Inspection on 08/11/05 for Holly Bush Nursing Home

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holly Bush Nursing Home 14/08/07

Holly Bush Nursing Home 20/06/06

Holly Bush Nursing Home 11/05/05

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 Middx HA7 3QY Lead Inspector Judith Brindle Announced Inspection 8th November 2005 08:45 X10029.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 Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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 DS0000022927.V260709.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holly Bush Nursing Home Address 99/101 Gordon Avenue Stanmore Middx HA7 3QY 020 8420 7256 020 8954 1446 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) Holly Bush (UK) Limited Mr Emmanuel Dick Essel Care Home 12 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Learning disability (12), Learning disability of places over 65 years of age (12) Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum 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. Holly Bush Nursing Home is registered for learning disability over 65 years of age as well as learning disability 45-65 years of age. 11th May 2005 2. Date of last inspection 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 of 45-65 years of age. The registered provider is Holly Bush (UK) Limited. The care home is situated in a residential area, close to Stanmore, and Harrow Weald. The care home is near local amenities,which include shops and parks. The home is located close to local bus services, and there are train stations at Stanmore and Harrow Weald. There are ten single rooms and one shared room. There are no bedrooms, which have ensuite facilities. The bedrooms are situated on the ground floor, and the first floor of the care home. 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 DS0000022927.V260709.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place throughout 7 hours during a day in November 2005. The care home had five vacancies at the time of the inspection. The inspector was pleased to meet, and spend a significant part of the inspection with the seven residents. The residents have varied communication skills; some were able to converse with the inspector others use gestures and sounds to communicate. Observation of staff interaction with residents formed part of the inspection process. The deputy manager, and the operations manager were present during the inspection. Several care staff also spoke with the inspector. The focus of the inspection was, spending time with residents to obtain as much feedback as possible about the service provided to them, assessment as to whether previous inspection requirements had been met, and whether action had and was being taken to improve the service for residents, and prospective residents. A tour of the premises, and inspection of a variety of records took place. These included residents’ care plan records, health and safety records, and staff personnel records. 19 National Minimum Standards for Older persons (and adults) were assessed. These were met or almost met, and one was not met. The notice of the announced inspection was displayed. The conditions of registration had been met. What the service does well: What has improved since the last inspection? The environment has continued to improve, resulting in the communal areas being more homely, light and airy. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 6 The number, and the variety of activities that are offered to residents have continued to be developed. Several day trips had taken place this year to a variety of historic, and coastal places. Residents care plans have improved significantly, enabling information to be more accessible to staff. Record keeping has generally improved. Involvement, support, and advice from specialist services were more evident from records assessed during this inspection. Staff have benefited from varied and appropriate training during 2005. 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 DS0000022927.V260709.R01.S.doc Version 5.0 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 Outcomes 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, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 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. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) 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. (YA NMS 4) 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 the following standard(s): Standard 1, 3 (OP), 5, 2 (YA) 6 (OP) is not applicable Information, and documentation in regard to the service provided is accessible to residents, and others, to enable prospective residents (and others), to gain knowledge and understanding of the service provided. Arrangements are in place to ensure that prospective residents receive appropriate and comprehensive assessment of their needs prior to moving into the care home. EVIDENCE: The statement of purpose, and the service user guide documentation were available for inspection. The statement of purpose had been recently reviewed. Residents each had a copy of the service user guide. The notice of inspection was displayed. There have been no recent admissions to the care home. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 9 The care home has an admission procedure. This generally involves a referral from a care manager. Senior staff informed the inspector that the manager, and or the deputy manager with a care staff member would then assess the prospective service user. The inspector was informed by the deputy manager that a prospective resident had recently had their needs assessed. This assessment information was available for inspection, and included assessment of individual health, personal care, and welfare needs. The inspector was informed that from this assessment a care plan recording the resident’s needs and staff action to meet these assessed needs would be developed. The operations manager confirmed that a copy of the assessment information obtained by the purchasing authority would be obtained by the service, and would then be placed in the resident’s care plan file. The inspector was informed by the deputy manager of the process of transition to the care home, which would generally include a variety of visits to the care home prior to moving into the home. Following a six week trail period, a multi-disciplinary (with the prospective resident, and generally relatives) review meeting takes place prior to confirmation of the placement. The care plans inspected recorded documentation of assessment of needs of residents having been reviewed. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 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 the following standard(s): Standard 7,8,9 and 10(OP)(6,9,16,18,19 and20 (Adults) Residents each have a plan of care that forms the basis for the care provided to meet the needs of residents. Arrangements are in place to ensure that resident’s health, and personal care needs are met. Appropriate policies and procedures are in place to ensure that medication is administered safely. EVIDENCE: Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 11 Records confirmed that all the residents have an individual plan of care. The care plan format had recently been reviewed, which has improved the accessibility of this information. The four care plans inspected recorded evidence of comprehensive assessment of individual resident’s needs, including assessment of their mobility needs, social needs, and individual personal care needs. These care plans recorded evidence of having been regularly reviewed. Recorded staff guidance is in place to ensure that these assessed needs are met. Records informed the inspector that this staff guidance to meet resident’s assessed needs had been developed considerably since the previous inspection, enabling staff to obtain information that is clear and accessible, so that they are able to meet resident’s need appropriately. Records confirmed that residents receive risk assessment, which includes nutritional risk assessment, mobility risk assessment, falls risk assessment, and pressure sore risk assessment. Staff guidance to meet these risked assessed needs was recorded in the care plans inspected. Records confirmed that residents have access to healthcare services, including GP services, chiropody care, optician services, and specialist services, which include psychiatric treatment and care, specialist epilepsy nurse and tissue viability nurse advice and guidance. Medication is stored securely. Records inspected confirmed that there were no gaps in recording. Commission for Social Care Inspection pharmacist inspection requirements from a previous inspection had been met. It is recommended that a copy of guidance for the administration of medication in response to a resident’s specialist medical need, is located in the medication storage facility, and so more accessible. The registered person needs to make arrangements for the collection of waste medication with licensed waste disposal company. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 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. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 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 the following standard(s): Standard 12,15 (OP) Arrangements are in place to provide a choice of activities including community based activities. The variety of activities continues to be developed. Meals are wholesome and are presented in an attractive and appropriate manner. EVIDENCE: Some residents attend day resource centres on weekdays. Staff spoke of activities for residents having been further developed. Residents were observed to participate in art activities with hobby therapists during the inspection. The inspector was informed about the content of some previous art sessions. An art collage picture was displayed that recorded pictures and Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 13 records of individual resident’s birthdays, staff spoke of residents having participated in the making of the picture. Staff informed the inspector that a resident enjoys visits to the local pub. Staff spoke of residents being involved in making an apple pie during a recent activity session. Staff were observed to participate with residents on a one to one basis during some activities. It was noted that staff were sensitive in encouraging residents to participate in activities, and that staff were judged to have a good understanding of resident’s individual needs and preferences. Knitting, word search puzzles, and drawing pictures were some activities that residents participated in during the inspection. A staff member spoke of the everyday living skills, including helping to lay the table that a resident participated in. Staff should recorded activities participated in. It is recommended that staff seek advice from specialist organisations in gaining knowledge of how to meet the activity needs of those with specialist medical needs such as dementia care needs. It is recommended that residents have the opportunity to participate in daily exercise sessions. Staff and records confirmed that residents had had the opportunity to participate in a variety of day trips, which included visits to Bath Brighton, and Hastings. Staff informed the inspector that a resident had completed a drawing of the buildings of a historic town following their visit. Staff informed the inspector that holidays for residents would be planned. The menu was displayed, but remains in written format. In respect of the residents varied needs, the menu format should be developed to increase the accessibility of the menu information. This was discussed with staff, who spoke positively of plans to develop this. The menu has been reviewed and was judged to have improved. The menu should record that choice in regard to the meals/vegetables provided is offered and that snacks are offered. The cook confirmed that there is choice in regard to the menu. The cook spoke of quality food items being bought fresh rather than frozen or processed. The menu corresponded with the meal being served during the inspection, and was judged to be wholesome and nutritious. The cook aware of the specialist dietary needs of residents, and also of their food preferences. She confirmed that she had completed food and hygiene training in 2004. Food eaten by residents is recorded. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) 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 the following standard(s): Standards 16 and18 Arrangements are in place for handling complaints objectively. Arrangements are in place to ensure that systems are in place for responding appropriately to any suspicion or allegation of abuse. EVIDENCE: The complaints procedure was displayed in the communal area of the care home, and is included in the service user guide documentation, which is supplied to residents. Staff who spoke with the inspector were aware of protection of vulnerable adult reporting procedures. Senior staff informed the inspector that all staff have received protection of vulnerable adults training on 20/9/05, and that abuse awareness is included in the staff induction programme. Financial procedures in regard to residents need review (see standard 35). Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 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 live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) 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 the following standard(s): Standard 19 and 26 Arrangements are in place to ensure that residents live in a safe and generally well maintained environment. The service users are provided with clean, comfortable and safe surroundings. EVIDENCE: The communal sitting/dining room décor has continued to be improved. There are two seating areas, which are separated, one of which has a television, so residents have a choice as to whether to watch the television or not. The sitting room was well lit and the general homeliness of the communal areas Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 16 has continued to be developed. There is clock, plants and other items displayed in the sitting room. A new sofa had been recently bought. The kitchen worktop is cracked near the sink and is in need of repair. Inspector informed that there were plans to replace this, and also to replace the kitchen flooring; a person obtained measurements during the inspection. There should be an appropriate shade on a light bulb in the laundry facility, particularly due to the smallness’ of the room and the risk of the light being left on. Rugs need to be risked assessed and if not of low risk be secured or removed. The registered person should consider redecorating an upstairs bathroom (bathroom with toilet and bath in). The registered person needs to ensure that paper hand towels are available in bathrooms and toilets, and that if there are issues in regard to resident’s behaviour, arrangements need to be looked into to ensure accessibility of hand towels. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 28, 29 and 30(OP) Arrangements need development in regard to providing staff with the opportunity to complete NVQ care training courses. Arrangements are in place to provide the safeguards to offer protection to people living in the care home. These systems are not always pursued. Staff receive training, which includes induction training. This needs to be recorded at all times. EVIDENCE: The inspector was informed from pre-inspection documentation that two staff have completed NVQ level 2 care courses. The registered person should ensure that all care staff have the opportunity to complete NVQ care training courses. Staff spoke of the recent training that they had received. This included care plan training, abuse awareness, health and safety, risk assessment training, manual handling training. Records confirmed that staff had received first aid training (27/9/05), which included resuscitation training, other staff training Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 18 included basic food and hygiene training, and infection control training, and challenging behaviour training. Staff had also received dementia awareness training in 2005. A staff induction record was available for inspection. The format is comprehensive, but it was not complete despite the staff member having been in post for several months. A new staff member had not commenced a recorded induction. A recorded induction needs to be completed for every staff member. The inspector was provided with a format of an induction checklist, which includes safety procedures that a new staff member needs to be aware of within the first day of commencement of their employment. The deputy manager, and a care staff member confirmed that new staff ‘shadows’ other staff for their first week of employment to enable them to gain understanding, and knowledge of the resident’s needs, and of how to meet them. Staff receive a three month probation period. Three staff personnel records were inspected. Two personnel records contained required information. One staff record had only one reference on file. At least two references need to be obtained and verified prior to employment. Pre inspection information was supplied in regard to CRB checks. Records informed that all staff had either received a CRB check or POVA first. All staff job descriptions were available for inspection. The inspector was informed that these have recently been reviewed. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 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. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 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 the following standard(s): Standard 31,35 and 38 The registered manager is qualified and experienced. Arrangements need to be in place to ensure that there is recorded evidence that resident’s financial interests are safe guarded. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 20 The health, safety and welfare of people living in the care home are generally promoted and protected, some development in risk assessment, and monitoring of some safety systems is needed. EVIDENCE: The registered manager is a qualified nurse. The inspector was informed that the registered manager has recently commenced a NVQ 4 management course. The inspector was informed during a previous inspection that the manager has worked with adults with a learning disability for several years. All staff job descriptions including the registered manager’s job description were available for inspection. There are clear lines of accountability within the home and with external management. Records confirmed that staff have the opportunity to attend regular team meetings. The home has a resident’s financial policy. The operations manager informed the inspector that the registered manager is appointee for three service users financial affairs. This needs to be reviewed, the registered person shall ensure that so far as practicable that the persons working in the care home do not act as agent of a resident. The registered person needs to ensure that there is more than one staff signature needed to access residents’ bank/building society accounts. The operations manager informed the inspector that new residents to the care home would not have their money managed in this manner. Records of three resident’s monies were available for inspection, and balanced with their monies. No receipts of recent purchases were available for inspection, there were some receipts dated from two years ago. Building society books of these residents were not available for inspection. There needs to be an investigation by the provider in regard to the location of receipts and also the whereabouts of the building society/bank books. Financial procedures/systems within the care home need to be reviewed. The registered person needs to keep the Commission for Social care Inspection informed of the progress of the investigation. The inspector was informed that the other residents have their monies managed by relatives/significant others. Records must be kept of monies received into the care home by relatives/significant others, and receipts obtained from any purchases the monies are spent on. This was discussed with the deputy manager. It is recommended that the deputy manager gains knowledge and understanding of the resident’s monies and that there is also more than one signature for accessing monies from the resident’s bank accounts. Resident’s monies should be audited during the required monthly provider visits. Fire equipment within the care home had been recently serviced. Records informed the inspector that there had been one fire drill this year (24/12/05). Fire drills need to take place at least twice a year, but more often if not all staff attend a fire drill twice a year. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 21 There needs to be recorded evidence that the hoist has been serviced recently. The date recorded on the hoist was dated 2/11/03. Records confirmed that the specialist bath, and the passenger lift had been recently serviced. The required gas safety certificate was available for inspection. The fridge/freezer temperatures are monitored daily. Accidents/incidents are recorded. Rugs located within the care home need to be risked assessed and appropriate action taken if the risk of tripping is not of minimal risk. There needs to be a risk assessment in regard to the stair gate. Doors within the care home were wedged open, and wedges were observed within rooms of the care home. Doors must not be wedged/propped open. Advice needs to be sought from the fire service and appropriate door mechanisms put in place to enable doors to be kept open during the day. This was discussed with the operations manager. The employer’s liability insurance certificate was displayed and up to date. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 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 3 2 X 3 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 X 34 X 35 1 36 X 37 X 38 2 Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 23 NO 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 OP9 Regulation 16(k) Requirement The registered person needs to make arrangements for the collection of waste medication with licensed waste disposal company. The kitchen worktop is cracked near the sink and is in need of repair. The registered person needs to ensure that paper hand towels are available in bathrooms and toilets. At least two references need to be obtained and verified prior to employment. • The registered person needs to ensure that the checklist induction format (covering the first few days of induction) documentation is completed for new staff. • A recorded induction needs to be completed for every staff member. • There needs to be an investigation by the provider in regard to the location of receipts and also the whereabouts of the building society/bank books. The registered person needs to DS0000022927.V260709.R01.S.doc Timescale for action 01/02/06 2 3 4 5 OP19 OP26 OP29 OP30 23(2) 16(j) 13(4) 17 18(c) 01/03/06 01/02/06 01/01/06 01/02/06 6 OP35 12, 13(6) 16(1) 01/01/06 Holly Bush Nursing Home Version 5.0 Page 24 7 OP35 12, 13(6) 16(1) 8 9 OP38 OP38 12, 13(4) 23(4) 10 OP38 23(4) 11 OP38 13(4) keep the Commission for Social care Inspection informed of the progress of the investigation. • Financial/procedures/systems within the care home need to be reviewed. • The registered person needs to ensure that there is more than one staff signature needed to access residents’ bank/building society accounts. Records must be kept of monies received into the care home by relatives/significant others, and receipts obtained from any purchases the monies are spent on The hoist needs evidence of having been serviced. Fire drills need to take place at least twice a year, but more often if not all staff attends two drills a year. Doors must not be wedged/propped open. Advice needs to be sought from the fire service and appropriate door mechanisms put in place to enable doors to be kept open during the day. • Rugs located within the care home need to be risked assessed and appropriate action taken if the risk of tripping is not of minimal risk. • There needs to be a risk assessment in regards to the use of the stair gate. 01/01/06 01/01/06 01/01/06 01/01/06 01/01/06 Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 25 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 OP9 Good Practice Recommendations It is recommended that a copy of guidance for the administration of medication in response to a resident’s specialist medical need, is located in the medication storage facility, and so more accessible. Staff should recorded activities participated in. It is recommended that staff seek advice from specialist organisations in gaining knowledge of how to meet the activity needs of those with specialist medical needs such as dementia care needs. • It is recommended that residents have the opportunity to participate in daily exercise sessions. In consideration of the residents varied needs, the menu format should be developed to increase the accessibility of the menu information for those with communication needs. • There should be an appropriate shade on a light bulb in the laundry facility. • The registered person should consider redecorating an upstairs bathroom (with toilet and bath in). The registered person should ensure that all care staff have the opportunity to complete NVQ care training courses It is recommended that the deputy manager gains knowledge and understanding of the resident’s monies and that there is also more than one signature for accessing monies from the resident’s bank accounts. Resident’s monies should be audited darning the required monthly provider visits. • • 2 OP12 3 4 OP15 OP19 5 6 OP28 OP35 Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Harrow Area office Fourth 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. Extracts may not be used or reproduced without the express permission of CSCI. Holly Bush Nursing Home DS0000022927.V260709.R01.S.doc Version 5.0 Page 27 - 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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