receive personal care until after 12 midday. Further examination of the rotas indicated that several mornings are covered with only two Registered Nurses and five care staff. The domestic and catering rotas examined indicated that on the 24th and 25th April there were no laundry staff on duty. On both days of the inspection there was no laundry staff on duty and the Housekeeper was undertaking laundry duties as well as cleaning. In the kitchen on the second day of the inspection only the cook was on duty. On both days of the inspection care staff served the evening supper and washed the dishes as no catering staff were on duty in the Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 19 evening. Staff confirmed that this is the normal routine. This practice is unacceptable as care hours are being used to cover catering needs. An immediate requirement was issued at the end of the inspection in relation to the ancillary staff shortfalls. The management rota viewed did not detail the actual hours worked by the Registered Manager. The duty rota for the first day of the inspection indicated that the receptionist was on duty. The Inspectors were informed that the receptionist was not on duty however the duty rota had not been amended to reflect this. The Registered Manager was on annual leave at the time of the inspection. It was not clear who was in charge of the home in her absence. The Deputy Manager was on duty and was supernumerary for only one day in the whole week in the absence of the Registered Manager. One requirement of the last inspection was that the staffing provision must be reviewed. This had taken place, however there was no evidence that this is an ongoing process. At the time of inspection there were 38 service users in residence and 2 vacancies. The ratio of staff to service users must determined according to the assessed needs and dependencies of the service users, and not just according to the numbers of service users accommodated at the home. Staff spoken with commented that there are not always enough staff to ensure that service users individual needs can be met. The staff employment files viewed contained details of the applicants completed application forms, Criminal Record Bureau checks, medical declaration, 2 references, plus terms & conditions of contract. There is no robust system in place for the tracking of each application and the obtaining all of the required information. The Criminal Record Bureau checks file was viewed and one Inspector found that six of the staff working in the home had a Scottish CRB check. This is not valid for Care Homes Registered in England. This issue was discussed with the Operations Manager for the home and it was agreed that these staff would have a new CRB undertaken as a matter of urgency. No progress has been made with the introduction of induction and foundation training to meet the Skills For Care core standards. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, 36, 37, 38 and aspects of 33 The quality monitoring systems are not robust enough to clearly identify follow-up procedures, and this could affect service user care. Systems for the management of service users monies are in place and secure facilities are available. Systems for health & safety within the home are in place, however shortfalls identified could potentially place service users at risk. EVIDENCE: Regulation 26 visits by the Responsible Individual are undertaken and copies of the report forwarded to the CSCI. Audits take place, however it was not always clear what follow-up action is taken to address any shortfalls identified in the audits. Residents and relative meetings take place and minutes of these were viewed. Visitors commented that the Registered Manager is open and approachable and addresses concerns raised promptly. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 21 The home did not have a business and financial plan. A copy of the monthly budget figures was available to view. There was a current Employers Liability insurance certificate on display. One Inspector viewed some of the records for service users personal monies. These were up to date and the income and expenditure was clearly recorded and receipts were available. The administrator receives support from the regional finance team and a regional audit is undertaken. There was evidence that staff supervision takes place. Records of this were available and had been signed by the supervisor and supervisee. Overall the records available in the home in relation to supervision, service users finances, servicing and medications were being well maintained. Shortfalls have been identified in other areas to include staff employment records, duty rosters, service user plans, maintenance, business, development and financial plans, and action must be taken to address any shortfalls identified. Requirements have been made under the relevant Standards. Servicing records were viewed at random and those viewed were up to date. The maintenance records were up to date, however where a bedrail had been reported as faulty, it was not clear what action had been taken to address this. This gave cause for concern and was discussed at the time of inspection. The Registered Manager said that prompt action would be taken to address the situation. Bedrail protective bumpers were not available for all the bedrails in use, and additional ones were to be purchased. The London Fire & Emergency Planning Authority had visited the home on 20/01/06 and recommended that the fire risk assessment be updated. The maintenance man said that this had been done, but the written copy was not available for inspection as it was at head office. The fire safety check records to include fire drills were up to date. Generic risk assessments for safe working practices were available. It is recommended that copies of the risk assessments for kitchen and laundry equipment be made available in these areas. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 2 3 2 3 1 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 2 3 3 2 2 Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 23 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 OP3 Regulation 14 Requirement Pre-admission assessments must be fully completed and clearly identify the needs of the service user so that the home can ascertain if they can meet these needs. The CSCI must be kept informed of the work being progressed, to include dementia care training, for the variation for the Dementia Category. The home must not admit service users outside their categories of registration. Service user plans must be completed promptly after service user admissions so that the service users needs have been clearly identified and addressed. Service user plans must clearly reflect any treatment being provided to the individual. (previous timescale 01/12/05 not met) Falls risk assessments must be in place for each service user. These must be updated regularly and following any falls. The home must ensure that it DS0000010932.V288877.R01.S.doc Timescale for action 01/06/06 2. OP4 12(1)(b) 01/07/06 3. 4. OP4 OP7OP8 12(1)(b) 17(1)(a) 01/06/06 01/06/06 5. OP7 17(1)(a) 01/06/06 6. OP7 13(4) 01/06/06 7. OP8 13(1) 01/06/06 Page 24 Harefield Nursing Centre Version 5.1 8. OP8 17(1)(a) 9. 10. OP9 OP9 13(2) 13(2) 11. OP9 13(2) 12. 13. OP9 OP9 13(2) 13(2) 14. OP15 17(2) 15. 16. OP15 OP15 17(2) 16(2) 17. OP19 12 18. OP21 23(2) maintains an adequate stock of prescribed dressings. The frequency of any observations being carried out must tally with that identified in the service user plan. (previous timescale 01/12/05 not met) Liquid medications must be dated when opened. The fridge temperature maintained between 2 and 8 degrees centigrade. (previous timescales of 01/08/05 and 25/11/05 not met) Where a variable dose of a medication is prescribed, the actual dose administered must always be clearly recorded. (previous timescale 25/11/05 not met) Medication administration records must be fully completed. All areas used for medication storage must be maintained in a clean condition. (previous timescale 25/11/05 not met) Service users must be offered a choice at mealtimes. A record of each service users meal choice option must be maintained. The menu must accurately reflect the choice of meals being offered for all mealtimes. The mealtimes must be reviewed in consultation with the service users to ensure that there are appropriate intervals between the lunch and supper meals. The environmental assessment must include the action to be taken to address shortfalls in adjustable bed provision, en suite heating and fixtures and furnishings. (previous timescale 01/01/06 not met) Bathrooms must not be used as general storage areas. DS0000010932.V288877.R01.S.doc 01/06/06 08/05/06 01/06/06 08/05/06 08/05/06 01/06/06 01/06/06 01/06/06 01/07/06 01/07/06 01/06/06 Harefield Nursing Centre Version 5.1 Page 25 19. OP21 23(2) 20. OP22 13(4) 23(2) 12 16(2)k 21. 22. OP22 OP26 23. OP27 18 24. OP27 18 25. OP27 10 18(2) 26. OP27 17(2) 27. OP29 7,9,19 (previous timescale 01/12/05 not met) Sluice rooms must be maintained in a clean condition and must not be used as storage areas. Any equipment in use in the home must be maintained in good working order. This must include the bedrail provision. Call bells must be answered promptly. Where malodours are present, this must be assessed and appropriate action taken to address the reasons identified. (previous timescale 01/12/05 not met) There must be on duty at all times suitably qualified, competent and experienced staff working at the care home in such numbers as are appropriate for the health and welfare of the service users. An action plan detailing the action taken to address the staffing shortfalls must be forwarded to the CSCI. Service user dependencies must be reviewed. Additional staff must be on duty at peak times of activity during the day. Care staff hours must not be used to cover catering duties. The home must be competently managed at all times. This must include the provision of adequate management cover arrangements in the absence of the Registered Manager. The staffing rosters must accurately reflect the hours worked by all staff employed at the home. Staff records must contain the information required under the Care Homes Regulations 2001. (previous timescale DS0000010932.V288877.R01.S.doc 01/06/06 01/06/06 08/05/06 01/07/06 12/05/06 01/06/06 01/06/06 01/06/06 01/06/06 Harefield Nursing Centre Version 5.1 Page 26 28. OP30 18(1) 29. OP33 24 30. OP34 25 31. OP37 17 32. OP38 12 01/12/05 not met) There must be evidence that all new staff complete induction and foundation training, to Skills For Care Core Standards. Quality monitoring systems must clearly identify follow-up procedures to address shortfalls identified. A business and financial plan must be formulated and available for inspection in the home. The Registered Manager must ensure that records required by regulation and for the efficient running of the business are up to date, available and accurate. Maintenance records must clearly detail any action taken where equipment has been identified as faulty. 01/07/06 01/06/06 01/07/06 01/06/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP8 OP15 OP38 Good Practice Recommendations It is strongly recommended that the home purchase photographic equipment that provides a clear picture. It is strongly recommended that the menu for each meal is displayed clearly in the dining room, so that service users can easily read it. It is strongly recommended that copies of the risk assessments for the kitchen and laundry equipment be made available in theses areas. Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection West London Area Office 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 Harefield Nursing Centre DS0000010932.V288877.R01.S.doc Version 5.1 Page 28 - 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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