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

This inspection was carried out on 1st 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

Howard House Nursing Home 28/11/08

Howard House Nursing Home 01/12/06

Howard House Nursing Home 15/02/06

Howard House Nursing Home 26/10/05

Howard House Nursing Home 15/12/04

Howard House Nursing Home 08/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Howard House Nursing Home Vicarage Way Gerrards Cross Buckinghamshire SL9 8AT Lead Inspector Mr Guy Horwood Unannounced Inspection 09:20 1st June 2006 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.V292109.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. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 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 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.V292109.R01.S.doc Version 5.1 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 home’s 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 home’s 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. 15th February 2006 4. Date of last inspection Brief Description of the Service: Howard house is located in a quiet residential area of Gerrards Cross. The town centre of Gerrards Cross is located a short distance from the home, and contains a selection of shops and local amenities. 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 area. Residents are accommodated in single rooms, 2 of which have en-suite facilities. Access to the first floor is possible by stairs or through floor lift. The home utilises fixed and mobile hoists for safe moving and handling practice; bathrooms provide disabled bathing facilities; and toilets are fitted with grab rails. 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. Fees range £480 and £803 per week, and are based upon the level of care Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 5 required. 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. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Howard House Nursing Home on the 1st June 2006, commencing at 09:40a.m. The lead inspector, Mr Guy Horwood, was accompanied by Mrs Caroline Roberts, Regulatory Inspector. The inspectors were able to meet with residents, a visitor and staff members during the visit, and examined records pertaining to the provision of care and the running of the home. The visit included a tour of the building, including communal areas and resident’s bedrooms. The inspectors were met by the homes manager, Mrs Joy Gâl, upon their arrival. The inspectors discussed the inspection findings with Mrs Gâl at the conclusion of the visit. At the time of the inspection the home was accommodating 28 residents. Residents made a number of complimentary comments during conversations with the inspectors. These included that they were “very happy”, that the food was “great”, and that they looked “10 years younger for being here”. A relative informed the inspectors – “ I am so happy that my mother is here. She is well cared for and I do not have to worry about her because they do such a wonderful job”. From their findings the inspectors have concluded that residents are well cared for by a team of caring staff, and that health and social care needs are well catered for. However, there are concerns as to the maintenance of the building, the process of staff recruitment, the lack of staff training and some areas of management with regards to the home. The inspectors found staff polite and helpful, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspectors found it very enjoyable to spend time with the residents of Howard House, and would especially like to thank them for their time and for allowing the inspectors into their home. What the service does well: Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 7 The ethos of the home is to provide a caring and homely environment for residents. The providers and staff appear caring and kind, and residents appear well cared for. Residents health care needs are documented in care plans. These care plans are orderly, working documents, are up to date and subject to review and auditing. This ensures residents current identified needs are known to staff to enable them to provide the appropriate care. Residents have access to healthcare professionals external to the home to ensure that their healthcare needs are met. Residents are presented with choice within everyday routines and are able to maintain relationships with families and friends. Residents are treated with privacy, dignity and respect. Meals are served in an attractive setting, and at times convenient to residents. Catering for residents is of an extremely high standard, with a varied selection of food and drinks suited to individual preferences and providing residents with wholesome, nourishing and varied meals. The complaints procedure is satisfactory and accessible. The home appeared secure, clean and tidy, providing a pleasant environment for residents. What has improved since the last inspection? What they could do better: Pre-admission assessments must be completed with good detail. The registered persons need to be aware of the terms and conditions of registration pertaining to the home in regards to whom they are able to accommodate. Residents may be placed at risk through a lack of staff training. Improvements need to be made where resident’s money is handled by the home. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 8 The health, safety and welfare of residents, visitors and staff may be compromised through the lack of a robust programme of maintenance, servicing and adherence to health and safety guidelines. This may be addressed through the appointment of someone to the role of maintenance person in order to manage the on-going process of renewal, repair and refurbishment within the home. Doors must not be held open other than with approved devices, and following consultation with the fire officer. The registered persons must conduct a meaningful process of quality assurance in order to test the services provision and to identify areas requiring improvement. 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. Howard House Nursing Home DS0000019230.V292109.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 Howard House Nursing Home DS0000019230.V292109.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): 1, 3, 5 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential residents, and / or their representatives, receive sufficient information about Howard House in order to make an informed choice as to whether they wish to live there. Pre-admission assessments of potential residents are conducted, however, insufficient detail is recorded from these assessments with regard to care needs. As a result the home may be unable to make an informed decision as to whether they can meet a residents needs, and as a consequence, residents may be placed inappropriately. Intermediate care is not provided at this service. EVIDENCE: The homes Statement of Purpose and Service Users Guide were reviewed. These appear to have been reviewed annually and provide the required information for potential and existing residents. Copies of the last inspection Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 11 report conducted by the Commission for Social Care Inspection are on display in the front reception area. Residents are admitted for a four-week trial period, and one resident who had recently moved in to the home was spoken with during the visit. This resident confirmed that they had received information about the home before they were admitted, and that the trial period allowed them to make an informed decision as to whether they wanted to live at Howard House or not. Potential residents are visited and assessed by the homes manager or a senior nurse, and records of these visits are made on a provided template. A selection of pre-admission assessment records for recently admitted residents were viewed. These were not consistent in providing sufficient detail as to potential residents care needs, and in some cases were not completed fully. Intermediate care is not provided at Howard House. Howard House Nursing Home DS0000019230.V292109.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health care needs are documented in care plans. These care plans are orderly, working documents, are up to date and subject to review. This ensures residents current identified needs are known to staff to enable them to provide the appropriate care. Staff are caring and kind and residents appear to be well cared for. Residents have access to healthcare professionals external to the home in order to ensure that their healthcare needs are met. Medication is received, recorded, stored, and administered safely, and residents receive their medication as prescribed. Observation and comments made at the time of the inspection provide evidence that residents are afforded with privacy, dignity and respect. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 13 EVIDENCE: The home uses the Standex system for care plans. A selection of these were viewed. They were found to be orderly, well maintained, up to date and subject to review. Those care plans viewed provided good information that would enable the resident to be cared for by a staff member unfamiliar with their care needs. Information was detailed as to what assistance residents required from staff in order to meet personal hygiene needs, and the undertaking of specific healthcare assessments were detailed, (nutritional status, moving and handling needs, tissue viability, risk of falls). Records monitoring the resident’s healthcare status, (weights, vital signs, blood sugar levels), were complete and up to date. There was evidence in care plans that residents are registered with a General Practitioner and have access to specialist health services. The manager feels that communication with the local General Practitioners is good. Visits by healthcare professionals such as tissue viability and diabetes specialist nurses, was recorded within the care plans. In the majority of cases, the person who had written the plan of care had failed to date and sign the initial care plan. At the time of the inspection no residents were said to have pressure ulcers. Pressure relieving mattresses were seen in use on beds, and pressure-relieving cushions were noted in use for several residents in the lounge. Evidence of discussion with tissue viability specialist nurses was apparent, as was the use of skin integrity assessment tools and the provision of supplementary drinks. A number of residents were noted to exhibit signs of confusion. Through discussion with the manager and her deputy, and from viewing medication charts and care plans, it was apparent that a number of residents might have dementia. The pre-inspection questionnaire describes 20 residents as having dementia. The inspectors think this is substantially higher than the actual number of residents with this condition, nonetheless, the registered persons are required to submit an application for a variation to the homes current registration to address this issue immediately. A variation was recently made to the homes registration to enable a resident with dementia to remain there. This variation was subject to the condition that all care staff receive training in providing care to residents with dementia. At the time of the inspection only the deputy had received such training. An immediate requirement was served for all staff to receive training in this topic. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 14 Practices relating to the receipt, storage, handling, administration and disposal of medication were assessed at this visit. Controlled medications were correct and stored appropriately. Medication trolleys and stock were secure. Records were satisfactory. One resident self-medicates, and this had been assessed and documented appropriately. Within residents bedrooms prescribed creams were noted to be in use. Some of these creams were labelled with names other than the room’s occupant. The manager is reminded that prescribed creams are for use with the named person and must not be used for other residents. Staff appeared friendly, kind and caring; were noted to speak to residents politely; to knock at doors before entering rooms; to discuss procedures with residents before undertaking them, (e.g., hoisting and assisting with meals). Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides choice as to daily routines, meals and meal times and activities. Residents receive a variety of stimulating and interesting activities. Residents are provided with choice and stimulation in pleasant surroundings to satisfy recreational and personal needs. Meals are served in an attractive setting, by attentive staff, and at times convenient to residents. Catering for residents is of an extremely high standard, and the dietary needs of residents are well catered for with a balanced and varied selection of food and drinks, which reflect resident’s likes, requests and choices. EVIDENCE: The home has a number of quiet areas where residents can sit in peace to read or meet visitors. The homes lounges are spacious, provide ample seating for all residents, are attractively furnished and decorated and have pleasant views across the garden. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 16 An activities organiser is employed on a part time basis, and has the use of an activities room. An activities plan for the week was displayed next to the lounge and copies are provided to residents. The home possesses large print books and cards, has access to library services, and possesses a selection of games, videos and music. The activities organiser provides a variety of art and craft related activities, which residents stated were age and ability appropriate. Of the 3 comment cards returned to the Commission by residents, all stated that the home provided suitable activities. Residents commented that their participation in activities was always by choice. Residents were seen to take breakfast in their bedrooms where requested, and this was provided on attractively laid trays and was well presented. Lunch is served either in the homes dining room, or where requested, in residents rooms. Some residents require assistance with meals and this is undertaken in the lounge. Menus were displayed, and these offer variety including seasonal variation. Residents confirmed that they were able to pass requests to the chef, that menus were a true reflection of what was provided, and that where requested they had access to snacks between meals. As is usual at Howard House, meals are a very sociable event, with the majority of the homes residents seated at 3 tables. The dining room is an attractively decorated room, sufficiently spacious, and tables are laid with linen tablecloths, fresh flowers and full sets of cutlery. The inspectors were invited to take lunch with the residents. A choice of two main dishes were offered, with vegetables served in serving dishes left on the table for residents to help them selves. A choice of desserts was offered to residents, and this was followed by tea or coffee. A variety of cold drinks were offered throughout the meal, including wine, which residents said was common for special events – including inspections! Residents were able to converse freely throughout lunch, and staff members serving lunch were polite, discreet and courteous, often leaving the room so as not to impinge on the resident’s conversations. Residents were highly complimentary of the provision of meals within the home. One visitor joined her mother for lunch, and passed comment to the inspector that they were always made to feel welcome at the home, and that meals were of an extremely high standard. The kitchen held a good stock of fresh, seasonal produce of good quality. The quality of the food was, as usual, of a very high standard, and when coupled with the surroundings and service of staff made the meal a very Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 17 enjoyable and sociable occasion. Residents confirmed that the quality, service and setting of meals are always of the high standard experienced on the day of the visit, and the homes catering and care staff are to be commended on this provision. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the inspection, which included a visit to the service. The home has a well-publicised complaints procedure for residents and their representatives, which enables them to express their concerns and expect a structured response. Not all care staff have received training with regards to the Protection of Vulnerable Adults. The home does not hold a copy of the local interagency adult protection policy. The inspectors were unable to determine whether the homes recruitment practices are robust and protect residents. These factors may result in residents being placed at risk of harm. EVIDENCE: The homes complaints policy is displayed within the home and is provided to residents within the Service Users Guide. No complaints have been received since the last inspection One of the deputy managers has undertaken a “train the trainer” course in order to provide staff training in regards to identifying and reporting abuse. However, at the time of this inspection, not all staff members had received annual mandatory training in this topic due to a planned training day being cancelled for a resident’s funeral. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 19 The home has adult protection polices in place, which are available to staff. However, it was advised that the home obtain a copy of the Buckinghamshire inter-agency protocols in relation to dealing with allegations of abuse. The homes recruitment procedures were unable to be fully inspected due to records, (including PoVA and Criminal Record Bureau checks), being unavailable at the time of the inspection. Howard House Nursing Home DS0000019230.V292109.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 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The grounds are pleasant, the home is kept clean and tidy throughout, and rooms possess character with pleasant furnishings and decoration. However, despite the efforts of the registered persons, signs of ageing and areas requiring maintenance are not being attended to promptly and effectively, and this detracts from the homely environment sought by the manager and staff. The failure of fire doors to close fully, the practice of residents propping doors open, the lack of window restrictors and the presence of latex gloves in residents rooms, presents a risk to the health and safety of residents. EVIDENCE: The grounds are well maintained and provide a pleasant outlook from the majority of bedrooms and communal rooms. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 21 Visitors to the home are permitted entry by staff through the locked front door, thus providing some measure of security. Some rooms were noted to have received attention to their decoration, and residents had brought in personal belongings, furnishings and indicators of their interests. The manager pointed out one room for which new accessories had been purchased. The room itself needs redecorating in order to compliment the new accessories. In some areas of the home flaking and chipped paint was noted to be in need of attention. Windows open to provide ventilation, although it was noted that not all windows above ground level are fitted with restrictors. At least 2 windows were noted to open fully, presenting a risk to residents. 3 radiators were noted to be without low surface temperature covers, (2 in the lounge and 1 in the first floor reading room). Communal areas were very pleasant, well decorated and suitably furnished, and the home appeared clean and tidy throughout with no offensive odours noted. Kitchenettes, located in 3 areas of the home were noted to be in use by staff. These areas were clean and tidy, with records present for the monitoring of fridge / freezer temperatures. The door to the kitchenette on the ground floor did not close to its stops. The inspectors noted the use of approved hold open devices throughout the home, but were informed that on two doors, where no such devices were fitted, the residents persisted in propping the door open themselves. A requirement is served for the home to fit these doors with similar hold open devices as are in use throughout the home, following consultation with a fire officer. The home currently has no maintenance person, and as a result the manager and responsible individual attempt to attend to areas requiring repair or attention. Despite their best efforts, the registered persons are not able to provide sufficient time to attend to this role, as is evidenced by the above observations, and a requirement is made for the employment of a designated maintenance person to fulfil this role and attend to the upkeep of the premises. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. At the time of the inspection the home appeared to be staffed with a sufficient number of care staff to meet residents needs. However, staff do not receive sufficient training and may therefore be insufficiently skilled to meet resident’s personal, health and social care needs. The inspectors were unable to access all of the requested documentation pertaining to the homes recruitment procedures. The documentation that was accessible did not provided sufficient information for the recruitment procedure to be robust and as a result residents may be placed at risk of harm. EVIDENCE: At the time of the inspection the home appeared suitably staffed to meet the residents needs. Rotas were viewed and staffing levels appear to fluctuate between 1 and 2 trained nurses on duty, (sometimes these numbers included the manager), and between 4 and 6 care staff. At night there is one nurse and 2 carers on duty. A selection of staff recruitment files were viewed. Although some changes have been made to the application form following a recommendation at the last inspection, it still holds little information with regards to previous employment. Application forms viewed within the staff files held poor information as to previous employment, and in some cases were incomplete. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 23 A number of recruitment files and documents pertaining to Criminal Record Bureau and PoVA checks were not available for inspection due to being locked away by the Responsible Individual. The manager did not have the ability to access these records and the Responsible Individual was on leave. The registered persons are reminded that all records pertinent to the running of the home must be available and accessible for inspection at all times. A member of domestic staff spoken with confirmed attending training in health and safety, infection control and moving and handling, and that they were due to attend abuse awareness training soon. However, staff training records were viewed, and in a large number of cases staff had not received updates in mandatory training including moving and handling, fire safety, food hygiene and abuse awareness. It was also apparent that not all staff receive 3 days paid training per year. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified to manage the home, is caring and kind, and presents a suitable role model for staff to follow. No formal quality assurance process is undertaken and as such the views of residents does not influence the provision of the service or the running of the home. Finances handled for residents are kept in an orderly manner, however further improvements are required to ensure a clear audit trail is available and secure book keeping is present. No formal supervision of staff is undertaken and as a result staff performance, training and practice needs are unknown. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 25 The inspectors were unable to access all of the requested documentation pertaining to the servicing and maintenance of equipment. As a result no conclusion can be drawn as to whether this equipment is maintained to a good standard and as a result is safe, in good working order and protects residents, visitors and staff. A number of health and safety concerns have been identified with regards to the environment, and these may place the welfare of residents, visitors and staff at risk. EVIDENCE: Through meeting with residents, numerous compliments were received with regards to the manager and staff of the home. The manager and staff were polite and co-operative in their dealings with the inspectors throughout the visit, and interaction with residents was witnessed as courteous, kind and caring. The manager was knowledgeable of all residents’ specific health and personal needs, and could give an account of each individual’s current situation. Communication between staff of all levels was clear, professional and friendly; staff were aware of their roles and the role of others; and as a result residents appeared well cared for with their needs being met. Trustees of the Perseverance Trust conduct monthly unannounced visits to the home, and reports of these visits are forwarded to the Commission. The manager informed the inspectors that no formal quality assurance process tales place at the home. A requirement is made that a full audit is conducted to measure the success in meeting its aims, objectives and the Statement of Purpose of the home. This process must include seeking the views of residents and their representatives. From information provided by the registered persons 4-weeks prior to the inspection, it would appear that the homes policies and procedures are not subject to annual review and up dates. A requirement is served for the regular review of all policies and procedures within the home. None of the employees of the Perseverance Trust act as a Power of Attorney or Guardian for residents. At the last inspection, (February 2006), a recommendation was made that a small cash float be held for access in “emergencies”. The manager stated that this recommendation was discussed amongst staff who have decided this facility is not required at Howard House. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 26 The records pertaining to financial dealings for residents within the home were reviewed. These records were clear and user friendly, however improvements are required in order that these records are transparent and provide a clear audit trail. Improvements include the need for: - Duplicate receipts are required for individual residents where money held on their behalf is received from, or given out, to them. - Individual receipts are required from any person being paid to provide a service, (e.g., hairdresser, newsagent, chiropodist). - A weekly tally of cash is required with records kept. The manager stated that she supervises trained nurses, although no records were available to substantiate this. Nurses are then charged with undertaking supervision of carers, although the process for this was not clear to the manager and deputy. The inspectors discussed how supervision should be conducted and recorded, and this provision will be reviewed at the next inspection. The kitchen was clean and tidy at the time of the visit, with well-kept records pertaining to temperatures of food service and food storage. Cleaning rotas were detailed and appeared to be adhered to. The inspectors were unable to access service records and contracts at the time of the inspection, (including fire detection systems, lifts, gas and electrical systems), due to them being locked away and inaccessible to the manager. As with staff recruitment files, the registered persons are reminded that all records pertinent to the running of the home must be available and accessible for inspection at all times. Information provided prior to the inspection gives service dates for a number of items of moving and handling equipment. These appear to be in order, although original certificates to substantiate this information was not available at the time of the inspection. Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 1 X 2 Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 28 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 2 Standard OP3 OP8 Regulation 14 12(1) Requirement All pre-ad assessments must be detailed and complete. The registered persons are to submit an application for a variation to the homes registration categories to enable them to accommodate those residents identified with dementia. Medicines, (including creams), prescribed to an individual, must only be used for that named resident. The registered persons are to employ a maintenance person. Following discussion with the fire officer, rooms 12 and 25 are to be fitted with hold open devices, which will allow the door to close in the event of the fire alarm sounding. Timescale for action 01/09/06 01/09/06 3 OP9 13(2) 01/08/06 4 5 OP19 OP38 23(2) 23(4) 01/11/06 01/09/06 Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 29 6 OP38 13(4) Window restrictors must be fitted 01/08/06 and in working order for all windows above the first floor. Low surface temperature covers must be fitted to the radiators in the lounge and library / reading room. Gloves must be stored out of sight, given that the home accommodates confused residents. The fire door to the ground floor kitchenette must be maintained to ensure that it closes to its stops. The registered persons are to ensure that records are at all times available for inspection in the care home by any person authorised by the Commission to enter the home for the purposes of inspection. 01/08/06 7 OP38 13(4) 8 OP38 13(4) 01/08/06 9 OP38 13(4) 01/08/06 10 OP37 17(3) 01/09/06 11 OP29 19 01/10/06 The job application form is to request more information with regards to previous employment. The manager is to fully explore any gaps in employment records. Immediate Requirement served 01/06/06: All staff must receive training in caring for residents with dementia. All staff must receive training in moving and handling, fire safety and food hygiene. This training is to be mandatory and provided on an annual basis. All staff must receive training in the identification and reporting of abuse. This training is to be mandatory and provided on an DS0000019230.V292109.R01.S.doc 12 OP30 18(1c)(i) 01/11/06 13 OP30 18(1c)(i) 01/01/07 14 OP30 18(1c)(i) 01/01/07 Howard House Nursing Home Version 5.1 Page 30 annual basis. 15 OP33 24 A full audit is to be conducted to measure the success in meeting the homes aims, objectives and the Statement of Purpose. This process must include seeking the views of residents and their representatives, and be conducted on an annual basis. A requirement is served for the review of all policies and procedures within the home on an annual basis. Duplicate receipts are required for individual residents where money held on their behalf is received from, or given out, to them. Individual receipts are required for individual residents from any person being paid to provide a service, (e.g., hairdresser, newsagent, chiropodist). A weekly tally of cash must be undertaken, with records of this action kept. Staff are to receive regular supervision with records of this undertaking kept. 01/01/07 16 OP33 24 01/01/07 17 OP35 13(6) 01/09/06 18 OP35 13(6) 01/09/06 19 OP35 13(6) 01/09/06 20 OP36 18(1) 01/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 31 1 2 OP7 OP18 Where staff write or alter care plans, they are to sign these documents. The manager should acquire a copy of the local interagency adult protection policy form Buckinghamshire County Council. Room 11 should be decorated to compliment the new furnishings and fittings. It is strongly recommended that a small cash float be held by the home, which is accessible to the shift leader in case of residents requiring access to. Policies and procedures detailing the use of this float will be required. 3 4 OP19 OP35 Howard House Nursing Home DS0000019230.V292109.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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