Inspection on 08/06/06 for Horton Cross Nursing Home

This inspection was carried out on 8th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Horton Cross Nursing Home 25/01/07

Horton Cross Nursing Home 16/03/06

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 Gail Richardson Unannounced Inspection 8th June 2006 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.V294505.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.V294505.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.V294505.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. 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.V294505.R01.S.doc Version 5.1 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 2 days by 2 inspectors. As part of the inspection process, service user and their representatives, local GP’s, District Nurses and Care Workers opinions were surveyed. On the first day of inspection the CSCI Pharmacist accompanied the inspectors to review medication practices. A tour of the home took place and all the bedrooms and communal areas were seen. There were 35 service users currently residing at the home. The inspector’s spoke to 14 service users, 4 visitors and 7 members of staff, the Registered Manager was available throughout both days of the inspection. The General Manager Mr Aukitt was available on the first day of inspection. Records relating to care, staff, finances and health and safety were examined. The inspectors noted that on both days service users appeared settled and comfortable. 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. Four visitors spoken to, were pleased with the care their relatives were receiving and confirmed that they were always made very welcome to the home at any time. The inspectors would like to thank the service users, staff and visitors for their time and co-operation through out the inspection. The inspectors were aware that both the Registered Manager and the Deputy Manager had made considerable effort since the previous inspection to ensure that care practices improve. The inspection confirmed that some issues raised at the previous inspection have been addressed, however, there are still areas that need improvement. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 6 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. What the service does well: What has improved since the last inspection? The inspectors noted an improvement in the level of care that the service users are receiving. Inspectors evidenced that service users are receiving regular pressure relief and the level of personal care has improved. A audit system has been put in place to monitor the actual food and fluid intake of service users and this information is returned to the Registered Manager. Kitchen staff confirmed that a significant improvement has taken place in the amount of fluid and dietary supplements service users are being assisted with. An audit of service users food preferences has taken place and a new menu has been devised. Implementation of the new menu is proposed very soon. Service users now have suitable clothing protection for use when eating and drinking. All radiators have now been risk assessed and suitably guarded to prevent service users at risk form injury. 20 new sets of bed rails have been purchased. Some maintenance is underway and the garden areas appeared well tended. Service users with MRSA now have a discreet indication system on the bedroom door to ensure staff are aware of any cross infection risks. The Whistle blowing Policy is now updated and correct. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 7 What they could do better: Service user contracts contained incorrect CSCI details and lacked sufficient detail regarding services included in the fees. Further detail is also required to ensure that service users and their relatives are aware of the course of action should the home no longer be able to provide the care needed. Further work is required to ensure that care plans are consistent with the needs required by service users. More detail is required to ensure that service users receive the care they require. Bedrails consents must be signed by the service user or their representative and not a staff member Systems for ordering medication require review to ensure that service users receive the medication and food supplements they are prescribed. *Immediate Requirement Made. The dating and recording of creams stored in service users en-suite bathrooms must be reviewed and further staff training given. Social care provision remains inconsistent but the inspectors are aware that an Activities Organiser has been employed and an audit of social care requirements is to take place. Broken chairs situated in the communal rooms are required to be removed and replaced with appropriate furniture. *Immediate Requirement made. The fridge’s and freezers are required to display the correct temperatures and these temperatures are to be recorded. Foods stored in fridges and freezers must be suitably labelled. *Immediate Requirement Made. The complaints policies both in service users bedrooms and available on request, require updating to contain correct contact information. Further maintenance work is required to ensure that all areas of the home maintain a satisfactory standard including the outside porch. Further equipment is required to provide enough suitable bathrooms for the home. Risk assessment outcomes for bedrails require suitable action to remove the risk of entrapment to service users. *Immediate Requirement Made. The hot water outlets in service users en-suite bathrooms require risk assessment and suitable fitting of thermostatic valve controllers to ensure there is no risk of scalding to service users. *Immediate Requirement Made Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 8 Some areas of the home require further cleaning to ensure a good standard of hygiene. The manager is required to consider the geographical layout of the home when looking a staff deployment particularly with reference to night duty. The Registered Manager must inform CSCI of all wounds of a Grade 2 and above. Under the COSHH Regulations 1988 Service users en-suite bathrooms must not contain bleach and other cleaning solutions *Immediate Requirement Made. The emergency lighting should be tested throughout the home on a monthly basis. 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.V294505.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.V294505.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): 12345 The Registered Manager consults the assessment information to see if they can meet the prospective residents needs before they make the decision to accept the application for admission and offer a placement. The home provides prospective service users with the information they require to make an informed choice about the home. EVIDENCE: The home has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a resident guide, which provides basic information about the service. The guide is made available to residents in a standard format. Evidence suggests that prospective residents have a needs assessment carried out by the Manager before they are admitted to the home. The Manager has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the residents. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 11 Six contracts were examined and were found to have incorrect contact details about CSCI. They also lacked sufficient details of what services were included in the fees and those services incurring additional costs. The contracts also did not state what the course of action would be if the home was no longer unable to provide the care required. Records of pre-admission assessments were seen and relatives confirmed that Matron had visited and assessed the service user and that they had been able to visit the home prior to admission. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 12 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 Each resident has a care plan, but practice of involving residents in the development and review of the plan is variable. The plan in most cases includes the basic information necessary to plan the individuals care and includes a risk assessment element When developing the plan the home has complied where possible with relevant clinical and social care guidelines. The ordering systems of medications and dietary supplements are in need of review and systems put in place to ensure that service users receive the medication and supplements prescribed for them. The management of medication in the care home has the potential to place service users at risk of harm EVIDENCE: Six care plans were examined and each addressed a range of assessed needs for the individual. Evidence of service users representative input in care planning was seen. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 13 Care plans had improved since the last inspection but remained inconsistent in some areas and the assessments did not completely match the assessed needs. One service user had a pressure risk assessment every three months, but was being nursed on an air mattress. This service user had been identified as needing dietary supplements but had not been weighed since March 2006. Wound care plans continue to be of a good standard. However, the inspectors reminded the Manager that any wound of a grade 2 and above must be reported to CSCI as a Regulation 37 notifiable event. This had not taken place. A staff member had signed one bed rail consent. This was discussed with the Registered Manager at the time of inspection and the Manager will investigate this matter. The inspectors spent some time observing the care practice of the staff and felt that there was some improvement on the standard and frequency of care being received by service users. Service users were seen having a change of position regularly and personal care appeared to be improved. The inspectors saw staff deal with service users discreetly and promptly. CSCI Pharmacist Mr Brian Brown inspected the medication systems. Several instances were observed where medication currently prescribed for service users was not available within the home and there was no clear audit trail to indicate when a new supply would be available. For one service user steps were taken during the inspection to obtain a further supply of appropriate pain relief medication. Hand written entries on the Medication Administration Record (MAR) charts, are normally signed by 2 people, although they are often not dated meaning that it is not possible to identify if the entries are correct. Medication is not always stored securely. Medicines are not stored securely within the trolley during the medication round and one of the storage cupboards was found not affixed in accordance with the specific regulations. The homes stock of “Homely Remedies” was found to contain some items that are only available on prescription and others that had been prescribed for an individual and had the label removed. The recording of medicine administration was much improved and there were few gaps in the record. The temperature control of both the ambient and refrigerated medicine storage areas was much improved and within the recommended ranges. The storage of prescribed creams is not satisfactory. Several prescribed creams stored in service users en-suite bathrooms were not dated and signed Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 14 when opened. One service user had an opened dressing ointment stored in the en-suite, this medication was for single use only. Dental tablets were also discovered in one service users en-suite and an unlocked bathroom on the second floor contained 10 tubes of dental tablets, prescribed bladder washouts and a sharps disposal box. The recording of oxygen cylinders was not correct with the cylinders seen. Directions for the use and maintenance of oxygen concentrators were also not available. Horton Cross Nursing Home DS0000057288.V294505.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 15 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 staff after consulting with residents. The home has open visiting arrangements and residents know they can entertain their family and friends in their own room. If they prefer they can use community areas of the home to talk to visitors, although this may not always provide privacy, and can be seen as intrusion by other residents. EVIDENCE: The Registered Manager confirmed that a new Activities Organiser will commence employment in the near future. The organiser intends to review all activities and audit choices of activities by service users. Some activities had been organised and a group of service users had been on a mini bus trip the previous day, this had been very much enjoyed. A notice board is in place in the front hall informing visitors of forthcoming events planned. Social care assessments had been evidenced in the Care Plans and had been updated regularly. a record of activities enjoyed was seen in the care plans but the range of activities was very limited. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 16 There were no activities planned for the service users who remained in bed and currently service users were not aware of any events taking place. Two service users confirmed that they had been out into the local village recently with their families and one service user goes home regularly. Inspectors noted that in the morning a service user was placed in the lounge in a wheelchair and was left without a call bell or means of raising assistance. This service user remained in the wheelchair in the lounge throughout the day. The inspectors observed that after lunch service users sat in a circle in the lounge, one staff member was available and was offering fruit. There was no social or recreational stimulation evident and many of the service users were sleeping. Visitors confirmed that they are always made welcome at any time and one visitor regularly stays for lunch. The inspectors visited all rooms and service users bedrooms contained personal items and were suitably decorated to reflect the service users tastes and lifestyles. The inspectors viewed breakfast and lunch. Breakfast was served in the service users bedrooms and assistance was given as required. This was then recorded as required on the food/fluid charts. Care plans indicated that some service users required nutritional supplements and these had been prescribed by the GP. It was noted that a new system is now in place to record drinks and supplements given and the actual amount of diet and fluids taken. This is a considerable improvement since the previous inspection. There continues to be no indication of action taken within the care plans when food/fluid intake is noted as being poor. A nutritional assessment is available in each service users care plan indicating the need for dietary supplements. However, inspectors noted that the stocks of food supplements varied. Some service users had no stock available whilst other service users had ample stock levels. 14 service users in total are prescribed dietary supplements, 5 of those service users had no stock and one had only 3 supplements left. It was confirmed by staff members and records on the Medication Administration Records that the service users did not always consistently receive the dietary supplements. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 17 *An immediate requirement was made for the home to ensure that service users requiring prescribed food supplements have adequate stock and receive them regularly. This is in line with Regulation 12(1)(a) of the Care Homes Regulations 2001. The Registered Manager confirmed that an audit of meal choices had taken place involving service users and the inspectors saw evidence of this. Planned changes in the menu have not yet taken place but are to be implemented soon. The menu was displayed late morning. Further stocks of cutlery and crockery have been ordered. The choice for lunch on the day of inspection was Meatloaf or Broccoli and Cheese Bake, with sauté potatoes, cabbage and broccoli followed by rice pudding. A further alternative was provided on request. The evening meal planned was Cheese and Potato Pie or Boiled Eggs on Toast. Soft diet is also available and the cook confirmed that specialised diets are also available. It was noted that staff were not always aware of the especial diets for each service user. One staff member offered a resident salt with the lunch when the resident is receiving a low salt diet. The kitchen assistant on duty requests service users meal choice each morning. Service users can choose to eat in the dining room, lounge or bedroom. Staff were observed assisting with eating a drinking in all these areas and did so discreetly and appropriately. Service users now have suitable clothing protection as required when eating. It was observed by the inspectors that several service users were sat at the dining table from 10:55am. The kitchen was observed, several items of food stored in the fridge were not dated and items stored in the freezer in plastic bags were not named or dated. * An immediate requirement was issued to ensure that all food stored in the fridge is dated. This is in line with Regulation 13(4)(c) of the Care Homes Regulation 2001. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 18 Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 The complaints procedure available to service users and staff is out of date and contains incorrect contact details. The recruitment policies and procedures protects service users from abuse. EVIDENCE: No complaints have been made since the previous inspection. The whistle blowing policy has now been updated and details of external agencies are now correct. Two relatives were able confirm that they would be happy to go to Matron with any concerns. The complaints policy available in some service users bedrooms is out of date and contains information relating to the previous owner of the home. The complaints policy available on request also contains incorrect CSCI contact details. Staff recruitment policies and procedures were seen and were all in place to protect service users from abuse. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 20 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 home has an on going maintenance programme, however some areas for example, the hot water system to the en-suite bathrooms requires urgent attention to protect service users. EVIDENCE: Service users are accommodated in mostly single rooms, with the majority of rooms having en-suite bathrooms. There is an on-going maintenance programme. Since the previous inspection; All radiators have been risk assessed and suitable guards fitted. Some work has been undertaken to improve the external aspect of the home and plans are in place to repair the front porch. Work was being undertaken to repair the staff room ceiling at the time of inspection. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 21 Further discussion and estimates received for work to be done to ensure a wheelchair access toilet close to the downstairs lounge area. The upstairs bathroom has been taken out of commission until essential repair/replacement has taken place. This leaves the home with two remaining working bathrooms. The general standard of cleanliness was satisfactory, however, one service users carpet and call bell were very dirty and the same service users dentures were found sat on the side in her room and were very dirty. This was discussed with the Registered manager at the time of inspection. A further en-suite was noted to have a malodour possibly caused by having carpet in the bathroom and one bath located in an en-suite was dirty. Discussions with domestic staff confirmed that were aware of where to access data sheets and were happy with the cleaning materials supplied by the home. Numerous flip top bins around the home were not working correctly. It was noted that there were inadequate seating available within the lounge and conservatory. Five chairs were broken and required removal from the lounge leaving 13 chairs for the remaining residents. *An immediate requirement was made that the home must ensure that the broken armchairs within the communal lounge and conservatory are removed and replaced with appropriate seating This is in line with Regulation 13(4)(c), 23(2)(c) of the Care Homes Regulations 2001 Further dining chairs were available but still had the plastic covering on the seat. This was ripped and hanging off. Specialist equipment was evident including pressure relieving cushions and oxygen concentrators, with the correct signage in place. Wheelchairs seen around the home were noted to be dirty. Two sets of bed rails were noted to have a wide gap at each side thus creating a risk of entrapment. Risk assessments have been completed but no remedial action has yet been taken. *An immediate requirement was issued for the home to ensure that bedrails are suitably fitted to ensure that they do not pose a potential risk of entrapment to service users. This is in line with Regulation 13(4)(c) of the Care Homes Regulations 2001. Hot water outlets located in service users bedrooms were tested and exceeded 60 degrees. Some service users have access to these areas. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 22 Hot water temperature records were available for all bathrooms but not ensuites. *An immediate requirement was issued to monitor and record the hot water outlet temperatures within en-suite bathrooms. Risk assessments are to be completed and appropriate action taken to ensure service users are not at risk of scalding. This is in line with Regulation 13(4)(c) of the Care Homes Regulations 2001. The bedrooms are of a good size and provide ample space for the use of specialised equipment. The rooms are personalised and reflect the service users lifestyle. The patio and garden areas within the inner area of the home were attractively laid out and access to a patio near the dining room was available. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 23 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 Residents are generally satisfied that the care they receive meet their needs, but there are some times when no one is available to immediately help them. They feel that staff is trained and able to deliver their care needs. Staffing rotas try to take into account the times of high and low activity. The Manager recognises the importance of training, and delivers where possible a programme that meets any statutory requirements. There are still some areas which need attention. The service is also able to recognise when additional training is needed, and attempts to plan over time to provide this training. EVIDENCE: The home employs adequate numbers of staff. On the day of inspection there were 2 qualified staff and 6 care staff on duty. Also available was the Registered Manager and the Administrator. There was one cook, two kitchen assistants, laundry and domestic staff also on duty. The General Manager was also visiting on the first day of inspection. Service users spoken to were happy with the care and staff. Comments included “Couldn’t be nicer” and “Staff are very kind”. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 24 Seven staff members spoke to the inspectors. Some staff felt that there had been some improvements recently and other staff members felt that although standards of care were improving that there were still areas of concern. One area highlighted was the numbers of staff on duty at night. Staff considered the geographical layout of the building a contributing risk factor when considering safe staff deployment. Responses received from service user surveys concluded that some relatives feel that there are not always sufficient numbers of staff on duty. Staff training on Moving and Handling was taking place on the first day of inspection. Staff training records indicates that staff have the facility to further their practice by training events organised by the home and are encouraged to do so. A programme of training has been planned and staff will be encouraged to undertake the NVQ2 qualification. The manager confirmed that she has commenced the Registered Managers Award. Staff confirmed that they receive induction training. No new staff have been employed since the previous inspection. Recruitment records were examined for staff members due to commence employment. The appropriate procedures for recruitment were underway but not completed at this time. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 36 37 38 The manager of the home has some management skills, which need further development. The manager is making considerable efforts to implement systems for improvements within the home. The management of service users finances is satisfactory. The storage of the homes records is in accordance with the Data Protection Act 1998. Health and Safety procedures are not satisfactory. EVIDENCE: The Registered Manager and Deputy Manager have made considerable efforts to improve the management and general running of the home. Both feel very positive that these efforts will be rewarding for the service users. However, more work is required to ensure that the standard of care continues to improve and that the service provided reaches the National Minimum Standards. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 26 The Registered Manager is undergoing the Registered Managers Award training. The Registered Manager and Deputy Manager are now both working separately in a more “Hands on “ role, this has proved beneficial. Several aspects of care have been audited and action taken to improve the service provided. Mr Aukitt who assumes the role of General manager has provided management support. Regulation 26 visits have taken place but the report has not yet been received by CSCI. The financial records of service users pocket money stored within the home, were examined and found to be satisfactory. Files and notes were stored securely with suitable access for staff. All financial records were locked away. Staff supervision is ongoing and training is arranged to support the staff in this area. Accident records were seen, one incident involved a service user being injured by a ladder stored in a bathroom. Appropriate notes regarding the safe storage of ladders were available to staff. This was discussed with the Registered Manager at the time of inspection. Accidents continue to be audited but no action plans were available as a result of these audits. A range of records were examined and demonstrated that satisfactory maintenance checks are carried out. These included; PAT Testing was being undertaken on the day of inspection. Electrical Hardwiring was underway on the day of inspection. Fire Alarm System Nurse Call system Gas Boiler Service Fire Alarm Tests Hoist servicing Weigh Scales Servicing Lift Certificate Waste Disposal Service Cert. Some areas of Health and Safety concern are: Inspectors found bleach and other cleaning solutions stored in service users en-suite bathrooms, 10 tubes of dental tablets and prescribed bladder washouts were discovered in the upstairs unlocked bathroom. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 27 * An immediate requirement was issued for the protection of vulnerable service users the home must ensure that all hazardous substances are stored securely and not accessible to service users. In line with Regulation 13(4)(a) of the Care Homes Regulations 2001. Two thermometers located in the freezer room both indicated a different temperature and both appeared to be incorrect. The corridor radiators were still producing heat when the home was already hot due to the weather. The hoist located in Room 48 had no sticker indicating that it had been serviced. Room 44 had a wardrobe, which was not secured firmly to the wall. Hand basin in Room 1 is damaged and requires replacement. The emergency lighting had not been recorded throughout the home on a monthly basis and it is recommended that this should be done. The Hardwiring certificate states it last for one year when the certificate should be valid for 5 years. Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 28 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 1 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 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 1 17 X 18 3 3 3 2 1 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 3 X 3 3 3 1 Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must be further developed in detail to accurately reflect the needs of the individual. Care plans must identify an action plan when an area of risk has been identified. Food and fluid chart outcomes must produce a plan of action. The home is required to ensure that all prescribed creams are dated and signed when opened. The home is required to ensure that service users are not sat at the dining table from midmorning awaiting lunch. The Registered Manager is required to review the ordering procedures for medications and dietary supplement to ensure all service users receive the supplements prescribed for them at the correct frequency. *Immediate Requirement Made The registered person shall make arrangements for the safe keeping of medicines in the care home. This refers to the need to DS0000057288.V294505.R01.S.doc Timescale for action 01/08/06 2. OP7 15(1) 01/08/06 3. 4. OP9 OP15 13(2) 12(2) 01/07/06 01/07/06 5. OP9 13(2) 01/07/06 6. OP9 13(2) 07/08/06 Horton Cross Nursing Home Version 5.1 Page 30 7. OP9 13(2) 8. OP12 16(2)(m) ensure that all cupboards are affixed in accordance with appropriate regulations and also that all medicines are stored securely during the medication round. The registered person shall make 07/07/06 arrangements for the safe administration of medicines in the care home. This refers to the need to ensure that prescribed medication is available to be administered and steps taken to ensure a continuity of supply. The Registered Manager must 01/07/06 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) The Registered Manager is required to update the complaints procedure available to service users to ensure it contains the correct contact details for CSCI. The Complaints policy must also be updated to contain the details of the current owner. The Registered Manager is required to ensure that bed rails are risk assessed and appropriate action taken to prevent the risk of entrapment. *Immediate Requirement made The Registered Provider is required to ensure the provision of a wheelchair accessible toilet on the ground floor in close proximity to the dining room and lounge. ( previous timescale not met) 06/08/06 9. OP16 22(7)(a) 10. OP22 14(1)(d) 01/07/06 11 . OP21 23(1)(n) 06/08/06 Horton Cross Nursing Home DS0000057288.V294505.R01.S.doc Version 5.1 Page 31 12. OP27 18(1)(a) 13. OP31 (24 (1) (a & b) The Registered Manager is required to review staff rotas to ensure adequate staffing levels are available on day and night shift, taking into consideration the layout of the building. The Registered Manager must establish and maintain an effective system for reviewing and improving the quality of care provided at the home. This will include amongst other aspects, the safe management of medication, provision of dietary supplements and social activities. 01/08/06 01/07/06 14. OP38 13(3)(a) 15. OP38 13(3) 16. OP38 13(3) 17. OP38 13(4)(c) The Registered Manager is required to ensure correct storage of all cleaning solutions. *Immediate Requirement made The Registered Manager is required to ensure that food stored is correctly dated. *Immediate Requirement Made The Registered Manager is required to ensure that the fridge temperatures are monitored and recorded correctly The Registered Manager is required to ensure that the ensuite hot water temperatures do not exceed the required health and safety guidelines. *Immediate Requirement Made The home is required to remove all broken chairs from the communal areas and the Registered Provider is required to provide appropriate replacements *Immediate Requirement Made DS0000057288.V294505.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 18. OP38 12(1)(a) 01/07/06 Horton Cross Nursing Home Version 5.1 Page 32 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 OP2 OP7 OP9 OP9 Good Practice Recommendations It is recommended that the home review the contractual details to include additional costs and action taken if suitable care cannot be provided and correct CSCI details. It is recommended that the manager inform CSCI of all wounds of Grade 2 status and above. It is recommended that the storage of dental tablets in service users bathrooms be risk assessed. It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. It is recommended that an audit of activities takes place and a plan of activities to suit service users requests be implemented. The upstairs bathroom is in need of the bath being repaired/replaced to enable the bathroom to be used. The home is required to ensure that carpets are kept clean and hygienic. Following the audit of accidents an action plan is recommended to reduce the risk of further accidents. Emergency lighting requires a record of which lights have been tested each month. It is recommended that all broken flip top bins be replaced. 5. 6. 7. 8. 9. 10. OP12 OP21 OP26 OP38 OP38 OP38 Horton Cross Nursing Home DS0000057288.V294505.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.V294505.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. 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