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Inspection on 01/12/06 for Howard House Nursing Home

Also see our care home review for Howard House Nursing Home for more information

This inspection was carried out on 1st December 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

Residents have information about the home and contracts are in place to ensure that residents and their families understand the fees and terms and conditions of their stay. Residents` personal, healthcare and medication needs are met in a timely way and in a manner which respects their privacy and dignity. Residents and families used phrases such as `this is a marvellous home` and `I am very happy here, the staff treat us as individuals and try hard to meet our wishes if possible`. Daily life is varied and residents are assisted to maintain their own interests where possible or to participate in activities, which bring interest to the day. The food is of a very high standard and residents` nutritional needs are met. There are effective policies and procedures in place to address residents concerns and to protect them from potential abuse. Residents feel that they are listened to and their views respected.The environment is welcoming, homely and clean and residents are encouraged to make it their home. There are sufficient staff with the right knowledge, skills and attitudes to care for residents. Recruitment procedures are thorough ensuring that staff are suitable to work with vulnerable adults. There is an experienced management team in place and the home is managed for the benefit of residents.

What has improved since the last inspection?

A more detailed assessment is undertaken prior to a resident moving to the home to ensure that the home can meet their needs. Medicine management has improved. The maintenance of the building has improved and safety requirements relating to radiator covers and window restrictors have been implemented. Recruitment procedures have improved and greater detail of applicant`s work history is now recorded on the application forms. Training has improved and staff now have the basic mandatory training and training in the care of residents who may have dementia. Staff also have training in safeguarding older adults. Formal supervision and appraisal has been implemented. A review of all policies and procedures has been commenced. Receipts are given where the home stores small amounts of personal allowance on resident`s behalf.

What the care home could do better:

The Statement of Purpose and Service Users guide should be updated in line with the Care Homes Regulations 2001, which were amended on the 1st September 2006, to give residents further information about the terms and conditions of their stay. The Home Manager and Trustees must keep the registration categories under review to ensure that they working within their current registration categories. The facilities require modernisation and plans for major refurbishment, in conjunction with a major care and housing provider are in hand. The manager should keep records as to progress with induction in addition to the staff held workbooks.The quality assurance programme could be further developed to embrace all aspects of the Trust`s business and the service and care offered to residents. The review of policies and procedures should be completed in a timely way. A health and safety audit should be undertaken in line with guidance set out by the Health and Safety Executive in their publication entitled Health and Safety in Care Homes.

CARE HOMES FOR OLDER PEOPLE Howard House Nursing Home Vicarage Way Gerrards Cross Buckinghamshire SL9 8AT Lead Inspector Christine Sidwell Unannounced Inspection 1st December 2006 10.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Howard House Nursing Home DS0000019230.V320937.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. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howard House Nursing Home Address Vicarage Way Gerrards Cross Buckinghamshire SL9 8AT 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) 01753 885258 01753 887574 N/A The Perseverance Trust Mrs Joy Gal Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 20 service users receiving general nursing care. 10 service users receiving personal care. Admission of a specific service user. That from 12th April 2006, the homes registration is varied to enable the continued accommodation of a specific service user with a dementia type illness. This is to be a temporary variation to the homes existing registration categories and will revert to the original registration when the named resident is no longer accommodated at the home. Dementia Care Training. For as long as residents with a dementia type illness are accommodated at Howard House, training in the care of people with dementia type illness is to be mandatory for all current and future staff. This condition is to be effective immediately. 4. Date of last inspection Brief Description of the Service: Howard House is located in a quiet residential area of Gerrards Cross a short distance for the town centre. The village is served by local bus services and has a mainline railway station. The home provides accommodation for up to 30 residents, 20 of whom may receive nursing care. The home is comprised of both old and modern buildings, and has a large, attractive and well-maintained garden. All rooms are single and two have en-suite facilities. There is a lift to the first floor. The home has been adapted to meet the needs of the elderly. The communal space is attractively decorated. Residents are able to take meals in their rooms, in an attractively decorated dining room, or in the summer months on the patio. The home has quiet areas, including a small library, where residents may receive guests in private. A team of qualified nurses, carers, catering, housekeeping and maintenance staff supports the home’s manager. A qualified nurse is on duty 24 hours a day. Allied healthcare professionals are accessible through direct contact or by General Practitioner referral. Fees range £417 and £823 per week, and are based upon the level of care required. Additional costs include hairdressing, chiropody, transport and Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 5 escorts if needed, toiletries, clothing and telephone. Information about the home can be obtained by contacting or visiting the home. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of three days and included an unannounced one-day visit to the home. Prior to the visit all previous information about the home was reviewed. Comment cards were sent to residents and their families and to other professionals who have contact with the home. Seven family members, four residents, three general practitioners and one healthcare professional responded. The care of four residents was case tracked. Residents, family members, staff and the manager were spoken to on the day of the unannounced visit. The home’s approach to equality and diversity was observed. As part of this unannounced inspection, the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service users guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Residents have information about the home and contracts are in place to ensure that residents and their families understand the fees and terms and conditions of their stay. Residents’ personal, healthcare and medication needs are met in a timely way and in a manner which respects their privacy and dignity. Residents and families used phrases such as this is a marvellous home and I am very happy here, the staff treat us as individuals and try hard to meet our wishes if possible. Daily life is varied and residents are assisted to maintain their own interests where possible or to participate in activities, which bring interest to the day. The food is of a very high standard and residents nutritional needs are met. There are effective policies and procedures in place to address residents concerns and to protect them from potential abuse. Residents feel that they are listened to and their views respected. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 7 The environment is welcoming, homely and clean and residents are encouraged to make it their home. There are sufficient staff with the right knowledge, skills and attitudes to care for residents. Recruitment procedures are thorough ensuring that staff are suitable to work with vulnerable adults. There is an experienced management team in place and the home is managed for the benefit of residents. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users guide should be updated in line with the Care Homes Regulations 2001, which were amended on the 1st September 2006, to give residents further information about the terms and conditions of their stay. The Home Manager and Trustees must keep the registration categories under review to ensure that they working within their current registration categories. The facilities require modernisation and plans for major refurbishment, in conjunction with a major care and housing provider are in hand. The manager should keep records as to progress with induction in addition to the staff held workbooks. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 8 The quality assurance programme could be further developed to embrace all aspects of the Trusts business and the service and care offered to residents. The review of policies and procedures should be completed in a timely way. A health and safety audit should be undertaken in line with guidance set out by the Health and Safety Executive in their publication entitled Health and Safety in Care Homes. 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. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 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 Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. Residents have information about the home, although this should be updated, and contracts are in place to ensure that residents and their families understand the fees and terms and conditions of their stay. EVIDENCE: There is a statement of purpose, which was last updated on the 28/08/06. The service users guide is dated 23/08/03. Both these documents should be updated in line with the Care Homes Regulations 2001, which were amended on the 1st September 2006. The care of four residents was case tracked. Only one of these could remember being given a contract although there were copies of signed contracts on all residents files. The contracts contained details of the fees to be charged and the terms and conditions of stay. One family member was spoken to and he could remember dealing with a contract on behalf of his family member and of receiving a months notice of fee increases. The files of the residents who care was case tracked had evidence that they had been visited before moving to the home and their needs had been assessed. A care plan had been drawn up from the initial assessment. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 11 The residents had been involved in drawing up their care plan. The initial assessment document covers the recommended areas described in the National Minimum Standards. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents personal, healthcare and medication needs are met in a timely way and in a manner which respects their privacy and dignity. EVIDENCE: The care of four residents was case tracked. All had care plans, which were dated and had been reviewed regularly. Two of the residents said that they had been involved in drawing up their care plan. They were detailed and reflected the residents current needs. There was evidence in the care plan that residents saw the general practitioner regularly and had seen an optician and chiropodist. Their risk of developing pressure damage and of falling had been assessed and appropriate action taken. Nutritional assessments were undertaken and residents weight was monitored regularly. None of those whose care as case tracked had lost weight since their move to the home. There are medication policies and procedures in place. One resident manages her own medication and appropriate risk assessments had been carried out. Records are kept of medication received and leaving the home. The medication administration records were completed accurately. Medication Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 13 requiring cold storage was stored correctly and records of the refrigerator temperatures were kept. Controlled drugs were stored correctly. Two controlled drugs were checked at random and found to be correct. The manager said that medicines are not administered covertly and that should a resident not wish to take their medication, their wishes are respected or should the medication be essential the doctor consulted. At the previous inspection a requirement had been made that prescribed creams should be kept on an individual basis. This has now been addressed. The staff were seen to speak to residents in a courteous manner. All personal care is given in residents own rooms. The general practitioners who returned the comment cards said that they always saw residents in their own rooms. Residents are addressed by their full name. The staff were proud of the fact that they were able to care for residents at the end of their life. Staff had received training in end of life care and additional staff were deployed if necessary. The manager said no one was left alone and a carer or nurse would stay with the residents and family if that were their wish. The thank you cards seen confirmed this and one family member who returned the comment cards said how well her late mother had been cared for. A requirement was made at the last inspection at the home apply to vary the categories of registration to accommodate people with a definite diagnosis of dementia. The lady to whom that requirement referred has now died and the requirement lapses. However the Home manager and Trustees must keep the registration categories under review to ensure that they working within their current registration categories. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life is varied and residents are assisted to maintain their own interests where possible or to participate in activities, which bring interest to the day. The food is of a very high standard and residents nutritional needs are met. EVIDENCE: The residents said that the routines of the home were flexible. The staffing levels are high, which allows for residents individual needs to be accommodated. Routines are flexible and residents were seen to be planning their day. The care plans held details of residents likes and dislikes. There is a regular activity programme, which is well publicised and open to families as well as residents. Visiting is open and residents maintain contact with their families. All residents who returned the comment cards said that the home organised activities, which they enjoyed. The home does not handle residents finances. Residents or families manage this. Details of local advocacy services were posted in the entrance hall. The food is of a very high standard. There is a rotating menu which residents said that they had had input to. The menu was varied and the content balanced. Lunch was observed and the dining room laid to a very high Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 15 standard. Lunch was seen to be a sociable occasion. The chef and assistant were aware of any special dietary needs. The staff were observed to helping residents discretely. They were aware of their special needs. Meals were not hurried and food was presented attractively. There is a choice of main meal and a cooked supper. The chef attends the monthly residents meetings. One residents said that the food and baking here is excellent. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are effective policies and procedures in place to address residents concerns and to protect them from potential abuse. Residents feel that they are listened to and that their views are respected. EVIDENCE: There is a complaints procedure. A record of concerns or complaints is kept, although there are few recorded. The Commission for Social Care Inspection has not received any complaints since the last inspection. The relatives who returned the comments cards said that they were aware of the complaints procedures, but that they had not had to make any complaints. Three general practitioners returned the comment cards and all said that they had not received any complaints. The residents spoken to said that they felt happy to raise any concerns which would be dealt with promptly. There are protection of vulnerable adult policies and procedures in place and the home has a copy of the local multi agency strategy for the protection of vulnerable adults. Staff had had training in this topic and the training records confirmed this. The staff spoken to were knowledgeable and could describe the categories of potential abuse. They were also quite clear that they had access to the manager and the trustees if they were concerned. The residents who returned the questionnaire said that the staff always treated them kindly. The Commission for Social Care Inspection has not been notified of any allegations regarding poor care. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 17 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, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is welcoming, homely and clean and residents are encouraged to make it their home. The facilities require modernisation and plans for major refurbishment, in conjunction with a major care and housing provider are in hand. EVIDENCE: The home is comprises and old Edwardian building with an annex providing more modern accommodation. The ambience in the home is welcoming and graceful. There is a maintenance programme and the manager stated that a maintenance person had now been employed to ensure that minor maintenance requirements were completed in a timely way. The building is however old and will need major refurbishment in the future. Discussions are underway with a national housing and care organisation to rebuild the accommodation and increase the size of the home. A planning application has been lodged. The maintenance records showed that equipment and services Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 18 are maintained on a regular basis. The last fire offices visit was in April 2006 and the recommendations from that visit have been implemented. Residents rooms varied in size but were homely and welcoming. Residents are encouraged to personalise their rooms and most had chosen to do so, bringing their own furniture, pictures and personal effects. One resident spoken to said that she had been here for many years and my room feel like home. Flooring in all rooms was domestic in character. Only two rooms have ensuite facilities. There are control of infection policies and procedures in place. These were last updated in 2006. The staff were observe to wash their hands and to be wearing appropriate protective clothing. The laundry is well managed and staff were aware of the correct way in which to manage soiled laundry items. There are contracts in place for the safe disposal of clinical waste. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. There are sufficient staff with the right knowledge, skills and attitudes to care for residents. Recruitment procedures are thorough ensuring that staff are suitable to work with vulnerable adults. EVIDENCE: There are good levels of staff on duty. There are ten qualified nurses on the rota and the rota shows that there is always one, and on some shifts, two on duty. There are six or seven carers in the morning and four or five in the afternoon. The residents spoken to said that staff were able to get to them quickly if they called. The staff spoken to said that they felt that they had time with residents and could give them individual attention. A staff record is kept which shows who is on duty. There are additional staff on duty in the mornings when the activity is at its peak. There are sufficient domestic and catering staff to ensure that the carers can focus on the care needs of residents. There is an active National Vocational Qualifications programme and 53 of care staff hold this qualification at Level 2 or above. The recruitment files of three staff members were examined. All had evidence that references and Criminal Records Bureau checks had been undertaken before the staff member started work. There was evidence in the files that proof of identity is sought and appropriate work permits were in place. A new Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 20 application form has been devised which shows the persons work history and enables the manager to check any gaps in work history. Interview records were kept. Both members of staff appointed in 2006 had commenced an induction programme although it was not possible to verify this as the staff hold their own induction records. It is recommended that the organisation develop a way in which a summary of progress with induction can be kept in the staff training records. Requirements were made at the last inspection that staff have the basic mandatory training and safeguarding and dementia care training. This has been complied with. A training programme was agreed and staff participated enthusiastically to help the home remedy this area of service provision. Extensive training was undertaken during the summer and the records updated. The staff spoken to said that they felt the training helpful. A system is now in place to ensure that all staff the relevant training, with annual updates and records are kept to verify this. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement was made using available evidence, including an unannounced visit to the service. There is an experienced management team in place and the home is managed for the benefit of residents. EVIDENCE: There is an experienced manager in post. She holds the National Vocational Qualification in management at level 4. The staff spoken to said that she was approachable and that they would have no hesitation in reporting issues to her. The residents and family members spoken to were supportive of her and said that she ran a good home and was responsive to their needs. There are clear lines of accountability within the home and with the Secretary and Chairman of the Trustees. The home has a development plan in association with a national housing and care provider to develop the facilities and planning applications have been made to rebuild parts of the home. A quality assurance system is being put in place and a resident and family questionnaire has been Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 22 undertaken. The outcome was generally positive and an action plan has been developed. The manager said that she had learnt from the construction of the questionnaire and would be developing it further. It is recommended that the quality assurance programme be developed further to systematically review other areas of the trusts service and care given to residents. Staff training is now in place and staff supervision has been implemented. Records were seen to verify this and the staff spoken to said that they found the process helpful. A programme to review all policies has been commenced although a number are still dated 2002. The programme to review all policies should be completed. The home hold appropriate levels of insurance and the accounts for the year ending June 2005 prepared under the Charities Act 1993 showed a balance and received an unqualified auditors opinion. The home holds a small amount of personal money for residents if they wish. Receipts are given for all money received and given to residents or for expenditure incurred on their behalf. There are health and safety policies and procedures in place. The minutes of health and safety meetings were not seen on this occasion. There are manual handling policies and procedures and staff training records show that they have had training in this area. Staff have also had food hygiene and infection control training. The manager is considering a way in which vinyl gloves, which may be a hazard for some residents, can be stored discretely and out of sight. Window restrictors have been fitted to the windows on the first floor and radiator covers have been fitted, or radiators are protected by furniture, to protect residents. Most staff have had fire training and the staff spoken to could describe the fire evacuation procedures. Not all night staff have had fire training with annual updates and this must be remedied. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 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 3 X 2 3 3 3 X 3 Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1) Timescale for action The Statement of Purpose should 31/01/07 be updated in line with the Care Homes Regulations 2001, which were amended on the 1st September 2006. The Service Users guide should 31/01/07 be updated in line with the Care Homes Regulations 2001, which were amended on the 1st September 2006. All night staff must have fire 31/01/07 training. Requirement 2 OP1 5 3 OP38 23(4)d RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP30 OP33 Good Practice Recommendations The Home Manager and Trustees must keep the registration categories under review to ensure that they working within their current registration categories. The manager should keep records as to staff progress with induction in addition to the staff held workbooks. The quality assurance programme could be further DS0000019230.V320937.R01.S.doc Version 5.2 Page 25 Howard House Nursing Home 4 5 OP33 OP38 developed to embrace all aspects of the Trusts business and the service and care offered to residents. The review of policies and procedures should be completed in a timely way. A health and safety audit should be undertaken in line with guidance set out by the Health and Safety Executive in their publication entitled Health and Safety in Care Homes. Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 © 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 Howard House Nursing Home DS0000019230.V320937.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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