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Inspection on 04/11/05 for Hornchurch Nursing Centre

Also see our care home review for Hornchurch Nursing Centre for more information

This inspection was carried out on 4th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good standard of care. The staff are competent caring and professional. The home provides a comprehensive and varied activities program. The home benefits from clear approachable and supportive management. The home keeps relatives informed of the service users care and involved in the life of the home.

What has improved since the last inspection?

The period since the last inspection has been one of significant change for the staff and manager and the home ahs focussed on maintaining the standards within the home during this period.

What the care home could do better:

Record keeping must evidence the standard of care given. Staff of all grades should have regular supervision. Staff should have access to a minimum of an induction three days paid training per year.

CARE HOMES FOR OLDER PEOPLE Hornchurch Nursing Centre 2a Suttons Lane Hornchurch Essex RM12 6RJ Lead Inspector Joanna Moore Unannounced Inspection 4th November 2005 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 Hornchurch Nursing Centre DS0000015596.V263399.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. 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. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hornchurch Nursing Centre Address 2a Suttons Lane Hornchurch Essex RM12 6RJ 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) 01708 454 422 01708 445 456 ANS Homes Limited Ms Carol Baldock Care Home 55 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (38), of places Physical disability (5) Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th March 2005 Brief Description of the Service: Hornchurch nursing home is a purpose built fifty-five bed home which is owned and operated by ANS Homes Ltd a company which operates similar homes throughout the country. ANS Homes Ltd has recently been bought by BUPA but remains a wholly owned subsidiary company. The home caters for three categories of service user: up to 16 people over the age of 65 with a diagnosis of dementia, up to 34 people over the age of 65 who have age related physical illnesses/ disabilities and up to 5 people between the ages of 18-65 who have physical disabilities / complex needs. The home is managed and staffed by registered nurses, care assistants and support staff. The home offers administrative, catering and laundry facilities on the ground floor and care accommodation on the further three floors. Each floor operates as a separate unit with staff allocated to each floor with bedrooms, lounge/ dining room, small kitchen area, bathrooms and toilets situated on each floor. The Home itself is situated within two minutes walk of the railway station and is easily accessed by car from the A13, A127 and M25. Hornchurch shopping centre is approximately twenty minutes walk or a short bus ride away. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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 annual inspection process. It took place over one day and included meeting with service users, their relatives, care staff, administrative staff and the manager. The manger on the day of inspection had a busy program planned and was under a lot of pressure. A visit by the responsible individuals representatives was also taking place which required the manager’s attention for some significant time and appointments had been made to assess two potential service users. The manager was however was able to spend some time with the inspector to review requirements and recommendations from the previous inspection and changes that were occurring in the home. The inspector stayed until 6.30 to observe tea being served to service users What the service does well: What has improved since the last inspection? The period since the last inspection has been one of significant change for the staff and manager and the home ahs focussed on maintaining the standards within the home during this period. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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 Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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): 2,3,4,5. Standard 6 is not applicable Service users needs are fully assessed before they move into the home to ensure that care can be appropriately provided. Where possible service users are encouraged to view the home before deciding to take up residence. An opportunity to “test drive” the home is provided via a trial stay period. EVIDENCE: Service users funded by the local authority are subject to a block contract between the home and the local authority. Those service users purchasing their care privately are provided with an individual contract, which meets the national minimum standards. A clear assessment process was in place prior to admission of new service users. Where service users were funded by the local authority then a copy of the central care needs assessment was obtained and the homes assessment process used to supplement this. The manager assessed two prospective Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 9 service users including one emergency placement on the day of the inspection. Service users are offered a trial stay period to ensure that the home meets their needs. One service user moved in during the inspection and was able to relate his experiences so far of the home. This gentleman said that he had visited the home and chatted with senior staff about what his expectations were and what the home was able to offer before making a decision to come to the home. As someone clearly able to guide his own care he was made to feel that the home could work with him on this rather than take over. He had been reassured that he would be able to make choices and retain his skills and only be ‘given care’ according to his needs rather than have it forced upon him. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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 Service users were protected by safe medication systems. Service users and their families benefited from high quality care which respected individual needs. Record keeping however was not of a sufficient standard to fully evidence the care given. EVIDENCE: An initial care plan was developed on admission with a long term plan devised within 3 months of admission. There was evidence that all service users have a plan of care. A sample of 3 care plans were tested. These were detailed and included a summary of care. Care plans covered social needs, diet, likes and dislikes as well as medical care required. Care plans were agreed where possible with the service user and either the service user or their relatives/ representatives sign the care plans. Care plans were recorded as reviewed on a monthly basis but those seen were not always up to date in relation to changes in care. For example service user (K) had a waterlow risk assessment for the development of pressure sores completed, this identified a high risk of 26 and that it should be reviewed monthly. The next review a month later identified the risk as increasing to 32 but no changes had been recorded in the care plan despite it being reviewed nor was there any evidence of specific care linked to Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 11 the waterlow assessment being carried out. The same care plan identified nutritional screening and fluid charts to be maintained but there was no evidence of these in some months. On discussing this with the qualified nurse they advised that this service user no longer needed these monitoring charts. The home must be able to evidence in detail the care that is required and the care that is provided. Records must be updated regularly to reflect changes in need. Where assessments such as waterlow are carried out and identify high levels of risk then the care plan must evidence that this risk is translated in to guidelines for care. Another service user (m) was observed to have a waterlow score of 27 again at high risk of developing pressure sores but no care plan could be found which translated this score into actual guidelines for care. One service users care records referred to bruising and dressings being applied but it was not possible to clearly identify when this had occurred and when the original dressings had been applied. The homes records must be accurate, detailed and evidence the care given. Moving and handling, bathing and falling risk assessments were in place. In one service users care plan the only items listed in the social care were approaches to address the screaming behaviours exhibited, the response to these was not in line with a social care plan but behavioural responses. It is recommended that care plans incorporate the social needs of service users. It should be noted that the above comments relate to standards of record keeping rather than care provided, the following comments from service users and their families evidence good quality care being provided. “ The carers are lovely but we feel a little unhappy with the record keeping (about a specific issue) which we will raise with the manager” The Gp who visits the home every couple of days said that … “the residents are very well cared for. Excellent manager and staff , clear leadership of the home comes down to the staff who are caring, professional and are able to follow directions clearly. Staff will raise any issues of concern.” One service user who was moving in on the day of the inspection said that as someone clearly able to guide their own care he was made to feel that the home could work with him on this rather than take over. He had been reassured that he would be able to make choices and retain his skills and only be ‘given care’ according to his needs rather than have it forced upon him. From observation of staff practice and discussion with relatives it was apparent that service users were treated with dignity and respect. Medication rooms were fitted with temperature control devices to ensure that the storage temperatures did not exceed 26 degrees. Medication was stored in a locked medication cabinet in the locked medication room. Medication was administered via blister packs where appropriate. Two service users Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 12 medications were checked. The medication held was in line with the medication administration record (mar) and was recorded as dispensed appropriately. Only qualified nurses administer medication. Appropriate policies and procedures have previously been noted to be in place and the inspector was advised that these had not been changed. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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): 12,13,14 &15 Service users benefit from a variety of nutritious wholesome home cooked food. Service users and their families enjoy a program of a wide variety of activities designed to reflect the needs of all service users in the home. Families felt involved in and supported by the home. It is recommended that the care of one service user be reviewed to understand whether the impact of their behaviour on others can be minimised. It has also been required that the manager investigate why five service users were dressed for bed at 5pm. EVIDENCE: One service user on the top unit was crying out continuously this was documented in their care plan. This service user was eating their tea in the communal area with other service users and was visibly impacting on their ability to enjoy a relaxing meal. Food sampled during the inspection was tasty, the menu showed a rotational menu which offered a varied and nutritious diet. The majority of food is home cooked on the premises by the chef who when interviewed in previous inspections has shown awareness of individual service users nutritional needs and preferences. Menu cards were in the dining rooms. The tea provided was mostly sandwiches and light tea, which service users and their relatives said Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 14 was what they wanted some service users however chose the daily available hot option. Relatives commented positively on the standard of food available as did residents. One relative was noted to assist their loved one with their meal however when asked was clear that this was not an expectation that the home had placed upon them but felt for them a way of practically expressing that they continued to ‘care’. Comments from relatives included: “The staff are lovely they all look after him so well…the staff are very welcoming” “First class home, first class nursing care. We visit every other day at different times, they don’t know we are coming and we always feel welcome.” “The entertainment lady is excellent she has lots of patience and ideas and there is always something going on.” Service users stated that the routines of daily living are flexible according to their needs and preferences and those they can exercise choice in relation to these. It was noted however on the top floor at 5pm that five service users were walking around in their night clothes, all were appropriately covered but it was unclear as to whether this was matter of choice for these service users or an ongoing practice which is convenient for staff. The manager is required to investigate this and inform the inspector. An activity organiser is responsible for ensuring that the social and recreational needs of service users are met. Information about activities is provided on notice boards and a notice board at the entrance to the home states what is planned for the day. Service users were given the choice whether to attend activities or not. At the previous inspection the activities co-ordinator advised the inspector that they operate a daily shop, which is also used as informal chatting time with service users staff and relatives confirmed this to be the same. Service users with dementia are encouraged to attend both the main activities and also receive one to one time. For the service users who were bed bound and uncommunicative the activities co-ordinator previously advised the inspector that they spent time every couple of days chatting and spending time doing hand massages, relatives said that they had seen this happen. A variety of activities had been held by the home in the previous few months and the inspector was advised that a full program is planned for Christmas which the inspector will review in the next inspection. Relatives said they were always made to feel welcome when visiting and were kept informed of events within the service users life, relatives were made especially welcome to join in with activities planned in the home. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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 Service users and their families were confident that any issues of concern would be listened to and acted upon effectively. EVIDENCE: The complaints record recorded two complaints as received by the home both of which had been investigated. It was possible to see from the complaints record that any shortfalls in the standard of care were taken up with staff individually and as a team. Relatives’ comments throughout the report support the view that complaints are few and far between. Complaints procedures were in place and had not changed since the previous inspection. Relatives said they felt able to approach the manager about any issues of concern and were confident that the issues would be investigated and addressed. “I am unhappy with records around mums dressings but will chat with the manager about that” Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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): 19,20,21,23,24,25 &26 Service users and their families benefit from safe and suitable accommodation which meets their needs and the national minimum standards. The home is clean and odour free. Décor is looking tired in some areas but plans are in place to redecorate communal areas. EVIDENCE: The home is divided into three units on three floors. Each unit operates independently and has its own staffing team for the shift. Sufficient and appropriate toilets, bathrooms, bedrooms and communal lounges with kitchenette are provided in each unit. All service users have their own private rooms, which are furnished and decorated according to their choice. The building was maintained to a safe standard. The homes internal decor is looking tired in a number of areas and a program of refurbishment is planned during the next twelve months this will include decorating all and carpeting many of the communal areas. New curtains were provided last summer. Those areas visited were clean and hygienic with no noticeable odours. From Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 17 discussions with relatives the day of the visit was representative of the normal standard in the building…“ It’s a lovely clean place and never smells”. The food is supplied from the kitchen situated on the ground floor. The kitchen was not inspected as part of this inspection. The manager advised the inspector that the home is budgeting for the remainder of service user beds to be replaced with high low beds for staff safety and service user comfort by the end of the next financial year. The manager advised the inspector that the whole home is due for refurbishment and that as part of this process over ridable locks will be fitted to all service users bedroom doors by the end of the next financial year. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 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 Service users benefit from caring competent staff that show a genuine interest in the welfare of the residents. The number of qualified nurses per daytime shift must be maintained at one per unit. Staff recruitment practices are generally safe however to be fully robust and in line with regulationary requirements a requirement has been made. Staff benefit from a variety of training however the employer is not fully supportive in line with the national minimum standards, as staff are not paid to attend training. EVIDENCE: Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 19 On the day of inspection one carer had called in sick, which caused some difficulties, but another carer was called into cover and arrived at 11am. The inspector was satisfied that there were sufficient staff on duty on the day of inspection and that shortages had been appropriately addressed. Examination of the duty rota showed that this was the norm. Service users stated that staff are helpful and respectful when providing assistance. There are sufficient ancillary staff to undertake all the non-care tasks. Staffing is required to be at the following level: Unit Ground floor Middle floor Top floor 8am – 1 qualified & 3 carers 1 qualified & 3 1 qualified & 3 carers 2pm carers 2pm1 qualified & 2 carers 1 qualified & 3 1 qualified & 3 carers 8pm carers On the day of inspection there were only two qualified staff on duty attempting to cover the third floor between them. From discussions with staff and relatives this would appear to be a regular occurrence and has been noted at a previous inspection when staff shortages were apparent. The home is required to have a qualified nurse on each floor between the hours of 8am and 8pm. From 8pm – 8am 2qualified and 4 carers were employed to cover the home with generally two each stationed on each floor. Three staff recruitment files were checked to sample staff recruitment processes. All these files were in line with regulatory requirements and included two written references, an employment history, a medical declaration, a Criminal Records Bureau check, evidence of identity and a current photograph. It is required that the application forms of prospective staff are monitored to ensure that actual dates of employment are detailed rather than just a year in order to identify gaps in employment. Files also held copies of job descriptions. Contracts the inspector was advised were under review. A clear system was in place to check the status of qualified nurses at the point of recruitment and also to monitor their ongoing registration. Evidence was held on staff legal working status within the UK. Staff sign to say that they have read all key policies and procedures. Of the three staff files viewed only one held records of an induction being completed. It is required that all staff receive a comprehensive induction and that records of this are held. Staff training records evidence that these three staff had received updated fire training, moving and handling, adult protection, first aid, skin and pressure area care, optical awareness, food hygiene and dementia awareness training. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 20 2 staff are going on tissue viability training. 10 staff are trained to level 2 NVQ and a further 4 are to be enrolled by December. The home has 35 care staff and will therefore in order to meet the national minimum standards, have to ensure at least another four staff in addition to the above complete NVQ level 2. The inspector was advised that the staff contract requires staff to attend mandatory training unpaid. It is not in line with good practice and constructive employer/ employee relationships that staff be required to attend training unpaid and in their own time although it is acknowledged that in this home staff in reality are recompensed through time off in lieu. It is recommended that in line with standard 30 staff receive a minimum of three paid training days per year. Comments received on the calibre and competency of staff are as follows: “The staff are lovely, kind, caring, friendly, so nice they all look after him so well” The Gp commented that the residents were well cared for by a caring and competent team of staff. “First class home with first class nursing care.., carers are lovely.. staff keep us informed of any accidents and/ or issues” “ All the staff are lovely and kind and look after my uncle so well. We have been visiting here for years for different members of our family. Staff are very kind and welcoming it feels lover the years like the staff are another family. The entertainment lady is excellent she has lots of patience and ideas and there is always something going on. We cannot find any fault. The carers work very hard” Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 21 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): 31,32,33,34,35,36,37 and 38 The home benefits from an approachable and competent manager who ensures the home is run in the best interests of service users. Financial systems are in place for the protection of service users. Service users benefit from a home which is maintained to a safe standard however two requirements have been made in this area. Staff benefit from an open door policy but are not supported by regular meetings and supervision. EVIDENCE: The registered manager is a registered nurse with experience of managing services for this client group who has undertaken a certificate in management studies and is currently studying for a degree in business management. Through discussion and observation it was evident that the manager has the qualities and experience necessary to manage the home. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 22 The Gp commented that he felt that the staff benefited from an “excellent manager” whose clear leadership and direction which ensured a caring, competent and professional staff team. The manager and hotel services manager operate an open door policy and were clearly known to all relatives interviewed and observed entering and leaving the building. Feedback from service users, relatives and staff confirmed that the management of the home are approachable and supportive. The most recent staff meeting recorded for carers was February 2004, the most recent staff meeting recorded for trained staff was similarly February 2004. It is strongly recommended that staff and management have meetings at least six times in any twelve month period. Staff supervision records were not viewed but this area was discussed with the manager the inspector was advised that a system of supervision for qualified staff had been implemented but had yet to be filtered through to care staff. It is required that staff receive regular supervision. It is recommended that all staff receive supervision at least six times per year. “Elaine and carol are very approachable and we can ask anything” The registered persons representative undertakes monthly visits of the home in line with regulation 26 and forwards copies of the reports to CSCI. The majority of service users families or representatives manage their finances. A petty cash float is held and a clear recording system was shown to the inspector which recorded all monies received and spent on the service users behalf and how that money had been spent. Expenditure could be traced to a receipt. One service user requires the home to manager their money and this is again recorded on the same database with the service user however having an individual bank account. A reconciliation of this service users account at the home and bank statements are sent to head office monthly for review. The home operated clears systems to monitor health and safety. The water supply was checked in line with guidance for the risk of legionnaires disease. Staff were provided with appropriate equipment for their job such as disposable gloves and aprons, sharps box and yellow bags for the disposal of ‘medical waste’. A contract was in place for pest control. A valid electrical certificate was in place (2003). The gas safety certificate expired in July and the maintenance officer advised the inspector that they believed that they had returned to carry out an annual check however this could not be evidenced at the time of the inspection but a certificate was subsequently sent to the Commission. Water temperatures within the home were checked monthly to prevent the risk of scalding. Fire appliances were checked and serviced regularly by a contractor. Fire doors, emergency lighting, alarm and extinguishers were checked in line with current fire prevention guidance but fire drills were recorded as occurring only three times within the previous twelve months. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 23 Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 24 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 3 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 3 3 1 2 2 Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The home must be able to evidence in detail the care that is required and the care that is provided and records must be updated regularly to reflect changes in need. Where assessments such as waterlow are carried out and identify high levels of risk then the care plan must evidence that this risk is translated in to guidelines for care. The homes records must be accurate, detailed and evidence the care given. The manager is required to investigate why five service users were dressed in their night clothes at 5pm and inform the inspector. The home is required to have a qualified nurse on each floor between the hours of 8am and 8pm It is required that the application form of prospective staff are monitored to ensure that actual dates of employment are detailed rather than just a year DS0000015596.V263399.R01.S.doc Timescale for action 01/12/05 2 3 OP7 OP14 17 12 01/12/05 19/12/05 4 OP27 18 01/12/05 5 OP29 19 01/12/05 Hornchurch Nursing Centre Version 5.0 Page 26 6 OP36 18 7 OP36 13 8 OP36 18 9 OP38 23 in order to identify gaps in employment. It is a requirement that supervision is started and records kept of sessions for all staff. (previous requirement with date set at 1.6.05) It is required that a minimum 20 minute handover time be built into each shift handover. (previous requirement with date set at 1.6.05) It is required that all staff receive a comprehensive induction and that records of this are held. It is required that fire drills be carried out 3 monthly in line with current LFEPA guidelines. (previous requirement with date set at 1.5.05) 02/02/06 02/02/06 02/02/06 01/12/05 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 2 3 Refer to Standard OP7 OP28 OP14 Good Practice Recommendations It is recommended that care plans incorporate the social needs of service users. It is recommended that the home ensure that at least 50 of care staff complete NVQ 2. It is recommended that a specific service users care be formally reviewed to understand whether the home is able to provide more support for the service user and to understand whether there are any specific strategies they can employ to make the service user more comfortable. It is also recommended that the home consider how the impact of this behaviour on other service users can be minimised whilst supporting the service users rights. It is recommended that in line with standard 30 staff receive a minimum of three paid training days per year. It is strongly recommended that staff and management DS0000015596.V263399.R01.S.doc Version 5.0 Page 27 4 5 OP30 OP36 Hornchurch Nursing Centre 6 7 OP36 OP36 have meetings at least six times in any twelve month period. It is recommended that all staff receive supervision at least six times per year. It is required that all staff receive a comprehensive induction and that records of this are held. Hornchurch Nursing Centre DS0000015596.V263399.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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