Inspection on 26/10/05 for Howard House Nursing Home

This inspection was carried out on 26th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 15/02/06

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 Announced Inspection 26th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 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.V268305.R01.S.doc Version 5.0 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.V268305.R01.S.doc Version 5.0 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 15th December 2004 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. The home’s manager is supported by a team of qualified nurses, carers, catering, housekeeping and maintenance staff. 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.V268305.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the announced inspection carried out at Howard House on the 26th October 2005 and commenced at 9.15am. The lead inspector was Mr Guy Horwood. Upon arrival Mrs Joy Gal, the home’s registered manager, met the inspector. At the conclusion of the visit the inspector discussed the inspection findings with Mrs Gal. The inspection consisted of meeting with residents and staff, sampling lunch and viewing records and documents pertaining to the provision of care and the running of the home. The inspector toured the building and viewed residents bedrooms and communal areas. The inspector found staff polite, helpful and welcoming, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector would especially like to thank the residents for their time, conversation and company, and for allowing the inspector into their home. What the service does well: The home operates a consistent and satisfactory admissions procedure, ensuring that the home can meet the needs of those they admit. Residents care plans, which are drawn up on admission are comprehensive, complete, informative and subject to regular review. Resident’s health care needs are monitored effectively, and staff liase with healthcare professionals external to the home promptly where needed. Medication records and storage practices are satisfactory, and residents appear to receive their medication as prescribed. All staff conduct themselves in a manner, which respects the privacy and dignity of residents. The home provides choice as to daily routines, meals and meal times and activities. Residents receive a variety of stimulating and interesting activities. 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 Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 6 balanced and varied selection of food and drinks, which reflect resident’s likes, requests and choices. The grounds are well maintained and provide a pleasant outlook from the majority of bedrooms and communal rooms. The communal areas and residents bedrooms are pleasantly decorated and residents are able to bring in personal belongings. On the day of the inspection staff were present in sufficient numbers and had received suitable training to meet residents care needs. What has improved since the last inspection? What they could do better: Mrs Gal, as the registered manager of the home, is reminded that she has overall responsibility for the health, welfare and safety of residents, staff and visitors to the building. Through the course of the inspection several areas have been highlighted as a source of potential risk, and it is the responsibility of the manager to attend to these issues promptly. Areas of potential risk identified during the visit included; • • • • Doors being prevented from closing to their stops and therefore impeding fire safety measures; Poor staff recruitment practices; External fire escape doors being left open compromising the homes security; Staff accepting verbal prescriptions by telephone; Although communal areas, corridors and the majority of bedrooms were free from odours, some resident’s bedrooms possessed unpleasant odours, which the manager is required to address. It is also the responsibility of Mrs Gal to ensure compliance with previously set requirements, specifically in this case with regards to fire safety and recruitment. Non-compliance with requirements set following an inspection, and in this case the subsequent enforcement notices, may lead to a review of the managers registration being undertaken by the Commission. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 7 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.V268305.R01.S.doc Version 5.0 Page 8 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.V268305.R01.S.doc Version 5.0 Page 9 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): 3 The admissions procedure appears consistent, and the pre-admission assessment satisfactory. This allows the home to make an informed decision as to whether they can meet a residents needs, and as a consequence, residents appear to be placed appropriately. EVIDENCE: The home has an admissions procedure, which includes meeting with potential residents and/or their representative prior to admission. The home utilises the Standex care plan system, which provides a template for pre-admission assessments. The records for 3 admissions were viewed and were found to be satisfactory. The manager conducts pre-admission visits. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 10 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. Care plans are working documents, are up to date and subject to regular review. This ensures residents identified needs are known to staff to enable them to provide the appropriate care. The staff have a good understanding of the residents support needs, which enables them to provide individualised care. Staff have developed positive relationships with residents, which allows Residents to be open in expressing their thoughts, feelings and needs. Staff monitor residents health care needs effectively and liase with healthcare professionals promptly. This ensures specific healthcare needs are identified and dealt with appropriately. Medication appears to be received, stored, administered and disposed of in a satisfactory manner in the majority of cases, and residents appear to receive their medication as prescribed. However, the practice of receiving directions by telephone from the General Practitioner as to the commencement of new medication and changes to current medication, presents a high risk of staff committing an error in the administration of medicines. Staff conduct themselves in a manner, which respects the privacy and dignity of residents. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 11 EVIDENCE: Three care plans were viewed. Documentation detailing individual care needs and how these needs were to be met were satisfactory and appeared subject to regular review and amendment where required. However, in one care plan it had been identified, following the undertaking of a pain assessment, that a resident had painful hands. No subsequent care plan had been developed to address this issue. Tissue viability, nutritional, wound care and moving and handling assessments were found in all care plans. All were complete and subject to review. Where nutritional assessments and the undertaking of regular weights identified weight loss, evidence of the provision of supplementary drinks was seen and care plans were noted. The home receives regular General Practitioner visits. Evidence of visits by healthcare professionals, (General Practitioner, Diabetic Specialist Nurse, Psychiatrist), was found in care records, with and subsequent changes to care needs recorded in relevant care plans. On the day of the visit a psychiatrist was noted to visit the home to meet with a resident. This consultation had come about following staff concerns and subsequent liaison with the residents General Practitioner. This consultation, and the issues leading to it, was found to be recorded in the care plan. The case of a resident with a possible diagnosis of dementia was noted. The registered manager was reminded that under the homes current registration, residents couldn’t be accommodated at the home if they are diagnosed with dementia, without an application for a variation to the homes registration being made to the Commission. If any residents currently accommodated at the home have a diagnosis of dementia, a variation application will have to be submitted presenting the case that they remain at Howard House, and stating how staff will meet the specialist care needs of such residents. A diabetic residents care plan was viewed and held good care plans covering diabetic care needs and nutritional provision. Care records pertaining to the monitoring of diabetic blood sugar levels were satisfactory, although in some cases it was not apparent as to the frequency of staff conducting such tests. Medication record sheets were viewed. There was evidence that medication charts had been audited, and that gaps had been investigated. Copies of prescriptions were present to support some cases of staff entering handwritten directions as to the administration of new or reviewed medicines. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 12 However, through discussion with staff members it was ascertained that staff also enter directions as to the administration of new medicines from telephone conversations with General Practitioners and prior to receiving written, signed prescriptions. Medication was found to be stored securely, and controlled drugs were all present and accounted for. A tour of the premises was conducted with the manager, during which time the inspector had the opportunity to meet with a number of residents. At all times the manager was courteous, knocked at doors prior to entry, and only introduced the inspector to residents where they permitted entry. Residents were in various stages of getting up; some had had baths, others were getting dressed with assistance, and some were enjoying breakfast. Where assisted by staff, residents appeared well groomed and dressed in their own, welllaundered and co-ordinating clothes. Throughout the inspection staff addressed residents in a respectful and dignified manner, and with the appropriate agreed title. Staff knocked at doors before entering and introduced the inspector to residents in a formal manner. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 13 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. 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: Residents were seen to be offered choice as to where they spent their time, what meals and drinks they required, and what activities they were involved in. A large list of planned activities was displayed pertaining to the Christmas period, and this included religious services. A new activities room has been set up within the home. Residents were complimentary of the activities organiser, who they said provided a variety of interesting and enjoyable activities for all residents. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 14 Photographs were viewed of events held at the home, including a summer garden party involving family members. The inspector was able to sit with residents in the drawing room prior to lunch, where staff offered a selection of drinks including sherry. The home continues to receive visits from volunteers, who provide some activities or spend time chatting with residents. Lunch is served either in the homes dining room, or where requested, in residents rooms. Menus were displayed throughout the home, and were seen to offer a variety of choice including seasonal variation. Residents confirmed that they were able to pass requests to the caters, that menus were a true reflection of what was provided, and that where requested they had access to snacks between meals. Lunch is 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 inspector was invited to take lunch with the residents. A choice of two main dishes was offered, and accompanying vegetables, served in warmed serving dishes, were left on the table for residents to help them selves to. A variety of cold drinks were offered throughout the meal, including wine. A choice of desserts was offered, and this was followed by tea or coffee and chocolates. Residents were able to converse freely throughout lunch, and staff members serving lunch were polite, discreet and courteous. The quality of the food was of a very high standard, and when coupled with the surroundings and service of staff made the meal a very 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.V268305.R01.S.doc Version 5.0 Page 15 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 The home has a satisfactory complaints system, ensuring that residents and their representatives can express their concerns and expect a structured response. Residents are potentially placed at risk through staff failing to adhere to health and safety guidelines. EVIDENCE: The home has a complaints procedure and this is displayed within the home. The manager stated that no complaints have been received, although she has addressed minor issues where brought to her attention by residents. The home has a complaints record book. During the course of the inspection potential risks to the health, welfare and safety of residents was noted: • • • • • Staff have been employed without all of the required employment checks having been undertaken; Staff are taking instructions as to medication by telephone; Doors are held open with inappropriate devices; Staff are leaving open external fire doors; Kitchenette doors are not fitted with intumescent seals. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26. The home is situated in pleasant and well-maintained grounds, and a programme of redecoration and refurbishment attempts to maintain the internal structure of the home. Resident’s rooms are suitably furnished, and are able to furnish their rooms with personal belongings. Residents are therefore accommodated in pleasant surroundings. Staff leave external fire escape doors open presenting a risk of entry to the home by unauthorised persons. This has the potential to place residents, staff and visitors at risk. Due to specific healthcare needs of some residents, some rooms possess an unpleasant odour, which detracts from the homely environment provided for residents. Doors to kitchenettes do not possess smoke seals and as a result may present a significant risk in the event of a fire. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 17 EVIDENCE: A tour of the premises was undertaken with the homes manager. The grounds are well maintained and provide a pleasant outlook from the majority of bedrooms and communal rooms. Visitors to the home are permitted entry by staff through the locked front door, thus providing some measure of security. However, during the visit 2 fire escape doors were noted to have been left open by staff, 1 to the front and 1 to the rear of the home. These doors were left open for some time with no staff member present, and this presents a risk to residents and staff. Some rooms were noted to have received attention to decoration and new carpets. Bedrooms contained personal belongings, furnishings and indicators of individual’s interests and character. Communal areas were very pleasant, well decorated and suitably furnished. Kitchenettes, located in 3 areas of the home were noted to be in use by both staff and residents. These areas were clean and tidy, with records present for the monitoring of fridge / freezer temperatures. It was noted that kitchenettes, which contain cooking equipment, do not have intumescent strips fitted to the doors. The home appeared clean and tidy throughout, with no offensive odours noted in halls, the majority of bedrooms and communal areas. A couple of bedrooms did present with an odour, and this needs to be attended to. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 18 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. At the time of the inspection the home was staffed with a sufficient number of appropriately trained staff. Resident’s needs could therefore be met as per their care plan. Residents are not protected by the homes recruitment procedures and practices. Staff receive suitable training to enable them to comply with the homes policies and procedures, to support residents and to meet residents care needs. EVIDENCE: At the time of the visit the home appeared to be staffed sufficiently to meet residents care needs, and residents spoken with felt that staff were in sufficient numbers to be available when requested. A selection of recruitment files pertaining to recently employed staff were examined. From these records it was apparent that staff had commenced in employment: • • Prior to a Criminal Record Bureau and Protection of Vulnerable Adult Register checks having been obtained; Without 2 references having been obtained; DS0000019230.V268305.R01.S.doc Version 5.0 Page 19 Howard House Nursing Home • • Without references from the named referees. References were titled “To whom it may concern”, and were not addressed to the homes manager; references were not on headed / stamped paper; hence the authenticity of references is questionable. The homes employment application form provides very limited information as to the applicant’s previous employment. An immediate requirement was set under Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, that staff are only to commence in employment when all of the checks required under regulation 19 have been obtained, and the manager is satisfied as to their authenticity. Due to the non-compliance with previously served requirements pertaining to staff recruitment practice, and the failure of the manager to operate a robust recruitment procedure intended to safeguard residents, following the inspection a statutory requirement notice was served to the organization under Regulation 43 of the Care Homes Regulations 2001. Further failure to comply with the notice, within the given timescales, may lead to the registered persons being liable to prosecution without further notice. Records pertaining to staff training were seen. Mandatory training records included regular fire safety; food handling and hygiene; infection control; moving and handling and Protection of Vulnerable Adults. The home uses both internal and external trainers, and trained nurses are able to access local NHS hospital training programmes by prior arrangement. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38. The management of the home appears to promote resident focused care, and ensures residents health, personal and social needs are catered for. The practice of holding open fire doors with inappropriate devices, places residents, staff and visitors at significant risk. The manager has failed to ensure that the home is run in a manner that ensures a safe and secure environment is provided for everyone accommodated at, or entering into, the home. Residents are able to discuss issues and raise concerns with all members of staff, with their views being respected and treated appropriately. This enables residents to affect the day-to-day running of the home and to ensure the home is run in their interests. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 21 EVIDENCE: Through meeting with residents during the tour of the premises, and chatting prior to and during lunch, numerous compliments were received with regards to the manager and staff of Howard House, who were said to be “excellent from the Matron down”. The manager and staff were polite and co-operative in their dealings with the inspector throughout the visit, and interaction with residents was witnessed as courteous, friendly and caring. The manager was knowledgeable of all residents, knew their specific health and personal needs, and could give an account of each individual’s current situation without fail. 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. An Environmental Health Officer has recently visited the home. Some issues were brought to the manager’s attention following this visit, (including the cleanliness of the kitchen and storage of food external to the kitchen), and the manager stated that these issues have been addressed. Evidence of the kitchen having been steam cleaned was noted. At the time of the visit the kitchen appeared clean, tidy and orderly. During the tour of the premises, several doors were seen to be fitted with hold open devices of the type that allow the door to close in the event of a fire alarm sounding. However, despite previous inspection requirements with regards to fire safety, it was noted that; • • • Cushions were being hung over door handles, and therefore doors were being prevented from closing fully, (this included the staff room); That cast iron items usually used to hold open doors were present inside the doors of some bedrooms, (although it is also acknowledged that none were being used at the time of the visit to hold open doors); Residents disclosed to the inspector that their bedroom doors were sometimes held open with weights or wedges. An immediate requirement was set under Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, that doors are not to be held open other than with devices that would allow the door to close automatically in the event of a fire. Due to a failure to comply with requirements served at previous inspections, which pertained to the same practice of wedging open doors, following the inspection a statutory requirement notice was served to the organization under Regulation 43 of the Care Homes Regulations 2001. This notice states that Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 22 further failure to comply with requirements through the continued use of door wedges, may lead to the registered persons being liable to prosecution without further notice. Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 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 X X 3 X X 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 1 2 3 X X 3 3 2 2 STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X X X 1 Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 24 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. 1 Standard OP29 Regulation 19 and Schedule 2 Requirement 26/10/05:Immediate requirement set - Staff are only to commence in employment when all of the checks required under Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, have been obtained, and the manager is satisfied as to their authenticity. 26/10/05:Immediate requirement set – Doors are not to be held open unless with an approved device which permits the door to close in the event of a fire. Staff are not to administer medication to residents without written directions from a General Practitioner. “Telephone prescribing” is not to be undertaken. Staff are not to leave open secure external doors such as fire escapes. Staff are to be reminded of the security needs of the premises. The manager is to consult with the fire officer as to whether intumescent seals are needed on DS0000019230.V268305.R01.S.doc Timescale for action 26/10/05 2 OP38 23(4)c(i) 26/10/05 3 OP9 13(2) 01/01/06 4 OP38 13(4) 01/01/06 5 OP38 23(4) 01/02/06 Howard House Nursing Home Version 5.0 Page 25 6 OP26 12(1) 7 OP38 12(1) 13(4) the doors of the kitchenettes. Suitable measures are to be taken to address areas presenting with unpleasant odours. The home is to be free of unpleasant odours. All recommendations / requirements raised following the inspection by the Environmental Health Officer are to be attended to. 01/01/06 01/03/06 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 OP29 Good Practice Recommendations The manager is strongly recommended to review the homes employment application template in order to obtain more information as to a potential employees work history. Care plans relating to pain, and how this is to be managed, should be included in care records. The manager is to review residents with a possible diagnosis of dementia, and is to submit a variation application for those residents with a confirmed diagnosis of dementia who are to remain accommodated at the home. 2 3 OP7 OP8 Howard House Nursing Home DS0000019230.V268305.R01.S.doc Version 5.0 Page 26 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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