Inspection on 16/03/06 for Horton Cross Nursing Home

This inspection was carried out on 16th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Horton Cross Nursing Home 25/01/07

Horton Cross Nursing Home 08/06/06

Horton Cross Nursing Home 16/08/05

Horton Cross Nursing Home 24/02/05

Horton Cross Nursing Home 10/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Horton Cross Nursing Home Horton Cross Ilminster Somerset TA19 9PT Lead Inspector Sally Murphy Unannounced Inspection 09:30 16 & 17 March 2006 th th 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 Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Horton Cross Nursing Home Address Horton Cross Ilminster Somerset TA19 9PT 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) 01460 52144 Sentimental Care Ltd Mrs Jacqueline Anne Gingell Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Where rooms are shared, they are occupied by service users who have made a positive choice to share with each other. One named service user, requiring nursing care, may be admitted in the age range 55 - 65 years. 16th August 2005 Date of last inspection 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 DS0000057288.V286113.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part the planned annual programme of inspections. Two inspectors carried out this unannounced inspection over 2 days. The last inspection was announced and took place on 16/08/05. Mrs Jackie Gingell, the Registered Manager and Jeanette Marshall, the Deputy manager were available throughout the inspection. The inspection confirmed that some issues raised at the previous inspection have been addressed, however, there are still areas that need improvement. 38 people are currently living at the home with six rooms available. A tour of the premises was made, care in the home observed and a range of records inspected, including care records. 18 service users, 10 staff and 6 visitors were spoken to. The inspectors would like to thank the Service Users, Staff and Visitors for their time and co-operation during this inspection. What the service does well: What has improved since the last inspection? At the last inspection 8 requirements and 6 recommendations were made. 1 requirement had been fully completed and 2 had been partially addressed. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 6 3 recommendations had been met and 3 recommendations had not been addressed. Some environmental improvements had been made and the standard of hygiene within the home was acceptable. What they could do better: The diet and fluid charts are required to be completed and any action as a result of those totals, implemented. Further attention is required to ensure that all service users receive adequate fluids and that staff are available to assist them to drink as required. *Immediate Requirement made 17/03/06 A signature must be recorded for all medications given or a definition used as appropriate. *Immediate requirement made 17/03/06 Service users are required to receive pressure relief as indicated in their care plans. Service users must be turned appropriately and the charts recorded accurately. *Immediate requirement made 17/03/06. Infection control measures must be planned, implemented, recorded and reviewed, for all service users with MRSA. Appropriate measures must be implemented to prevent the risk of cross infection. *Immediate Requirement made 17/03/06 The carpet in a service users room must be repaired/replaced to remove the risk of trips/falls *Immediate Requirement made 17/03/06 A service user audit is recommended to ensure that the nutritional likes and dislikes, personal preferences and portion size of service users are noted in their care plans and acted upon. It is recommended that a menu be displayed with the day’s choices for service users and visitors to view. Suitable protective clothing is also recommended to protect service users clothing whilst eating. Risk assessments are required for all creams and dental tablets stored in service users en- suite bathrooms and general bathrooms. The care plans are required to include social care planning with particular attention to service users who remain in bed. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 7 Further attention is required when receiving staff references to ensure they match with the employment history given. The whistle blowing policy requires updating to ensure it complies with the Public Disclosures Act 1998. The radiators on the upstairs floor which do not have covers on are required to have risk assessments and appropriate actions taken to reduce the risk of injury to service users. The home is required that service users have access to a wheel chair accessible toilet near the lounge/dining room. Staff are required to be aware of the location and purpose of the Data sheets for all chemicals used in the home. The manager is required to ensure that staff training for NVQ 2 is commenced for up to 50 of care staff employed at the home. The manager is also recommended to commence the Registered Managers Award. The Registered Provider is required to ensure that when his visits are recorded that service users spoken to and their input recorded. Hot water temperatures recorded in the bathrooms require review to ensure that they do not exceed the temperature 44 degrees, stated by the Health and Safety Executive. The upstairs bathroom is in need of repair to enable it’s use and cupboards being stored there must be removed. Service users are required to only receive dressings that are prescribed for them. It is also recommended that CSCI is notified when any wounds are of grade 4 status. Service users finances need to be re-organised so that the sum held for each person is stored separately. The wooden gate preventing access to the upstairs needs to be replaced with a gate made of a more substantial material. It is recommended that the date and time of supervision sessions be recorded, possibly in the supervision file or on the of-duty, to enable inspectors to track back and establish that supervision has taken place 6 times per year. The accident audit must include an action plan to reduce the risk to service users. Emergency lighting records need to include details of which lights have been tested each week. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 8 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 DS0000057288.V286113.R01.S.doc Version 5.1 Page 9 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 Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5. The home has a thorough pre-admission procedure to ensure that they can meet the needs of any service user admitted to the home. Prospective service users and their families are able to visit the home prior to admission. EVIDENCE: The manager or deputy will visit the service user prior to admission and assess the care needs required. Pre-admission assessments were seen within service users plans. A copy of the single Assessment Process is also obtained. One service users’ relative spoken to confirmed that they had visited the home prior to their relative moving into the home. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 11 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. Information recorded in some care plans is incorrect and some areas are in need of more detail to ensure that all service user needs are correctly and consistently addressed. Personal support is offered in such a way as to maintain the privacy and dignity of service users. The recording of medication and storage of creams is not satisfactory. EVIDENCE: Eight care plans were examined. The home is using the SHARP system of care planning which includes assessment, planning and review documentation. The care plans viewed addressed a range of assessed needs for individuals. The needs evidenced did not accurately reflect the care given. The care plan for one service user stated that they could choose a diet and eat independently. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 12 The community care review stated that the service user had been assessed by them, as needing help. This service user was observed by the inspectors needing all help with feeding and was clearly unable to choose their diet or maintain a constant weight. Another care plan indicated that a service user no longer needed insulin, however the service users diabetic care sheet confirmed that insulin was being prescribed. Blood sugar tests were advised in the diabetic care plan weekly, but daily records noted that the GP had asked for the tests to be done daily. Care plans did not give clear direction within the assessments of needs, should the service user be nursed in bed or in a chair. No directions for social care were given for those service users who were nursed in bed. No plan of action was in place for any service users being nursed in bed to meet their personal care or social/recreational needs. Care plans evidenced the need for service users with pressure sores to have a routine change of position on a regular basis throughout the day and this should be recorded on a chart in their room. Inspectors observed over the period of inspection, that these changes of position did not always occur. One chart stated that a service user had had a change of position, however the Inspectors witnessed that no change in position had occurred. One service user was transferred from bed to chair but had no sacral pressure relief throughout the day. *An immediate requirement was made that service users position must be changed and pressure relief obtained, as detailed in their care plans and the appropriate records maintained. This is in line with Regulation 12(1)(a) A further care plan for a service user with MRSA gave no directions to staff regarding the risk of cross infection and did not state that the service user had MRSA. *An immediate requirement was made for appropriate procedures to be implemented to prevent the risk of cross infection from MRSA. This is in line with Regulation 13(3). It is recommended the Registered Manager contact The Health Protection Unit for advice on the management of MRSA. The recording of wound care was very clear and the inspectors commended this. However it was observed that staff were not fully implementing the actions detailed within these plans. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 13 All care plans seen contained bedrail assessments and there was some evidence of care plans being agreed with service users representatives but this was not. There was documentation supporting visits by the GP’s. One service user stated that her care plan had been discussed with her. Concerns raised at previous inspections regarding nutritional monitoring was again observed. Each service user with identified nutritional need is required to have a file with them for the staff to record diet and fluid intake. This was not provided for all service users. Some files recorded that service users had eaten food and drunk which the inspectors observed being removed untouched. For example, one service users chart stated that they eaten a slice of toast but the toast was in her room uneaten until 4pm that day. The chart for a further service user stated that the service user had refused the drink, however the inspectors observed the drink being delivered and removed untouched and no member of staff offering it to the service user. An audit of morning coffee cups dispensed showed that on one floor, 25 cups were given out and 8 were collected an hour later full. Staff confirmed that this level of untouched returned drinks is common. The fluid chards seen indicated not all the totals had been added up but in the instance that where, no action taken with this information. Several of the totals seen were inaccurate and one was totalled zero with no action indicated. *An immediate requirement was made that all food and fluid charts must be completed and reviewed daily and action taken as appropriate, as required by Regulation 12(1)(a)of the Care Standards Act 2001. The management of the medicines is satisfactory in some areas. A Pharmacy Inspection had taken place 07/03/06 and a report is available. The temperature of the medicines room was consistently around 25 degrees and recorded daily. The previous inspection raised issues which have been largely addressed, however there were identified some further areas which require attention. The Medication Administration Records charts for the recording of medication given showed 8 gaps where medication had not been given and no indication given for the omission. *An immediate requirement was issued for a signature to be recorded for all medication given, or a definition used as appropriate. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 14 This is in line with Regulation 13(2) of The Care Standards Act 2001 Risk assessments were not completed for service users who self medicate. Lockable storage was not available in the service users bedrooms for safe storage of medicines for these residents. A bottle of insulin and a bottle of eye drops had not been signed and dated when opened. All wound dressings were stored in the service users individual boxes. A qualified member of staff informed us that one service user was receiving a wound dressing of Inadine, this was not prescribed for them and no record was available of who this wound dressing had originally been prescribed for Several prescribed creams stored in service users en-suite facilities were not dated when opened. One prescribed cream should be stored below 15 degrees and was being stored in a bathroom. Dental tablets were found in several en-suite bathrooms. These pose a risk of harm to service users if ingested. Risk assessments had not been completed in relation to their storage. A service user who was prescribed oxygen was seen on one occasion not receiving and another occasion when the oxygen nasal cannulli was fitted incorrectly and the service user was not receiving any oxygen. The inspectors saw staff deal with the service users discreetly and promptly and service users confirm that this is usually the case. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 15 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. The homes arrangements for meeting the social and psychological needs for the service users are limited and not suited to all service users. Visitors are made welcome at any time. Service users bedrooms are decorated and personalised to reflect their own personalities and lifestyles. The home offers a varied menu but is required to take into account personal preferences. EVIDENCE: The manager confirmed that the home’s activities organiser had left employment and a replacement had not yet been found. She informed the inspectors, that some activities were being organised and a member of staff was seen in the afternoon talking to service users. Activities records did not include details of any recent visitors from entertainers to the home. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 16 Activities and trips were last recorded on 01/12/05. There is no overall plan of activities. Those care plans examined by the Inspectors included social care assessments, which had been updated regularly. There was no evidence that these social activities had taken place. Some service users were nursed in bed. One service users notes stated that the activities organiser spent time with them in their room. The inspectors observed the lounge mid morning and after lunch. The service users were sat in a circle around the edge of the room; there was no call bell available to them and no staff in the room. There were no social or recreational stimulation evident. There was no music or TV and the fish tank on display in the lounge did not contain any fish. An activities organiser was seen in the afternoon talking to one service user. Records examined and evidence seen did not indicate that their social needs were being addressed. 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. Visitors spoken to all confirmed that they were free to visit the home at any time and are always made to feel welcome. The Inspectors viewed breakfast and lunch. Breakfast was served in the service users bedrooms and assistance was given as required with feeding. Care plans indicated that some service users required special diets and dietary supplements and some service users required monitoring of their diet and fluid intake. Service users requiring a record of intake has a folder with them, this includes a Medication Administration Records sheet for the staff to sign to confirm that prescribed dietary supplements had been given. The menu is not displayed. Staff ask each service user on the day which choice of lunch and evening meal they would prefer. The cook then plates the meals and they are delivered on the ground floor rooms. The upper floor has a hot-trolley with the choice of meal, which is served from the upstairs floor. The choice for lunch on the first day of inspection was steak and mushroom pie or lasagne with trifle for dessert. A soft diet was also available and was served pureed separately. A nutritional assessment is available in each service users care plan. The assessed needs, noted in their care plans, do not always correspond with the service users requirements. Service users may eat in the dining room or in their own bedrooms. Staff were seen assisting service users to eat in both areas and did so discreetly and appropriately. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 17 The service users were seen wearing plastic aprons to protect their clothing whilst eating. One service user was seen ripping this apron in an attempt to remove this. It is recommended that the manager purchase suitable aprons for the protection of service users clothing whilst eating. One service user commented that the content and size of portions were often inappropriate. The Inspectors feel that an audit of meal preference is required to correspond with the service users care plan assessment. The kitchen was observed, all food was covered but not all food was dated. Food supplements were stored in the cold store. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18. Service users are able to make their complaints known. The recruitment procedures require further attention to detail to ensure service users are protected from risk of abuse. EVIDENCE: No complaints have been made since the previous inspection. The whistle blowing policy did not contain details of external agencies that may be contacted. The policy stated that “If a complaint cannot be dealt with within the home setting, it will need to be referred to the Health Authority” This does not comply with the Public Disclosures Act 1998. Please see standard 29 regarding staff recruitment practices. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The standard of accommodation is satisfactory and there is evidence that maintenance and housekeeping improvements are being addressed. Bedrooms are decorated to the individual’s tastes and reflects their personalities and lifestyles. The home does not have sufficient accessible toilets near to communal areas. Most areas are suitably clean. The kitchen requires further cleaning. EVIDENCE: Service users are accommodated in mostly single rooms, with the majority of rooms having en-suite toilets. The lounges and dining room are comfortably furnished. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 20 The upstairs bedrooms radiators have not been guarded and it is required that risk assessments are undertaken and appropriate actions taken. *A carpet in one bedroom was noted to be loose and ridged. An immediate requirement was given to repair this carpet as it posed a potential trip hazard to the service user. The rear upstairs stairway has a wooden gate fixed across the top of the stairs to prevent service user access. This gate is insubstantial and would not take the weight of a person leaning against it. The rooms are personalised and reflect the service users tastes and lifestyles. Several rooms have a small patio area outside and these are attractively decorated with pots containing spring flowers and bird tables. One service user explained that if they sat in the chair in their room the call bell would not reach and so could not summon attention. Some rooms have been recently re-decorated, the refurbishment of the home continues but has not yet reached completion and further work is required to meet the required standards. The manager confirmed that there are plans to replace some furniture and a hoist. The manager also confirmed that there is a plan to ensure that enough air mattresses are purchased to ensure one spare one at all times. The previous inspection had identified a need to provide a wheelchair access toilet facility nearer to the lounge/dining room. This has been discussed but no action has yet been taken. The previous inspection also highlighted that the parker bath was leaking and there was damaged flooring in the downstairs bathroom. This has now been repaired and replaced. The showerhead has now been securely fixed in the downstairs bathroom and the sluice room has been suitably refurbished and a keypad lock fitted. The upstairs bathroom is not used as the bath is scratched and in need of repair. Cupboard doors are being stored on top of a cupboard in this bathroom and these need to be removed. The standard of cleanliness was generally satisfactory throughout the home and chemicals were stored safely. However, the inspectors recommend that the kitchen area be thoroughly cleaned. The inspectors viewed the laundry and found the systems in place to be efficient and the laundry staff aware of the risks of cross infection. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 21 All laundry takes place in-house and laundry staff is employed until 2pm each day and then care staff will keep the washing going through until the next day. The manager confirmed that company is planning to lease further washing machines. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. There are adequate numbers of staff employed. The recruitment procedure requires further attention. Domestic staff do not know the location of the data sheets for the chemicals they are using in the home. EVIDENCE: Staffing levels are adequate to meet the needs of the service users. 2 Registered Nurses are on duty each shift and between 4-6 care staff depending upon the shift. All staff employed as care staff are 18 years old and above. Staff under 18 are employed in the Kitchen. An administrator is employed to deal with invoicing. Staff spoken to by the inspectors felt that there were times when staff levels did not allow them the time needed with each service user. This situation was eased when the qualified staff assisted on each floor with the personal care, but this did not always happen. Staff spoken to felt that staff morale was low. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 23 The manager informed the Inspectors that she has requested a further member of staff to help with drinks and activities but this post has not yet been advertised. Recruitment records confirm that all pre-employment checks are carried out as required. Four staff files were seen, 2 did not contain photographs and 1 contained a reference, which did not correspond with the staff members’ employment history. All staff had undergone POVA and CRB checks and all files contained 2 references. On the day of inspection staff training was taking place for the Safeguarding of Vulnerable Adults. Previous training had taken place for Manual Handling and Fire Safety. All staff employed had completed Induction training. New staff were seen on the day of inspection undertaking Induction training. The manager confirmed that less than 50 of staff have completed NVQ 2. 4 staff out of a total of 30 have an NVQ 2 qualification. Some domestic staff have an NVQ 1. Following recent recruitment it is planned for more staff to undertake NVQ training. Domestic staff spoken to by Inspectors were unable to locate the Data sheets containing the information for use of cleaning chemicals used in the home. If accidental spillage or ingestion occurred staff are required to access the Data sheets for advice and directions. External training days are open to staff but they are require to fund these days themselves. No evidence was seen in the staff files of performance review. The inspectors feel that this review would enable management to identify and discuss areas such as food and fluid management, pressure relief management and meeting psychological and social care needs, with each staff member individually. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 24 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, 35, 36, 37 & 38. The Registered Manager is supernumerary to the staff team. The home must take further action to ensure that the management of service users finances follows best practice. A staff supervision policy is in place but requires further development. The storage of the homes records is in accordance with the Data Protection Act 1998. The health and safety procedures are mostly satisfactory. EVIDENCE: Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 25 The Registered Manager, Mrs Jackie Gingell, is a qualified and experienced nurse and has managed Horton Cross for a number of years. Previous inspections have required Mrs Gingell to take a more pro-active approach to problem solving and meeting regulatory requirements. Mrs Gingell explained that her current role as manager involves a large amount of administrative tasks and both herself and the deputy manager approach these tasks together. Service users and staff would benefit from the manager and deputy manager taking a more hands on approach within the home. The Inspectors felt that staff required more direction and input from the management to ensure that a satisfactory standard of care is given. Mrs Gingell has not yet commenced the Registered Managers Award training this has been discussed at previous inspection but has not yet happened. The inspectors feel that this qualification would help Mrs Gingell develop her management skills and contribute to the effective running of the home. Management support has been provided by Regulation 26 visits from Mr John Aukett and recorded evidence of this was seen. It was previously recommended on these visits that Mr Aukett includes service user feedback and detail of the service users spoken to. Records of these visits indicate that this has not happened. The owner Mr Ellis had visited the home 3 weeks prior to the inspection. The financial arrangements of service users money were seen. The recording of all pocket money up to a total of £50.00 was seen. Receipts were given for all purchases and services purchased within the home e.g. Hairdresser, chiropodist etc. The secretary, manager and deputy manager audits the service users money kept in the safe and two signatures were seen on all records. Service users financial records were last audited 01/06/05. It is recommended that Service users finances be re-organised so that the sum held for each person is stored separately. Files and notes were stored securely with access for staff. All financial details were locked away. The Registered Manager confirmed that a formal staff supervision system has been introduced for nurses. Supervision records have been devised but due to their confidential nature these records were not available to the inspectors. It is recommended that the date and time of supervision sessions be recorded, possibly in the supervision file or on the of-duty, to enable inspectors to track back and establish that supervision has taken place 6 times per year. Accident records were seen. An audit had been made of all accidents and a graph made. This highlighted the times of day and areas that accidents happened most frequently however these did not include details of any action Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 26 taken as a result of these findings. It is recommended that an action plan be drawn up as a result of the audit. A tour of the premises was made and all areas seen, some areas of concern are: A carpet causing a trip hazard –Immediate requirement made Radiators on the upstairs floor, needing risk assessments and safety covers Unstable stair gate in need of replacement with more suitable material. It was noted in the hot water temperatures records, that the bathroom water temperature is 48 degrees. The Health and Safety Executive recommends that the hot water temperature for service user areas should not exceed 44 degrees. The first aid box contained medication that was out of date and lancets that were unclean. Records of emergency lighting did not include details of which lights had been tested. It is recommended that a record be kept of which lights have been tested on each occasion. A range of records was examined and demonstrated satisfactory checks are carried out, these included; *Nurse call systems *COSHH *Hot water temperature records *Electrical Hard Wiring Certificate *PAT *Fire systems *Fire checks *Emergency Lighting *Hoist servicing *Lift Servicing *Sit on scales *Wheelchairs *Bedrails Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 2 1 3 2 1 3 STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 2 2 3 1 Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 28 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(1) Requirement Social care plans must be developed that reflect the interests, preferences and needs of the individual. (Previous timescale not met) 2. OP8 12(1)(a) The Registered Manager must review the nutritional provision for service users at risk and ensure that all staff provide for their needs and monitor intake accurately and ensure that appropriate action is taken. (Previous timescale not met) *Immediate requirement made that food and fluid charts must be completed and reviewed daily and action taken as appropriate. 3. OP8 12(1) The Registered Manager is required to ensure that service users receive the pressure relief indicated in their care plans and it is recorded correctly. *Immediate requirement that service users are turned Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 29 Timescale for action 30/06/06 17/03/06 17/03/06 appropriately as detailed in their care plans and recorded appropriately. 4. OP9 13(2) The following medication arrangements must be addressed: *Immediate Requirement A signature must be recorded for all medication given or a definition used as appropriate. -It is required that any dressings required be prescribed for the individual and not used from other service users stock. 5. OP12 16(2)(m) The Registered Manager must 06/05/06 review, in 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. (Previous timescale not met) 6. OP15 15(1) The Registered Manager is required to perform a service user audit of meals with reference to content, variety and portions. The results are to be used to alter menu’s to meet service users preferences. 7. OP18 12(1) The Registered Manager is required to update the Whistle blowing policy ensuring that any referral complies with the Public Disclosures Act 1998. Risk assessment must be completed in relation to unguarded radiators and DS0000057288.V286113.R01.S.doc 17/03/06 06/05/06 06/05/06 8. OP19 13(c) 06/08/06 Horton Cross Nursing Home Version 5.1 Page 30 appropriate actions taken. 9. OP19 13(4)(a) *Immediate Requirement was made for the repair/replacement of carpet in one service users bedroom to remove the risk of trips and falls. The Registered Manager is required to ensure the provision of a wheelchair accessible toilet on the ground floor in close proximity to the dining room and lounge. The Registered Provider is required to submit a training plan to CSCI, including timescales and funding arrangements, to identify how the NVQ training will be provided for staff and when training is to commence. (Previous timescale not met) 12. OP29 19(4)(c) The Registered Manager is 30/05/06 required to ensure that the references received from a prospective employee, match the employment history given. The Registered Provider visits must include consultation with service users. (Previous timescale not met) 14. OP38 13(3) The Registered Manager is required to ensure that all staff is aware of the need for infection control measures when caring for service users with MRSA. *Immediate Requirement for appropriate procedures to be implemented to prevent the Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 31 17/03/06 10. OP21 23(1)(n) 06/08/06 11. OP28 18(1)(c) 30/05/06 13. OP32 24(2) 30/05/06 17/03/06 risk of cross infection from MRSA in line with Regulation 13(3). 15. OP38 13(4)(c) The Registered Manager is required to ensure that the bathroom hot water temperatures do not exceed the required health and safety guidelines. 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP15 OP15 Good Practice Recommendations It is recommended that the manager inform CSCI of all wounds of Grade 4 status. It is recommended that the storage of dental tablets in service users bathrooms be risk assessed. It is recommended that the menu be on display for service users and visitors to view. It is recommended that purpose designed clothing protection be purchased for service users to use at mealtimes. It is strongly recommended that the wooden gate at the top of the stairs be replaced with a more robust and suitable replacement. The upstairs bathroom is in need of the bath being repaired/replaced to enable the bathroom to be used. The storage of cupboards in this bathroom also need removing. It is recommended that the staff supervision be recorded separately to ensure that tracking is possible. Following the audit of accidents an action plan is DS0000057288.V286113.R01.S.doc Version 5.1 Page 32 5. OP19 6. OP21 7. 8. OP36 OP38 Horton Cross Nursing Home recommended to reduce the risk of further accidents. 9. 10. OP38 OP38 Emergency lighting requires a record of which lights have been tested each week. It is recommended the Registered Manager contact The Health Protection Unit for advice on the management of MRSA. Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street 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. Extracts may not be used or reproduced without the express permission of CSCI Horton Cross Nursing Home DS0000057288.V286113.R01.S.doc Version 5.1 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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