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Inspection on 16/08/05 for Horton Cross Nursing Home

Also see our care home review for Horton Cross Nursing Home for more information

This inspection was carried out on 16th August 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.

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 standard of wound care planning is detailed and thorough to support the healing of wounds and comfort of individuals. The home has a robust recruitment and induction procedures that protects service users from the risk of abuse. Service users benefit from a kindly and respectful team of staff. The Registered Manager ensures that there are appropriate numbers of staff on duty to meet service users` needs. Newly appointed staff are provided with thorough Induction Training.

What has improved since the last inspection?

At the last inspection 10 requirements and 13 recommendations were raised with the home. 9 of these requirements had been fully complied with. The requirement relating to the monitoring of individual`s nutritional needs had been partly addressed. 9 of the recommendations had been actioned, with the remaining 4 partly achieved. Medication management is now satisfactory. Service users are able to make more choices about their daily lives, in particular the time they go to bed, achieved through an increase in staffing levels in the evening and a review of routines within the home. Regular staff supervision has been implemented enabling practice to be reviewed. Provider support has been made available to the registered manager to enable systems to be reviewed and implemented. The environmental improvements have been continued and rooms were tidier and better organised. Recruitment practices are satisfactory and include the required preemployment checks. The provision of social opportunities has been reviewed and an additional member of staff is to be involved in providing these.

What the care home could do better:

Social and recreational opportunities need to be developed to ensure that they are appropriate for people`s needs and preferences. The monitoring of nutritional needs requires closer scrutiny to ensure that all at risk have sufficient food and fluids for their needs. The environment remains in need of ongoing refurbishment with the provision of a wheelchair accessible toilet near to the main lounge. The manager and staff do not have access to management and NVQ training, which is essential to promote the development of standards and the provision of a suitably trained and supported workforce.

CARE HOMES FOR OLDER PEOPLE Horton Cross Nursing Home Horton Cross Ilminster Somerset TA19 9PT Lead Inspector Sue Burn Announced 16 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Horton Cross Nursing Home Address Horton Cross, Ilminster, Somerset. TA19 9PT 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) 01460 52144 Sentimental Care Ltd Mrs Jacqueline Anne Gingell Care home with nursing 47 Category(ies) of Old age (47) registration, with number of places Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Where rooms are shared, they are occupied by service users who have made a positive choice to share with each other. 2. One named service user, requiring nursing care, may be admitted in the age range 55 - 65 years. Date of last inspection 24 February 2005 Brief Description of the Service: Horton Cross is a home providing general nursing care for older people. The home is a former motel on the edge of the small village of Horton, 2 miles from Ilminster. Accommodation is on two floors accessible by a passenger lift. Most of the rooms are for single occupancy although a small number of shared rooms are available. Downstairs there is a large lounge/diner with adjoining dining room/lounge area, overlooking the garden and patio area with seating, overlooking the garden. There is also a quieter lounge available and a seating area in the reception hall. Access to local services would require transport but are within a short distance of the home. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part of the planned annual programme of inspections. Two inspectors carried out this announced inspection over one day. The last inspection was unannounced and took place on 24 February 2005. Mr David Aukett, Company Secretary, accompanied Mrs Jackie Gingell, the Registered Manager. Mr Aukett has been working with the home, since the last inspection, to develop and implement management systems to raise standards throughout the home. This inspection confirmed that both the provider and manager have proactively addressed the concerns raised at the last inspection. Areas for improvement remain but staffing levels and the flexibility of service users routine in particular have improved. Mrs Gingell and her deputy were both available throughout the inspection. 40 people were living in the home. All service users spoken to, and who were able, told inspectors that they were satisfied with their care and found the staff kind. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. 20 service users, 6 staff and 2 visitors were spoken to. What the service does well: The standard of wound care planning is detailed and thorough to support the healing of wounds and comfort of individuals. The home has a robust recruitment and induction procedures that protects service users from the risk of abuse. Service users benefit from a kindly and respectful team of staff. The Registered Manager ensures that there are appropriate numbers of staff on duty to meet service users’ needs. Newly appointed staff are provided with thorough Induction Training. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5 (standard 6 does not apply). The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. The home is able to meet the assessed nursing needs of current service users. EVIDENCE: The home has agreed to send a copy of their Statement of Purpose to the CSCI. Comment will be made in the next inspection report. The fee range is £470 - £650 per week. Additional charges are made for hairdressing, chiropody and personal items. Rotas examined confirmed that the required numbers of Registered Nurses are on duty at all times. The home has been suitably adapted for its purpose. The manager or deputy will assess all service users prior to moving in and a copy of this assessment were examined in the care records. A copy of the Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 9 Single Assessment Process is also obtained. Service users/families are encouraged to visit the home before they make a decision. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10. Information recorded in some care plans is in need of further detail to ensure that all service user needs are consistently addressed. Personal support is offered in such a way as to maintain the privacy and dignity of service users. Medication management has improved and arrangements are now in place to ensure service user medication needs are met. Storage arrangements are not satisfactory. EVIDENCE: 8 care plans were sampled to track care and support. The home is using the SHARP system of care planning that includes comprehensive assessment, planning and review documentation. The care plans examined addressed range of assessed needs for individuals. Wound care plans were particularly detailed enabling nursing staff to monitor the progress of a wound and take appropriate action. Inspectors commend this improvement. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 11 Care plans addressed the physical needs of service users, including nutrition, but did not detail sufficiently the support required for behavioural, social and psychological needs in the service user plans examined. Specific behaviours should be clearly and objectively described and a plan developed to support the service user and give staff clear directions to follow. A number of people were nursed in bed throughout all or part of the inspection. A clear rationale must be provided where service users remain in bed during all or part of the day, including how their psychological and social needs are met. Not all plans were consistent with one another, for example, one person’s mobility assessment recorded that they are nursed in bed; daily records indicated that they spend time out of bed. Another indicated a person could not weight bear but there was a pressure mat in the bedroom. Social care plans need to be developed that reflect the interests, preferences and needs of individuals. The plans evidenced that service user/representative consultation takes place occasionally but can be erratic. The manager should establish a system for regular consultation with regard to the care plans agreed with service users and staff. It is recommended that this review take place each month. The records evidenced that other professionals are involved with the service user as required and GPs, district nurse and CPN support the home regularly. Concerns were raised at the last inspection at the standard of nutritional monitoring. There was evidence at this inspection that this has improved and a system of checking implemented. The nurses on duty will check the recording charts at the end of each shift to ensure that they have been completed and that sufficient intake has been achieved. Each person being monitored has their own file that is kept with them throughout the day. Records examined and observations made by inspectors indicated that this aspect of care requires further attention to ensure that all service user nutritional needs are met as indicated in their care plan. A specific example was discussed with the manager during the inspection. Not all food/fluid charts are being totalled at the end of 24 hours, which is part of the monitoring system introduced. One chart recorded only 3 entries over a 24-hour period. Another chart indicated that the person regularly received less than 500mls of fluid per day, this was not consistent with her care plan. None of the charts examined recorded food being offered between 5pm and 9am the next day, this length of time is considered to be too long for older people to go without food and/or fluids. The manager must address this to ensure that service users are offered supper and also snacks where their dietary intake is poor. Fluid intake should meet individual needs over a 24-hour period. The manager Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 12 must review the nutritional provision for service users at risk and ensure that all staff provide for their needs and monitor intake accurately to ensure that appropriate action can be taken. Since the last inspection the Pharmacy Inspector has visited the home to advise on medication management. Inspectors noted significant improvements in this practice. Arrangements are now mostly satisfactory with a small number of areas left to address to comply with safe practice and Royal Pharmaceutical Society guidance. • The temperature of the medicine room is recorded and regularly exceeds 25C. This is not exceeded by more than one or two degrees but requires addressing to maintain the temperature at 25C or below. • Covert administration of medicines should be discussed and agreed with the service user/representative and care manager as well as the GP. • The homely remedies stock must be checked regularly as an error was found. • Medicines must not be left on the open area of the trolley during administration (Lactulose and Movicol). • Internal and external medicines must be stored separately. The inspector saw staff assist service users discreetly and promptly and service users confirmed that this is usually the case. The manager is monitoring how promptly staff answers bells. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 15. Service user lifestyle is flexible and people are supported to get up and go to bed as they wish. Service user’s benefit from identified and personalised bedrooms reflecting their own preferences. Recreational activities are available to those who wish to participate. The arrangements for meeting the social and psychological needs for service users are limited and not suited to all service users. Visitors are made welcome at any time. The home offers a varied menu and taking account of personal preference. EVIDENCE: The manager, staff and service users all confirmed that the evening arrangements in the home had been altered to better meet service user’s needs and wishes. At the last inspection a significant number of service users were in bed by 5.30pm. The manager, with the support of the provider, has reviewed the routines of the home and provided more staff to work in the evenings. At this inspection more people took tea in the dining room and only those people who were nursed in bed were in bed at the end of this inspection. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 14 Service users spoken to, who were able, all confirmed that they can go to bed when they choose. This change in practice is a positive development and one that can be built on to continue to develop a more individualised approach to care. The manager has identified another member of staff who is having dedicated time to develop recreational opportunities for service users, she has not yet started in this role, which is welcomed by inspectors and will be monitored in future inspections. A visiting entertainer was planned for the day of the inspection but unfortunately had to cancel. The activities organiser spent time with those service users who were in the lounge and was kindly and attentive. This provision is in need of review to take account of individual needs and preferences and the appropriateness of the activities for older people. Inspectors observed the TV on at the same time as the CD player and three people with children’s puzzles in front of them. These are the same activities observed at previous inspections and did not appear to be stimulating or interesting the people in the lounge. Service users spoken to had varying experiences of their lifestyle at the home. Some preferred to stay in their room, some enjoyed the trips out and the entertainers and some did not have enough to do. A number of people were less able to voice their views and a clear understanding of their capabilities and previous interests should be developed to enable appropriate occupation and recreation to be provided. Records examined did not indicate that people’s social needs were being addressed with infrequent recording of social activity. The manager needs to review the provision of activities to ensure that they are consistent with the needs and interests of all individuals in the home. Records should be made at least weekly to monitor likes/dislikes and the input provided for people. Visitors spoken to all confirmed that they are free to visit at anytime and are always made to feel welcome. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 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 standard(s) 16, 18. Service users are able to make their complaints known. The recruitment and training procedures carried out ensure that people are protected from the risk of harm or abuse. EVIDENCE: The home’s complaints procedure is displayed in the home. No complaints have been received since the last inspection. The manager also maintains a record of ‘Relative’s Concerns’ and any action taken. Recruitment records examined confirmed that all pre-employment checks are carried out as required. The home has appropriate policies for the protection of vulnerable adults. Staff spoken to were aware of what action to take should they suspect abuse and abuse awareness is part of the induction programme. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 23, 24, 25, 26. The standard of accommodation has improved with evidence that maintenance and housekeeping improvements are being addressed. Bedrooms are homely and are personalised according to individual preferences. The home does not have sufficient accessible toilets near to communal areas. Most areas are suitably clean, with improvements required in the kitchen. EVIDENCE: Service users are accommodated mostly in single bedrooms, some of which have been redecorated and refurbished. The home has 2 lounges and a dining room. These areas have been made homely and been redecorated recently, some furniture has been renewed and some chairs are in need of renewal. A tour of the premises confirmed that arrangements have been made to guard the skirting level heating system to ensure that scalding risks are minimised. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 17 The home has appointed a maintenance person since the last inspection, which should enable a more immediate response to maintenance problems as they occur and help with the refurbishment. A storage shed has been constructed and service user rooms and communal areas were less cluttered and more organised and homely. The ‘drafty’ windows found to be contributing to cold areas in the home are being insulated. The manager confirmed that the refurbishment still needed in a number of areas to improve the general décor for service users would continue. This will be monitored through inspections to ensure that standards continue to improve. The proprietor is continuing the redecoration and re-carpeting of bedrooms, some furniture has been renewed. The refurbished rooms were pleasant and homely. When this work is complete it is anticipated that the required standards will be met. The standard of cleanliness was generally satisfactory throughout the home and all chemicals are now stored safely. Inspectors identified a number of priority areas to be addressed, which included: • Inspecting the Parker baths which appeared to be leaking. • Renewal of the damaged flooring in the downstairs bathroom. • Fixing the showerhead to the wall in the downstairs bathroom. • Repainting or resurfacing of the peeling paint in the downstairs sluice room to reduce the risk of harbouring infection. • More thorough cleaning in some areas of the kitchen. The downstairs bathroom does not have a toilet, which may not suit all service users, as there is not a wheelchair accessible toilet near the lounge/dining room. It was reported at a previous inspection that an architect is being consulted regarding the provision of an accessible toilet nearer the main lounge but no plans have yet been confirmed. The proprietor is considering ways to achieve this and Mr Aukett informed inspectors during the inspection that he felt this could be achieved and he would take action after the inspection. It is strongly recommended that this toilet be provided. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. The home has sufficient numbers of suitably experienced staff on duty to meet service user needs. Staff recruitment and induction is thorough and protects service users. Access to NVQ training is inadequate and does not promote a trained and competent workforce. EVIDENCE: Staffing levels have been reviewed since the last inspection. Rotas examined confirmed that the previous Somerset Health Authority requirements are now being adhered to. These requirements are used as guidance to assess minimum staffing levels. A number of agency staff are employed, particularly at weekends. One nurse continues to work in excess of 55 hours a week; the manager should keep this under review to ensure adequate time to rest. 2 Registered nurses are on duty 24 hours a day in addition to care staff. The kitchen, laundry and cleaning duties are separately staffed 7 days a week. The home employs 2 part time activities organisers, covering late afternoons/evenings each day of the week. The staff do not have access to NVQ training in Care, 3 are undertaking NVQ2 but no further training has been organised. The deputy manager stated that this was due to problems with funding and identifying a training provider. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 19 Contact details for advice were supplied after the inspection. The home currently has one care assistant with an NVQ in care, which is 4 of the care staff. The home will not meet the standard of 50 by the end of 2005. Provision of this training will contribute to a competent workforce and recruitment and retention of staff. The provider is required to submit a training plan to CSCI, including timescales and funding arrangements, to identify how this training will be provided. Nine staff recruitment records were examined. All contained evidence of satisfactory pre-employment checks (see Complaints and Protection) and interview information. The manager should ensure that all information listed in Schedule 2 is maintained in each staff file. The deputy manager has training responsibility and maintains individual training records for staff. A number of nurses have accessed free courses at a local college in Safe Handling of Medicines and Effective Personal Development. There is no identified budget for training based on training needs, although appraisal has been introduced to identify individual’s needs for nurses. It is recommended that a training plan for the home to be developed, alongside the NVQ plan. This will identify individual and service training needs that can then be implemented in a systematic way and also be of use if the home intends approaching external organisations for help with funding. There is a competence-based approach to induction, which would probably meet Skills for Care requirements. New staff spoken to confirmed that they are following this induction programme and felt well supported. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 38. The Registered Manager is experienced in providing care to older people but requires additional training and support to develop her management skills. The clinical leadership of the home would benefit from more direct and structured leadership to support the clinical practice throughout the home. Appropriate measures have been taken to promote health and safety within the home. EVIDENCE: The Registered Manager, Mrs Jackie Gingell, is a qualified and experienced nurse, having managed Horton Cross for a number of years. At the last inspection the manager was required to take a more pro-active approach to problem-solving and meeting regulatory requirements. Evidence was available at this inspection that this is been addressed and the provider has also Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 21 provided Mrs Gingell with management support and advice through John Aukett. Mrs Gingell attends regular update training days and has recently completed the NVQ Assessor course. Inspectors are concerned, however, that she has not yet registered to undertake the Registered Manager’s Award, which should be completed by the end of 2005. It is required that Mrs Gingell registers to undertake this qualification, or similar, that will enable her to develop her management skills and knowledge, which will also contribute to the effective management of the home. The manager is well thought of by staff, service users and visitors and considered open and approachable. Mrs Gingell has an open door policy. Staff feedback indicated that staff meetings can be irregular and the last one was about March 2005. However they now feel more involved in changes and the promotion of 24-hour care. Mr David Aukett has been supporting the development of management systems in the home on behalf of the provider. He has also been conducting the Regulation 26 Registered Provider visits. These visits do not include consultation with service users and Mr Aukett has agreed to address this to comply with the regulation and ensure that service views are known and can be acted upon. This will be monitored at the next inspection, along with the development of quality audit systems and service user feedback. Records for managing personal monies were examined and found to be satisfactory. The home does not manage the finances for any service users. A formal staff supervision system has been introduced for nurses. All nurses have received an annual appraisal. Training in clinical supervision has been provided and the facilitator will visit each month to support the introduction of supervision. One nurse spoken to confirmed that she has found this useful in reflecting on and improving her practice. This is to be cascaded to all care staff. This reflective supervision could be supported by the development of the deputy manager’s role to provide a more ‘hands-on’ clinical lead. This will enable the areas identified such as food and fluid management, care planning and meeting psychological and social care needs to be pro-actively addressed. A tour of the premises was made and all areas seen were free from hazards. The manager has made arrangements to ensure that all unguarded hot surfaces will be guarded by the time the heating is switched on. All staff have received recent fire training. Accidents are recorded and the manager makes an analysis of them using a graph. This should now be developed to plan and document any actions taken as a result of this analysis. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 22 A range of records was examined and demonstrated satisfactory checks are carried out, these included: • Fire equipment and systems. • Electrical testing. • Bath Hot Water temperatures. • Hoists, baths and the lift. • Bed rails. • Clinical Waste. • Wheelchairs. • Monthly Health and Safety Audit last completed 18 July 2005. Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 2 x 3 2 3 2 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 2 3 2 x 3 2 x 3 Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 24 Are there any outstanding requirements from the last inspection? No 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 7 Regulation 15(1) 12(1)(a) Requirement Timescale for action 30.10.05 2. 8 12(1)(a) 3. 9 13(2) Care plans must be reviewed to ensure that, where appropriate the following detail is included; - A clear rationale must be provided where service users remain in bed during all or part of the day, including how their psychological and social needs are met. - Social care plans must be developed that reflect the interests, preferences and needs of individuals. The manager must review the 30.9.05 nutritional provision for service users at risk and ensure that all staff provide for their needs and monitor intake accurately to ensure that appropriate action can be taken. The following medication 30.9.05 management arrangements must be addressed: - The temperature of the medicines room must be maintained at 25C or below at all times. - Covert administration of medicines must be discussed and agreed with the service user/representative and care Version 1.40 Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Page 25 manager as well as the GP. - The homely remedies stock must be checked regularly. - Medicines must not be left on the open area of the trolley during administration. - Internal and external medicines must be stored separately. 4. 12 16(2)(m) The manager must review, in 31.12.05 consultation with service users, the provision of activities, to ensure that they are consistent with the needs and interests of all individuals in the home. The following areas of 31.12.05 maintenance and cleaning must be addressed as priorities: - The Parker baths must be checked to identify any leaks and repair where necessary. - Renewal/repair of the damaged flooring in the downstairs bathroom. - Fixing of the showerhead to the wall in the downstairs bathroom. - Repainting or resurfacing the peeling paint in the downstairs sluice room to reduce the risk of harbouring infection. - More through cleaning in some areas of the kitchen. The provider is required to 30.10.05 submit a training plan to CSCI, including timescales and funding arrangements, to identify how NVQ training will be provided for care staff. Mrs Gingell is required to register 31.12.05 to undertake the Registered Managers Award qualification, or equivalent. The provider visits must include 30.9.05 consultation with service users. 5. 19, 24, 26 23(2)(b) 6. 30 18(1)(c) 7. 31 9(2)(b)(i) 8. 33 26 Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 26 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 Good Practice Recommendations The manager should establish a system for regular consultation with regard to the care plans agreed with service users and staff. It is recommended that this review takes place each month. Records of social opportunities should be made at least weekly to monitor likes/dislikes and the input provided for individuals. It is strongly recommended that a wheelchair accessible toilet be provided close to the lounge/dining room. It is recommended that a training plan for the home be developed to assist with funding applications, provider budget planning and systematic training implementation. It is recommended that the role of the deputy manager could be developed to provide a more direct and hands on clinical lead and supervsion for nurses and care staff. The accident analysis should be developed to plan and document any actions taken as a result of this analysis. 2. 3. 4. 5. 6. 12 21 30 36 38 Horton Cross Nursing Home D53 - D02 S57288 Horton Cross V235228 160805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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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