Inspection on 11/05/05 for Holly Bush Nursing Home

This inspection was carried out on 11th May 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

Holly Bush Nursing Home 14/08/07

Holly Bush Nursing Home 20/06/06

Holly Bush Nursing Home 08/11/05

Holly Bush Nursing Home 13/01/05

Holly Bush Nursing Home 18/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Holly Bush Nursing Home 99-101 Gordon Avenue Stanmore Middlesex HA7 3QY Lead Inspector Judith Brindle Unannounced 11 May 2005 9.30am 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 and Care Homes for Adults 18 – 65*. 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. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holly Bush Nursing home Address 99-101 Gordon Avenue Stanmore Middlesex HA7 3QY 020 8420 7256 020 8954 1446 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) Holly Bush (UK) Limited Mr Emmanuel Dick Essel CRH (N) 12 Category(ies) of LD registration, with number LD(E) of places Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minium staffing notice: The staffing of the home is increased to ensure that there are 3 care staff on duty with the registered nurse for both morning and afternoon/evening shifts when service users are back from day care. 2. Holly Bush Nursing Home is registered for learning disability over 65 years of age as well as learning disability 45-65 years of age. Date of last inspection 13/1/05 Brief Description of the Service: Holly Bush Nursing Home is a registered care home providing nursing care and accommodation for up to 12 service users with learning disabilities over 65 years of age as well as adults with a learning disability 45-65 years of age. The registered provider is Holly Bush (UK) Limited. The care home is located in a residential area, close to Stanmore and Harrow Weald. The care home is near local amenities,which include shops and parks. Stanmore is within a few minutes drive from the home, and has a variety of amenities and facilities. The home is near local bus services, and there are train stations at Stanmore and Harrow Weald.. There are ten single rooms and one shared room. No bedrooms have ensuite facilities. The bedrooms are situated on the ground floor and first floor. Bathroom facilities are located on both floors. The home has a passenger lift. The home has an enclosed accessible maintained garden. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 5 hours during the day in May 2005. The inspector was pleased to meet, and greet 6 residents, and all the staff on duty. The inspection process consisted of spending time with the residents, talking to them. The residents have varied needs including communication needs, some of whom have a verbal impairment, so verbal feedback about the service from residents was limited. The inspector spent some time in the communal areas of the care home with the residents observing interaction and talking with residents and staff. A partial tour of the premises, and inspection of residents’ care records and staff personnel records took place. The deputy manager was on duty and was the shift leader during the inspection. Comment/feedback cards in regard to the service were supplied to the deputy manager to give to visitors/professionals and service users to complete, and be returned to the CSCI. Leaflets in regard to information about the CSCI were left for service users information. A minor application for variation of registration had been received by the CSCI. The CSCI is awaiting response to the letter sent to the provider in February 2005, in regard to this application. What the service does well: What has improved since the last inspection? The décor of the home has improved. Communal sitting and dining room areas have been decorated, and some new furnishings and fittings provided. These areas look much brighter and more homely. Care plan documentation has shown some development and improvement since the last inspection, and review of some other records has taken place. Staff have received training in regards to caring, and supporting residents with dementia care needs. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 (6 Older persons is not applicable) and 2 (Adults 18-65) Documentation about the care home is up to date. This information is available to residents (and others) to help them choose a service that is right for them. The format and the location of this documentation should be reviewed, so residents, and staff can access this information more easily. Arrangements are in place to for residents to receive assessment of their needs prior to their admission to the care home. All assessment information needs to be accessible to ensure that residents’ needs are met by the service. EVIDENCE: The statement of purpose, and service user guide documentation were available for inspection. There was evidence that the statement of purpose had been reviewed this year, and that the previous requirement in regards to recording room sizes had been met. The deputy manager informed the Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 9 inspector that residents each have a service user guide located in their room. The residents’ rooms that were inspected confirmed this. A notice was displayed informing visitors how the previous CSCI inspection report could be accessed to read. A new assessment record format was available for inspection. This documentation includes evidence of comprehensive assessment information. The care plan was inspected of a resident admitted to the care home within the last 6 months. This recorded evidence of assessment of the residents’ needs, which had been completed by the registered manager. This assessment information includes a personal profile and assessment of risk, health, social and personal care needs. There was an assessment from the previous placement included in this care plan documentation. There was not evidence of initial assessment by the purchasing authority. This documentation needs to be accessible, particularly due to the complex and varied needs of the residents admitted to the care home. Though a comprehensive six week local authority review assessment was available for inspection. The other care plan inspected included some assessment documentation from the purchasing authority. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are 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(Older People) and 6,7,18,19, 20(Adults 18-25) Arrangements are in place to identify residents’ health and personal care needs, and to ensure that residents’ privacy and dignity is respected. There needs to be development in the recorded staff guidance to meet assessed needs, to ensure that residents health and personal care needs are met by knowledgeable and competent staff. Medication is stored and administered safely. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 11 EVIDENCE: Care plan documentation, and information needs to be further developed, so that there is always up to date information and documentation including staff guidance to meet these needs, which is easily accessible by staff. There was some recorded evidence of risk assessment, but there were not always evidence of staff guidance when risked assessed needs were recorded as high or medium. These risk assessments include mental health assessments, and falls risk assessments. There was evidence of residents having access to specialist healthcare services. There needs to be evidence that exercises including passive exercise has been considered for the resident on bed rest, and that a referral to a physiotherapist be made if required. The registered person needs to ensure that a resident needing a specialist medical referral appointment accesses an appointment with the specialist. This was discussed with the deputy manager. It is recommended that referrals to the specialist epilepsy nurse be made for all service users with symptoms of epilepsy, and that individual staff action guidance be in place if required. Records and the deputy staff member informed the inspector that there one resident has a sacral sore. Records informed the inspector that dressing instructions (from a community nurse) records 2 hourly position changes for a resident. Other documentation within the care plan records 4 hourly changes in positioning. There needs to be consistency of recorded staff guidance in regard to the care to be given to residents. Records confirmed that during one night, guidance was not carried out by staff in regard to the number of hours between position changes of a service user. This was discussed with the deputy manager and needs to be investigated. Records confirmed that service users’ weight was monitored. There was evidence that a residents’ care plan in regard to their feeding had been partially amended in regard to the recent changes in feeding, but that previous recorded identified eating and drinking needs had not been discontinued in regard to the change in need. Also, there was recorded information regarding a residents’ behaviour. The deputy manager reported that this documentation was no longer relevant. This can lead to confusion and it needs to be clear when identified needs have changed. Old care plan information should be archived. There was little evidence of the monthly review documentation located in care plans being recorded. There needs to be recorded evidence of regular review of all residents’ needs. The registered person should consider delegation of some staff duties, such as reviewing and updating residents’ care plans to competent trained staff, so that management staff can focus on other numerous managerial duties. Medication is stored securely. Arrangements are in place to ensure that medication is administered safely. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14 and 15 Arrangements are in place to provide some activities including community based activities. There is room for developing the variety and number of activities to meet the individual assessed needs of residents’. There is knowledge and understanding of residents’ particular dietary needs, but there needs to be evidence that the menu meets all the nutritional needs of residents. Meals are presented in an attractive and appropriate manner. Service users are supported in maintaining contact with family/friends. EVIDENCE: Activity programmes were recorded, but there needs to be documented confirmation that a number of varied preferred activities are offered to residents, and that it is recorded when residents choose or not choose to participate in them. The home has a passenger vehicle and employs a driver who is keen to ensure that community activities take place. Staff reported that a day trip to Brighton Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 13 was planned for the next day, and that other day trips and holidays were planned. This is positive. Two residents attended a day resource centre on the day of the inspection. The other residents stayed at home. Residents were observed watching television, and one resident participated in a drawing/colouring activity. The care home had a visitor’s policy. Residents have differing levels of family/friends contact. The home has a visitors recording book. This confirmed that there were visitors to the care home. Four weeks recorded menus were inspected. These recorded varied meals. There were some recorded supper, and lunch meals that did not include vegetables, and also recorded foods, which included chicken nuggets. The registered person needs to review the menu and seek advice from a dietician, to ensure that meals provided are nutritional. The menu needs to be more accessible to service users. It was located in a drawer in the kitchen. The pudding of the lunch on the day of the inspection was different to the pudding recorded on the menu. The cook explained the reason for this, but there needs to be evidence that this information is accessible to residents. The cook was aware of residents’ specialist dietary needs and preferences. Residents were offered drinks frequently during the inspection. Food eaten by residents was recorded. A variety of fresh, dried, frozen and tinned foods were stored, an accessible. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 OP, (22, 23A) Arrangements are in place for handling complaints objectively. All protection of adult procedures need to be accessible, and the service protection of vulnerable adults procedure needs review to ensure that systems are in place for responding appropriately to any suspicion or allegation of abuse. EVIDENCE: The complaints procedure is recorded in the statement of purpose and the service user guide documentation. There have been no recorded complaints since the last inspection. The protection of vulnerable adults policy needs to link with the Local Authority policy, to ensure that a proper response to any suspicion of abuse. The Local Authority protection of vulnerable adults policy was not available for inspection. The inspector supplied the deputy manager with a copy of this documentation. Appropriate Local Authority adult protection policies need to be accessible. The care home has a whistle blowing policy, and antiharassment policy. All staff need to receive adult protection/abuse awareness training. This was a previous requirement, but the timescale had not passed. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 OP, (24,30A) Improvements to the décor and furnishings and fittings have been carried out, which have contributed to making the premises have a more homely appearance. Service users bedrooms are personalised. The service users are provided with clean, comfortable and safe surroundings. EVIDENCE: Records confirmed that maintenance checks are carried out, and that a redecoration programme of the premises is in the process of being carried out. Target completion dates for this work were recorded. A vacant residents’ bedroom was in the process of being painted during the inspection. New armchairs for residents were accessible in the communal areas. The sitting room and dining areas had been decorated. The layout of the interior communal areas had been changed since the last inspection. There are now Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 16 two seating areas with a television located in one communal sitting area. New furnishings and fittings, which include light fittings, and pictures, and ornaments and plants, have all contributed to the homeliness of the care home. The new light fittings have improved the lighting in the care, which contributes to safer surroundings for residents. There are some areas that need attention: Some doorframes, doors and some skirting boards within the care home show evidence of wear and tear, and need repainting. • The location of the shelf supporting the medication fridge needs risk assessment, and needs removing if of high risk to the safety of staff, and others. • Kitchen food trolley needs replacing as it is scratched and damaged in some areas and could be a health risk. There were some ants located near a radiator in a communal seating area. The registered person needs to examine ways to get rid of the ants and so minimise the risk of them getting into the care home, and to seek advice if required. A sample of residents’ rooms was inspected. These were individually personalised. The home has an infection control policy. The home was very clean at the time of the unannounced inspection, and there were no offensive odours. Staff were observed to be wearing protective clothing, which included aprons and gloves. A domestic staff member is employed. • Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30(OP)34,35(A) Arrangements are in place for ensuring that there are sufficient numbers and skill mix of staff to meet the varied needs of the residents. There are robust recruitment procedures, which provide the safeguards to offer protection to people living in the care home. Staff receive training, which includes induction training. There needs to be recorded evidence that staff are appropriately trained in all specialist care procedures, to ensure that all residents care needs are met by competent staff. EVIDENCE: Records informed the inspector that there was a registered nurse and one care staff member on duty at night. The registration condition in regard to minimum staffing numbers had been met. Records confirmed that there were at least three care staff and a registered nurse on duty during the day. The registered manager, and the deputy manager work some weekend shifts. The deputy manager spoke of on-going recruitment taking place for full time registered nurses Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 18 There needs to be recorded evidence that staff have received training, and are competent in providing care for a resident with specialist eating/feeding needs. The deputy manager reported that she and the registered manager had received this training. Training records confirmed that staff had received dementia awareness training in 2005, and that staff had completed manual handling training, First Aid, fire training, health and safety training, and report writing. There was also evidence that a care staff member had completed NVQ level 2 care training. Communication systems need to be examined. Records confirmed that a changing need regarding a service user had been identified and recorded, but that guidelines were not put in place immediately and there was not evidence that a GP saw the resident promptly. Records record that a dressing was applied a week following observation of this. Staff supervision records were available for inspection. A random sample of staff personnel files was inspected. These contained required information and documentation. Staff meetings are held regularly and records confirmed that the meetings are well attended. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, and 38(OP),39,42(A) The home has recorded systems in place to monitor the quality of the service provided. Monitoring systems include procedures to obtain feedback from residents and visitors. There are health and safety monitoring systems in place, but there needs to be development in some health and safety assessments to ensure that the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: Quality audit documentation in regard to the service for 2005 was available for inspection. This included a format of a service user questionnaire. Quality Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 20 audit monitoring systems documentation in regard to the service for 2005 was available for inspection. Visits by the provider take place as required. Commission for Social Care Inspection comment cards/feedback cards were supplied to the deputy manager to be given to service users, visitors and health and social care professionals. Records confirmed that there was a risk assessment of the building. Fire action guidelines were displayed. The kitchen door and the office door were wedged open. Suitable door safety mechanism needs to be in place if these doors need to be kept open during the day. The registered person needs to obtain advice from the fire service. The slope in the flooring upstairs needs risk assessment, and clear identification of the slope be actioned by the registered person, if assessed as needed. There also needs to be a recorded risk assessment in regards to the use of the stair gate. Documentation in regards to a previous requirement concerning risk assessment of portable fans was not available for inspection. There need to be safety guidance in place regarding residents using wheelchairs. This needs to include evidence of regular safety checks. Radiators within the care home were observed to be guarded. Records informed the inspector that water temperature checks are monitored. Evidence of system safety monitoring records were available for inspection. These included emergency lighting, and call bell checks. Health and safety checks of the service are monitored monthly. There is a COSHH policy. Service users monies were not inspected. These will be inspected at the next inspection. The deputy manager informed the inspector that the registered manager maintains the records in regards to residents’ monies. It is recommended that the deputy manager be informed of the systems in regard to residents’ monies. The certificate of employers liability insurance was displayed and up to date. Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 21 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 x 2 2 3 x 4 x 5 x 6 2 HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 x x x x x x 3 Score Standard No 7 8 9 10 11 Score 2 2 3 x x Standard No 27 28 29 30 3 x 3 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 3 34 x 35 x 36 x 37 x 38 2 Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 22 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. Standard 2,3 Regulation 14(1)(b) Requirement A copy of the initial purchasing authority assessment of individual residents needs, must be accessible in each service user plan. Timescale of 1/5/05 not met. Care plan documentation, and staff guidance needs further development. There needs to be recorded evidence of regular review of all residents’ needs. Risk assessments need to be further developed, in regard to recording staff action to be taken to minimise risk to residents, and as to why there might be a risk. Timescale of 1/5/05 not met. The registered person needs to ensure that a resident needing a specialist medical referral appointment accesses an appointment with the specialist. There needs to be consistency of recorded staff guidance in regard to the care to be given to residents. The registered person needs to investigate as to why a Timescale for action 1/8/05 2. 6,7,8 12,13,15 1/9/05 3. 9YA 13(4) 1/8/05 4. 7,8 12, 13 1/8/05 5. 7,8 12,13(4) 1/7/05 6. 7,8,9 12, 13 21/6/05 Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 23 7. 7,8 12 8. 7,8 17 9. 13 16(2)(m) (n) 10. 15 12,16(i) 11. 15 12(3) 12. 18 13(6) 13. 18 13(6) residents position during one night was not changed as often as documented as needed. There needs to be evidence that exercises including passive exercise has been considered for the resident on bed rest, and that a referral to a physiotherapist be made if required. Records need to be clear, and old records identified as discontinued when assessed care needs have changed. There needs to be up to date recorded information in regard to resdents changing needs. There need to be records in place that confirm that varied preferred activities are offered to residents, and take place regularly. The registered person needs to review the menu, and seek advice from a dietician, to ensure that all meals provided are nutritional. The menu and information in regard to changes to the menu needs to be more accessible to residents. As far as practicable residents shall be consulted regarding the menu. The protection of vulnerable adults policy needs to link with the Local Authority policy, to ensure that there is a proper response to any suspicion of abuse. Appropriate Local Authority adult protection policies need to be accessible. All staff need to receive adult protection/abuse awareness training. Timescale of 1/6/05 still in place. 1/7/05 1/8/05 1/9/05 1/9/05 1/8/05 1/8/05 1/6/05 Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 24 14. 19 23 (2) 15. 19 23 16. 30 18(1) 17. 31 12,13 18. 38 13(4) 19. 35 13(4) 20. 38 23(4) · Some door frames, doors and some skirting boards within the care home show evidence of wear and tear, and need repainting. · The location of the shelf supporting the medication fridge needs risk assessment, and needs removing if of high risk to the safety of staff, and others. · Kitchen food trolley needs replacing as it is scratched and damaged in some areas and could be a health risk. The registered person needs to examine ways to get rid of the ants, and to minimise the risk of ants getting into the care home, and to seek advice if required. There needs to be recorded evidence that staff have received training and are competent in providing care for a resident with specialist eating/feeding needs Staff communication and reporting systems need to be examined by the registered person. The registered person needs to ensure that there are records in place , confirming that residents wheelchairs are serviced regularly and that regular wheelchair checks take place. Timescale 1/5/05 not met. Wheelchair safety staff guidance needs to be in place. Residents personal money records need to be further developed to ensure that records are clear in regard to residents expenditure. Previous requirement timescale 1/4/05 A suitable door safety mechanism needs to be in place if doors need to be kept open during the day. The registered 1/9/05 1/7/05 21/6/05 1/8/05 1/8/05 1/8/05 1/8/05 Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 25 21. 38 13(4) 22. 38 13(4) person needs to obtain advice from the fire service. A free standing fan located in a residents room needs to be risked assessed as of being of low risk to residents and to others. Timescale 1/4/05 not met. There needs to be recorded risk assessments in regard to the slope in the flooring on the first floor, and in regards to the use of the stair gate. 1/7/05 1/7/05 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. Refer to Standard 7,8 Good Practice Recommendations It is recommended that referrals to the specialist epilepsy nurse be made for all service users with symptoms of epilepsy, and that individual staff action guidance be in place if required. Old care plan information should be archived. The registered person should consider delegation of some staff duties, such as reviewing and updating residents’ care plans to competent trained staff, so that management staff can focus on other numerous managerial duties It is recommended that the deputy manager be informed of the systems in regard to residents’ monies. 2. 3. 37 27 4. 5. 35 Holly Bush Nursing Home G62-G11 S22927 Holly Bush v212180 110505 Stage 2.doc Version 1.30 Page 26 Commission for Social Care Inspection 4th Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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