Inspection on 15/02/06 for Howard House Nursing Home

This inspection was carried out on 15th February 2006.

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

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

Other inspections for this house

Howard House Nursing Home 28/11/08

Howard House Nursing Home 01/12/06

Howard House Nursing Home 01/06/06

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 15th February 2006 11:00 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.V281150.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.V281150.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.V281150.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 20 service users receiving general nursing care. 10 service users receiving personal care. Date of last inspection 26th October 2005 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. 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.V281150.R01.S.doc Version 5.1 Page 5 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 Care Home on the 15th February 2006, between the hours of 11am and 1pm. The inspector was Mr Guy Horwood. The inspection consisted of touring the premises, meeting with some residents and staff, and viewing a selection of records pertaining to the provision of care and the running of the home. The home’s manager, Mrs Joy Gal, and the home’s Responsible Individual, Mr Tim Myers, were present at the time of the inspection. The inspectors found staff polite and helpful and would like to thank them for their co-operation and assistance during the inspection. The inspectors would especially like to thank the residents for their time and for allowing the inspectors into their home. What the service does well: What has improved since the last inspection? Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 6 No unpleasant odours were noted within the home at the time of the visit. External fire escape doors appeared secure. What they could do better: 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.V281150.R01.S.doc Version 5.1 Page 7 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.V281150.R01.S.doc Version 5.1 Page 8 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): EVIDENCE: These standards were not assessed at this inspection. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 9 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): EVIDENCE: These standards were not assessed at this inspection. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 10 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): 12,15. Residents have the opportunity to exercise their choice in relation to religious observance. 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 tastes. EVIDENCE: Residents were noted to be receiving Holy Communion on the day of the visit. The inspector was informed by the manager and residents that they had had a Valentines Day themed meal on the 14th of February. This was said to have been a very enjoyable lunch, with roses provided for all residents. Residents confirmed that meals remain of a high standard and commented that the “food is still excellent”. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 11 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): 18 Staff receive training with regards to the identification of adult abuse and subsequent methods of reporting. Residents are potentially placed at risk through staff failing to adhere to health and safety guidelines. EVIDENCE: The home possesses policies pertaining to the protection of vulnerable adults and this includes a “Whistle-blowing” policy. All staff undertake adult protection training, which forms part of the induction process for new staff. One of the senior nurses has undertaken Buckinghamshire County Council’s trainers course in the Protection of Vulnerable Adults and is to cascade this to all staff members. During the course of the inspection doors were seen to be held open with inappropriate devices. This presents a potential fire risk to the health, welfare and safety of residents, staff and visitors. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 12 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. The home is secure, clean and tidy, with residents able to decorate their rooms with personal belongings and furnishings. This ensures a pleasant and secure environment for residents. EVIDENCE: At the time of the visit the home was found to be secure, with fire exits secure and the front entrance fitted with a coded key entry system. The home was clean and tidy throughout, and no unpleasant odours were noted during the tour of the premises. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 13 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): 30 A staff training programme is in place to provide staff with the skills required to care for the residents group. EVIDENCE: The manager was able to provide a list of training to be undertaken in the coming month, and this included Moving and Handling, the Protection of Vulnerable Adults, Fire Prevention, Food Hygiene and Infection Control. One of the senior nurses has undertaken Buckinghamshire County Council’s trainers course in the Protection of Vulnerable Adults and is to cascade this to all staff members. Trained nurses employed at the home are able to access local NHS establishments training courses through the home paying annual fees. These courses are pertinent to the care provided and ensure nursing staff meet requirements for the maintenance of their nurse registration. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 14 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): 35 & 38. Residents do not always have access to their money, which may result in limitations to their choice of activity. The continued practice of holding open fire doors with inappropriate devices places residents, staff and visitors at significant risk of harm. EVIDENCE: No representative of the home is appointed to manage resident’s finances or is a legal representative. All residents’ financial arrangements are managed by family members, legal representatives or power of attorney. Small amounts of cash are held by the home on behalf of residents. This money is stored securely with records kept. These records were viewed and appeared well maintained and orderly. The Responsible Individual informed the inspector that these records are subject to a regular audit. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 15 Access to this personal money is by a member of administrative staff, and as such is not accessible during unsocial hours, for example at weekends and evenings. Care staff have no access to these finances at any time. Mrs Gal advised the inspector that should a resident require access to money during these unsocial hours, that staff would personally lend money and claim it back when the administrative staff were present. The inspector strongly recommends that a small cash float is held and made available at all times to the shift leader / nurse-in-charge. Policies and procedures for the use of this float will be required. Upon arriving unannounced at the home, the inspector was extremely disappointed to find that, despite an enforcement notice having been served to the home in November 2005, the office and lounge doors were being held open with wedges. Staff were also noted dispersing through the home, and it would appear that this was in order to close doors and ensure any wedges in use were removed prior to the inspector touring the premises. The inspector spoke to the homes manager, Mrs Gal, the Responsible Individual, Mr Tim Mears, and a group of staff to reaffirm why the practice of wedging doors open is unacceptable and places the lives of people within the home at significant risk. Mr Mears advised the inspector that he had been attempting to ascertain whether a number of bedroom doors, (Bedrooms 1,3,6,7,8,11,16,19,28.), could be fitted with approved hold open devices, (i.e., Dorgard). A number of doors within the home were noted to have already been fitted with these devices, and given the severity of the situation and length of time since the serving of the enforcement notice, it is difficult to see why this issue has not been attended to already. The inspector stressed that until the designated doors are fitted with appropriate hold open devices they are not to be held open with wedges or by any other means. Staff commented that sometimes residents prop doors open, and were reminded that they have a responsibility for the safety of all residents, colleagues and visitors within the home, and where required must discuss the reasons for the removal of inappropriate hold open devices with residents. Following the inspection the inspector has discussed the wedging open of doors and the need to fit approved hold open devices with a Fire Officer of Buckinghamshire Fire and Rescue Service. This Fire Officer has agreed to contact Mr Mears to discuss the fitting of hold open devices as soon as possible. This issue is currently being discussed with the Commissions legal department. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 16 During the inspectors tour of the premises it was noted that some doors are failing to close to there stops, most notably the 2 kitchenettes doors. Intumescent strips have not been fitted to these doors, and this issue was raised at the last Announced Inspection for discussion with the Fire Officer. A record of all incidents and accidents is maintained by the home. Records to evidence this were seen and appeared in order. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 1 Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 2. Standard OP38 Regulation 23(4)c(i) Requirement Doors are not to be held open unless with an approved device which permits the door to close in the event of a fire. Timescale for action 15/02/06 (26/10/05:Immediate requirement served. 14/11/05: Enforcement Notice served) 5. OP38 23(4) The manager is to consult with the fire officer as to whether intumescent seals are needed on the doors of the kitchenettes. (01/02/06) 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP35 Good Practice Recommendations 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. Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 19 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. Extracts may not be used or reproduced without the express permission of CSCI Howard House Nursing Home DS0000019230.V281150.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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