CARE HOMES FOR OLDER PEOPLE
Horton Cross Nursing Home Horton Cross Ilminster Somerset TA19 9PT Lead Inspector
Gail Richardson Unannounced Inspection 25th January 2007 09:30 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.V321251.R01.S.doc Version 5.2 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.V321251.R01.S.doc Version 5.2 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.V321251.R01.S.doc Version 5.2 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. 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. 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. The current fee scale is £487 to £685. Extra charges are made for hairdressing, newspapers and magazines and private chiropody. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned annual programme of inspections. This was an unannounced inspection, which took place over 1 day by 2 inspectors Gail Richardson and Sally Murphy and lasted 8 hours (16 inspection hours). Prior to the inspection the home completed a CSCI pre-inspection questionnaire about service provision, staffing, resident admissions, complaints procedures, meal times and arrangements made for community health care support for residents. Comment cards about the service were also received at the CSCI from residents, relatives and visitors, staff and visiting health professionals following the inspection visit. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 40 service users currently residing at the home. The inspector’s spoke to 8 service users, 3 visitors and 6 members of staff, the Registered Manager was available throughout the inspection. Records relating to care, staff and health and safety were examined. Time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and spoke to them at all times with support and reassurance. Service users appeared comfortable, settled and well cared for. Visitors both on the day of inspection and through surveys received , indicated that they were always made welcome. The inspectors would like to thank the service users, staff and visitors for their time and co-operation through out the inspection. The inspectors noted that considerable improvements to the care practices within the home had taken place .The support systems implemented by the Manager and Deputy Manager to ensure continued development of these systems were evident. Staff appeared supportive of these changes. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Care plan records had improved in content and consistency to ensure staff were given the information required to provide the appropriate care. Daily records reflected the care plan and were supported by well documented and clear food / fluid charts and evidence of changes of position when planned. All prescribed creams, with one exception, are now stored safely in en-suite bathrooms and were clearly named and dated when opened. The manager has addressed mealtimes and service users know what is on the menu and are served individually to ensure choice. Seating has been altered to become more central so early seating is no longer an issue and appropriate clothing protection is provided. Dietary supplements are now administered as prescribed and recorded when taken. Stocks were evident and systems for checking if they had been administered were in place. The medication trolley now has lockable sides to ensure medicines are stored securely during medication rounds. Medication stocks were adequate and whilst very few gaps were seen in the Medication Administration Records ,evidence was available of continual monitoring to ensure all medications were administered as prescribed. All hand transcribed medications are now signed by 2 staff members. A cooling unit and a new suction machine have been purchased for the treatment room The complaints procedure now contains the correct CSCI contact details.
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 7 Bedrails were risk assessed and appeared to be well fitted and checked monthly.12 new sets of bedrails have been purchased, 3 new beds have been purchased and 2 sets of new bedroom furniture have also been purchased. A hoist has been fitted to the downstairs toilet to enable service users to access a toilet from the lounge/dining room. The home have further purchased a digital weighing scale which can be attached to this hoist to enable service users to be weighed accurately and in more comfort. The storage of cleaning solutions, with one exception, was now secure and did not put service users at risk. Kitchen fridge temperatures are now correct and recorded. There has been a new freezer and a new dishwasher purchased and new storage in the kitchen store room has been provided. Hot water temperatures are being routinely checked and recorded. The manager is prioritising the fitting of thermostatic valve controllers in the service users en-suite with the highest risk of injury fitted first. A rate of 5 valves per month was confirmed by the manager. All chairs in the lounge appeared in good condition and recliners were in working order. There appeared to be enough seating for service users who use the lounge and the fish tank is now repaired and running. The front hallway has been redecorated and is a welcoming area for service users and visitors. Contracts now contain all details required to provide service users with the detail they need to make an informed decision about the home. All grade 2 and above pressure sores are now reported to CSCI under Regulation 37 scope of notification. The upstairs bathroom has been refurbished to a good standard to provide suitable and appropriate bathing facilities. The standard of hygiene within the home has improved and the carpets appeared clean. All accidents are now audited monthly and indicate trends and areas of highest incidence. Flip top bins and lockable storage in each en-suite bathroom are now evident throughout the home to prevent risk of cross infection. The outside areas have been fenced to ensure a safe area for service users and reduce the risk of falls and injury. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 8 The administrator was able to give the inspector an inventory of items purchased for the home which includes further items not listed above. What they could do better: Risk assessments are recommended for service users who have dental cleaning tablets stored in their en-suite facilities. This is to reduce any risk of injury to service users from ingestion. One en-suite was noted to contain 2 open dressings and various prescribed creams and lotions without clear indication of which to use, this bathroom also contained a cleaning solution and the sink area required re-sealing to prevent the risk of cross infection. The manager confirmed that after inspection this repair was undertaken and cleaning solution removed. Some carpets are in need of repair to prevent the risk of trips and falls to service users and staff. Further decoration of the home, with particular reference to the upstairs corridor is required to ensure the home is maintained in a clean and reasonably decorated manner. Emergency lighting is recommended to be checked monthly and a record of these checks kept. The home is currently having a problem with the heating system, the administrator confirmed that quotes for repair/replacement have been received but the general manager has yet to reach a final decision. Until that time the manager has purchased individual heaters for bedrooms and the temperature of the home appeared comfortable at inspection. The manager is recommended to continue to monitor the temperature of the home to ensure suitable heating is provided during any cold weather, One heater being used was noted to be very hot and may create a risk of injury to service users. The manager was advised of the urgency to remedy this situation. The storage of unlabelled solutions in the upstairs kitchen poses a risk of inappropriate use for service users and staff, this was discussed with the manager at the time of inspection. Controlled medications are required to be stored correctly in the controlled drug section of the drug cupboard. Some blood bottles were noted to be out of date for use and may pose a risk to service users. The policy for staff outlining the types and actions to be taken if abuse is seen within the home requires further detail to contain all types of abuse and making reference to the whistle blowing policy. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 9 The application form for staff is required to contain a section for staff to complete a full employment history to enable the manager to identify any employment gaps and investigate and record any reasons for them. The manager confirmed following inspection that the application form has been updated as required. The manager is recommended to monitor service users dependency levels to ensure that staffing levels are appropriate to those needs. The manager is also recommended to ensure that staff working a night shift who then wish to return to do the late shift the following day have a period of 11 hours break between shifts. Following comments received from service users, the manager is recommended to further develop the service users preferences in the choice of menu. Regulation 26 visits have been maintained by the general manager and were accessed at inspection. These reports have not been forwarded to CSCI since September 2006 and are required to be forwarded monthly. 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. The summary of this inspection report can be made available in other formats on request. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 10 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.V321251.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. The home provides prospective service users with the information they require to make an informed choice about the home. The homes contracts contain all the required information. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which is made available to service users, prospective service users and their representatives. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 12 Prior to admission service users and their representatives have the opportunity to visit the home to view prospective rooms and communal areas. Comments received from service users surveys included; “My daughter had the information and made the decision” and “The care manager came to see me also I viewed Horton Cross” a further comment received was “I had a long talk with Matron, visited the home-looked at all facilities, I was allowed to visit several times before mother arrived to put personal belongings in room “. Each service user had received a pre-admission visit by the Manager or a representative from the home, their needs were assessed and documented. Further assessments from other health care professionals are received. Contracts were examined and were found to contain all the correct details Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans give information to enable staff to meet residents’ health and social care needs. The management of medicines in the home was found to be improved in most areas. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. EVIDENCE: Six care plans were examined, inspectors case tracked these service users care from pre-admission , care planning, involvement of other care professionals, observation of care and included other issues such as complaints and accident reports. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 14 Care plans had improved since the last inspection and were able to provide staff with clear direction in all areas of assessed need. Input from visiting health professionals and service users representatives was evident. Comments received by visiting health professionals were variable and were fed back to the manager at inspection. The home now has a system of recording prescribed creams applied, in the service users care plans. This was noted to have significant gaps and the manager must ensure that all prescribed creams are administered as prescribed and recorded accurately. Wound care plans continue to be of a good standard and the home informs CSCI under regulation 37 scope of notification of all wounds grade 2 and above. A care plan was examined of a service user who had recently died. The plan of care had been regularly updated to meet the changing needs of the service user and all care given had been documented and involvement of the family was evident. All service users and relatives spoken to, were happy to comment on the kindness and caring attitude of the staff. One comment received from a service user was “I am really happy at Horton Cross” another stated “The staff are nice” and a further service user confirmed “ Staff are kind “ However, one comment received on a service users survey was “I do not communicate with the night staff very well,” Surveys received confirmed that 3 relatives/visitors were happy with the care provided and one commented “not completely” Service user surveys noted , when asked if staff listen and act on what you say responded 4-always, 1-usually. When asked if they receive the care and support they need, 2-always, 1-usually. The inspectors saw staff deal with service users discreetly and promptly. On the day of inspection call bells appeared to be answered within reasonable timescales .However, three comments received stated that staff were sometimes slow to answer bells, two of these comments went on to explain that this can cause distress to the service users. Medication systems were mostly satisfactory. The storage of controlled medications must be addressed and was discussed with the manager at inspection. The storage of prescribed creams had improved and all creams are now clearly named and dated when opened and stored in lockable storage in the service users en-suite bathroom. Only one en-suite was seen to contain inappropriately stored creams which were not all named and dated when opened, following the inspection the manager has confirmed that this situation has been rectified.
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 15 The inspectors noted that one oxygen cylinder was stored incorrectly and the manager confirmed that this was moved to secure storage shortly after inspection. The manager is advised to ensure that all vacutainer blood bottles are checked routinely as some were noted to have expired. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are given the opportunity to take part in a variety of activities both within the home and in the community , these are arranged by designated staff after consulting with residents to promote personal preference. Service users are supported to maintain contact with friends and families and visitors are always made welcome. Service users are able to exercise choice and control over their lives, Service users rooms are decorated to reflect their own choices and lifestyles. The mealtime provision has improved, however, further choice and presentation require improvement EVIDENCE: The home has recruited a designated activity organiser. This staff member had reviewed and updated social care assessments on each service user and has implemented a programme of activities. A notice board is available in the front hall listing planned trips.
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 17 This staff member spends each morning visiting each service user individually to discuss the menu choice and selection for the day. A mobile shop is also taken around the home once each week. Group activities are undertaken but the activity co-ordinator explained that these activities depend on service users ability, the activity organiser confirmed that external entertainment takes place every 2 weeks. One musical entertainer works with the activity co-ordinator to tailor the musical preferences of the service users to the entertainment provided. Twice a week videos are played in the lounge and four service users recently went to the theatre for an evening out. Planning for activities is made one month in advance and is recorded in both the service users care plan and the activity co-ordinator plans to record separately for her records to ensure that changing needs are identified and reflected in changes of activities provided. Further activities include, weekly hairdresser, visiting local clergy and manicures. One survey received stated “. I like the entertainment we have in “ and another confirmed that “I do come along to musical events, but I also like spending time in my room watching television and videos”. On the day of inspection there were no activities planned. Service users were seated in the lounge, some in wheelchairs and some in armchairs. The manager confirmed that this was through personal choice. The TV was switched on and some service users appeared to be watching whilst some were reading. One service user was noted to be positioned in front of the TV with their back to it. The dining tables have been rearranged to have a dining table in the centre of the lounge. Some service users had lunch there and some had lunch in the dining room. In the afternoon a family birthday celebration took place in the dining room. Some service users remained at the lounge dining table in wheelchairs for the afternoon, the manager confirmed that this was at the service users own choice. Visitors confirmed that they are always made welcome at any time and visitors can stay for lunch for a small charge. The inspectors visited a random selection of rooms and service users bedrooms seen contained personal items and were suitably decorated to reflect the service users tastes and lifestyles. The inspectors viewed morning coffee and lunch. Care plans indicated that some service users required nutritional supplements and these had been prescribed by the GP, staff were seen assisting service users with these supplements and then recording the intake on the fluid/food charts as
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 18 required. A system is in place for the kitchen to alert staff should food/fluids return to the kitchen not taken. Stock levels of dietary supplements were seen to have acceptable levels of stock. The choice for lunch on the day of inspection was braised beef or chicken casserole with mashed potato/rice, leeks, mixed vegetables or brussel sprouts. Desert was a choice of semolina with jam or spotted dick and custard. Menus were available on the dining tables and service users confirmed that they knew what was for lunch. Vegetables are now served in separate serving dishes and service users are encouraged to make their own selection. Specialised diets are available and puree diet is served individually. The lunch was served hot and staff delivered meals to rooms of service users who chose to eat there. Inspectors observed that service users had plate guards and clothing protection as required and the staff assisted in an appropriate and discreet manner. One service users commented that the food was “reasonable but nothing to look forward to”. One survey comment received stated “I would prefer more traditional foods i.e. casseroles, rather than pasta and curry dishes.” The inspector noted that one of the vegetable choices appeared over cooked one service user confirmed that “food needs to be better cooked” When surveyed if the service users liked the food; 2-always and 2-usually. The kitchen was observed, all food was dated and covered and the kitchen appeared clean to an acceptable standard. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that enables action to be taken. The homes recruitment procedures protect service users from the potential risk of harm or abuse. The policy regarding abuse requires further information to ensure staff are aware of all kinds of abuse. EVIDENCE: The complaints procedure is displayed in the home. The home has received two complaints since the last inspection. One issue has been investigated and an outcome reached within an appropriate timescale the second issue remains ongoing. Service users spoken to stated that they would be comfortable to raise any concerns with a member of staff or the manager. Service user surveys indicated that service user would know how to make a complaint, 3-always. When asked if they would know who to make a complaint to if they were not happy 3-always, 1-usually. 4 relatives / visitors stated that they were aware of the homes complaints procedure. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 20 All staff are checked against the Protection Of Vulnerable Adults (POVA) register before commencing work and all undergo an enhanced Criminal Records Bureau (CRB) check, 3 staff files examined confirmed this. 5 staff surveys confirmed that they were aware of the policies in place for the protection of vulnerable adults and the reporting of concerns about poor care and allegations of abuse. However, the policy regarding abuse does not contain sufficient information to provide staff with information about the range of abuse to include financial and emotional abuse, the signs for staff to be aware of and does not make reference to the whistle-blowing policy. This policy is required to be amended. The manager confirmed at the previous key inspection that all of the service users are registered to vote. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the environment of the home have improved and service users now benefit from an attractive front hallway. The home has purchased a variety of new equipment for areas throughout the home to improve the environment and lifestyle for service users. The standard of hygiene within the home is adequate. Bathrooms are provided in sufficient numbers for the amount of service users living in the home. EVIDENCE: Service users are accommodated in mostly single rooms, with the majority of rooms having en-suite bathrooms.
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 22 There is an on-going maintenance programme and inspectors noted a recent chance in maintenance staff may be reflected in the routine maintenance of the home. The administrator was able to give the inspector an inventory of items purchased for the home since the last key inspection, which includes further items not listed in the body of this report. However some items include; A cooling unit and a new suction machine have been purchased for the treatment room 12 new sets of bedrails have been purchased, 3 new beds have been purchased and 2 sets of new bedroom furniture have also been purchased. A hoist has been fitted to the downstairs toilet to enable service users to access a toilet from the lounge/dining room. The home have further purchased a digital weighing scale which can be attached to this hoist to enable service users to be weighed accurately and in more comfort. There has been a new freezer and a new dishwasher purchased and new storage in the kitchen store room has been provided. The manager is prioritising the fitting of thermostatic valve controllers in the service users en-suite with the highest risk of injury fitted first. A rate of 5 valves per month was confirmed with the manager. There appeared to be enough seating for service users who use the lounge and the fish tank is now repaired and running. The front hallway has been redecorated and is a welcoming area for service users and visitors. The upstairs bathroom has been refurbished to a good standard to provide suitable and appropriate bathing facilities. Flip top bins and lockable storage in each en-suite bathroom are now evident through the home to prevent risk of cross infection. The outside areas have been fenced to ensure a safe area for service users and reduce the risk of falls and injury. It was noted by inspectors that since the previous random inspection in November the upstairs corridor which was being prepared for decoration has not yet been redecorated and appears in need of attention. Furthermore the corridor carpets in some areas of the home are raised and loose due to ongoing work with the heating system of the home. These may pose a risk of trip hazard to service users and staff and are required to be repaired. A comment received from a relative /visitor was “outside –gardens etc, very
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 23 untidy-not a good image” and also “Wheelchairs not as clean a s they should be” Bedrails were risk assessed and appeared to be well fitted and checked monthly. The standard of hygiene within the home has improved and the carpets appeared clean. Service users surveys received said that the home was fresh and clean ; 3-always and 1-usually. The inspectors found that upstairs bathroom drawers contained a selection of items for personal hygiene and one out of date medication, these items had clearly been there some time and were not hygienic. The down stairs bathroom also contained a linen basket which was unclean. The manager confirmed to CSCI that following inspection these items had bee either removed or cleaned. The manager explained that there is an ongoing problem with the heating system which is being addressed. Until a permanent solution is achieved each room is equipped with a fan heater to ensure service users are kept warm. On the day of inspection the temperature of the home was acceptable. One service user survey stated that “My room is now being heated by a small fan heater which does not give enough warmth when the weather is cold.” The manager is recommended to monitor the temperature of the home to ensure adequate heating to all levels of choice. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are managed to ensure they are sufficient to manage the current care needs of residents. Residents have confidence in the staff that care for them. Staff training is ongoing to support staff in the delivery of a high standard of care. The homes recruitment procedures are robust and protect the service user from the risk of abuse. EVIDENCE: The home employs adequate numbers of staff. On the day of inspection there were 2 qualified staff and 8 care staff on duty. Also available was the Registered Manager and the Administrator. There were two cooks, one kitchen assistant, laundry, maintenance and domestic staff also on duty. Comments received following inspection from some service users, relatives and staff indicated that the dependency levels of service users are not always being met. Comments included “The staff do their best but I feel there are often not enough on duty to attend to everyone who needs attention”,
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 25 “I am concerned about the time taken to answer the bell.” And “Residents are becoming more dependant on the care staff, staff feel under too much pressure, I feel we are understaffed for the standard of care we would like to give to our residents.” “Our clients are getting more dependant but I feel that we do not have enough carers. I don’t think we have enough time with our clients”. Relatives/visitors indicated when asked if there were always sufficient staff on duty; 2-yes,2-no. Two comments received referenced the request for more regular bathing to take place. The manager confirmed at inspection that she is currently looking at staff organisation to try to alleviate staffing issues. The inspector noted that on some occasions night staff have returned to work a late shift the same day. The manager is required to ensure that all staff receive a suitable time break between shifts of 11 hours as directed by the Health and Safety Executive. A programme of training is in place and staff will be encouraged to undertake the NVQ2 qualification. The deputy manager confirmed that by March 2007 there is estimated to be above 50 of staff will have successfully completed NVQ training. The deputy manager explained that the home plans to have all staff complete basic food hygiene and first aid certificates. Staff confirmed that they receive induction training. The inspector viewed the recruitment files of the 3 recently appointed members of staff. These gave evidence that the homes application form did not have a space to record previous employment history, therefore, exploration of any unexplained gaps would not be evident and this may place service users at risk. Following inspection the manager supplied the inspector with an updated application form which is now in place at the home and contains all the relevant requirements. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is a Registered General Nurse with previous, varied nursing experience .She works to continuously improve services and provide an increased quality of life for residents and is working hard with her colleagues to improve standards within the home. The storage of the homes records is mostly in accordance with the Data Protection Act 1998. Health and Safety procedures are mostly satisfactory to promote th e health and well being of service users. EVIDENCE: Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 27 The Registered Manager and Deputy Manager have made considerable efforts to improve the management and general running of the home and evidence of those improvements is now being seen within the home. The Registered Manager and Deputy Manager are now both working separately in a more “Hands on “ role, this has proved beneficial for service users and in supporting staff. Further support by the providers, of this management team will be fundamental to ensure this ongoing progress. One staff comment care stated “I have found the matron and assistant care manager very supportive in my role and all equipment and materials to enable me to do my job have been supplied on request.” Regulation 26 visits have been maintained by the general manager and were accessed at inspection. These reports have not been forwarded to CSCI since September 2006 and are required to be forwarded monthly. Files and notes were stored securely with suitable access for staff. Inspectors noted that a staff member had left a written record of handover report of service users on the desk in the front hallway. This contained personal information relating to service users and staff must be reminded of confidentiality. Staff supervision has been developed and supervision forms had been completed,not all staff receive supervision regularly, staff were able to confirm this is the case but the manager confirmed that supervision is ongoing. Accident records were seen to be kept and routinely audited. Quality assurance questionnaires are currently being developed within the home, this standard will be inspected at the next inspection. A range of records were examined and demonstrated that satisfactory maintenance checks are carried out in the areas listed below. PAT Testing was being undertaken on the day of inspection. Electrical Hardwiring reports were forwarded to CSCI Fire Alarm System Nurse Call system Gas system Service Weekly Fire Alarm Tests Weekly bedrail monitoring Hoist servicing Lift Certificate Emergency lighting service Fire Risk Assessment May 2006 Some areas of Health and Safety concern are:
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 28 One temporary radiator in a service users bedroom was very hot to touch and may pose a risk to service users. The manager notified CSCI that this radiator has been removed to a safe area. The manager also confirmed that all new heaters have been dated for PAT checks. The emergency lighting had not been recorded throughout the home on a monthly basis and it is recommended that this should be done. Three bottles of unlabelled solution were found in the upstairs kitchen. The manager confirmed that these would be removed during inspection and later confirmed to CSCI that staff had been reminded of the need for labelling solutions. Carpets in some corridors may present a risk of trips and falls for service users. Risk assessments are recommended for service users who have dental cleaning tablets stored in their en-suite facilities. This is to reduce any risk of injury to service users from ingestion. One en-suite bathroom contained a cleaning solution and the sink area required re-sealing to prevent the risk of cross infection. The manager confirmed that after inspection this repair was undertaken and cleaning solution removed. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X x 3 3 1 Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) The registered person shall make arrangements for the safekeeping and safe administration of medicines in the care home. • • • controlled medication is stored in the correct area of the cupboard The storage of oxygen is required to be made safe and secure. The manager must also ensure that all creams used must be signed for at the appropriate time prescribed and a record maintained by the home. 01/04/07 The manager is required to ensure that the homes policy regarding abuse is updated to contain all types of abuse and the signs for staff to be aware of. 3. OP27 18(1)(a) The manager is required to ensure staffing levels reflect the
Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 31 Requirement Timescale for action 01/04/07 2. OP18 13(6) 01/04/07 dependency of service users needs. The manager is also required to ensure staff have suitable periods of time between shifts. 4. OP38 13(4)(a) The general manager is required to ensure that any carpets which may present a trip hazard to staff and service users are replaced. 5. OP38 13(4)(a) The manager is required to ensure that all solutions are stored safely, This is with particular reference to 3 bottles of unlabeled solution stored in the upstairs kitchen and also includes one cleaning solution found in a service users bathroom. 6. OP38 26(4)(5)( a) 01/04/07 Regulation 26 reports undertaken by the general manager are required to be forwarded to CSCI monthly. 01/04/07 The manager is required to ensure that all temporary heating is checked for temperature to ensure safety for service users 01/04/07 01/04/07 7. OP38 13(4)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 32 No. 1. Refer to Standard OP15 Good Practice Recommendations The manager is recommended to further develop the service users preferences in the choice of menu. 2. OP19 The manager is recommended to continue to monitor the temperature of the home to ensure suitable heating is provided during any cold weather 3. OP38 Risk assessments are recommended for service users who have dental cleaning tablets stored in their en-suite facilities. This is to reduce any risk of injury to service users from ingestion. 4. OP38 The manager is recommended to ensure that emergency lighting is checked monthly Horton Cross Nursing Home DS0000057288.V321251.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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