Inspection on 30/10/06 for Ivy House Nursing Home

This inspection was carried out on 30th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ivy House Nursing Home 26/09/08

Ivy House Nursing Home 08/01/08

Ivy House Nursing Home 14/03/06

Ivy House Nursing Home 14/12/05

Ivy House Nursing Home 20/01/05

Ivy House Nursing Home 25/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Ivy House Nursing Home Hollin Wood Close Moorhead Lane Shipley West Yorkshire BD18 4LG Lead Inspector Sean Cassidy Key Unannounced Inspection 30th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ivy House Nursing Home Address Hollin Wood Close Moorhead Lane Shipley West Yorkshire BD18 4LG 01274 591476 01274 591477 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) Holberry Care Ltd Mr Patrick Berry Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (15) Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users remaining in the home that fall under the category of older people will be named individually in separate covering letters of registration. As these service users die or move from the home they will be removed from the registration certificate and a new certificate will be issued. This process to continue until none of these service users remain in the home. It has been agreed that no charges will be made when new certificates are issued as part of this process. 14th March 2006 Date of last inspection Brief Description of the Service: Ivy House is a detached Victorian property, which has been converted and extended to provide the care home it is today. The home is registered to provide care, with nursing, for up to forty residents of both genders. The accommodation provides thirty-two single bedrooms and four double rooms. There are a number of communal areas, including lounges, dining area and bathrooms. The home is in a quiet residential area close to the village of Saltaire. The gardens and patio areas are well maintained and are accessible to residents. The main entrance has a ramp and there is ample car parking to the side and front of the home. The homes weekly charges range from £482.47 - £1192.94 Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk This was an unannounced inspection; it took place over one day. The inspection was carried out between 9.30am and 17.30pm on 30/10/06. During the inspection all the key standards, and others, were assessed. These are identified in the main body of the report. The inspector looked in detail at the care of four residents living in the home. I looked at care records; spoke to the residents and some of the visitors about their care needs and to the staff about how they deliver care. I inspected the environment in which these residents receive care and observed care practices. I also spoke to other residents and some of their visitors in the home, carried out a tour of the building and looked at other records including maintenance records, staff files and training records. A pre-inspection survey was completed by the home before the visit; the information provided was used during the inspection. Detailed feedback was given to the person in charge at the end of the visit. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The registered person must improve the way in which it enables people to choose the service that is on offer. The required information must be included in the Statement of Purpose. The availability of the Service User Guide must also be improved as feedback given suggested it is a document people are not familiar with. The care plans must be improved so that carers are provided with sufficient detail needed to ensure residents receive the correct care. The care documentation must become more ‘Person Centred’ in its approach. This will help to improve the well being of the resident group. Some of the vocabulary used in the care plans must be reviewed as it labelled residents and could be viewed as compromising their dignity. More work must be carried out to show the home is actively involving the resident or their families with developing the care plans and risk assessments. These documents must be made more accessible to the carers to ensure they are fully informed of the care needs of the residents. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 7 The medication systems used by the home must be reviewed and improved. They do not properly protecting the residents. Relatives said that although entertainment is brought into the home, there was a lack of activity provided on a daily basis. More one to one and group activity should be provided. Residents’ wellbeing would benefit more if the activities provided were evidence based around dementia care. Improvement is needed with the provision of adult protection training provided to the staff group. The manager must also be more vigilant with regard to aggressive incidents that occur in the home. Consultation must be sought from the appropriate authority when this occurs. The home must review the environment in relation to the specialist care it provides. There is a large array of evidenced based good practice in relation to environment available. The implementation of this within the home would improve resident care and well-being. The home must improve the recruitment procedure to ensure that the required information is obtained prior to an employee commencing work. A more structured training programme must be developed and implemented to ensure staff are properly trained to do their job. Particular attention must be given to the provision of dementia training. A system for improving the quality of care must be implemented. The health and safety procedures of the home must be reviewed to ensure everyone is protected. 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. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 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 Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 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): 1 and 3 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. The information provided by the home does not assist prospective residents or their families in making an informed choice about moving in. Pre assessments are carried out to ensure residents’ needs can be met prior to moving into the home. EVIDENCE: The home has developed a Statement of Purpose for prospective residents and their families. Not all the required information is included in this document and therefore, residents and families are not kept fully informed about the service the home offers. A Service user Guide has also been developed for those residents that choose to live in the home. One resident who gave feedback said he had not received a Service User Guide when he moved in and he was not aware of the homes Terms and Conditions. Relatives spoken to said they were not aware of these documents. The person in charge said that they are Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 10 looking at different ways in which they can make the Service User Guide more accessible to all groups. The care files of residents that were case tracked showed all were assessed before moving into the home. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. Residents care needs are not appropriately provided for within the care documentation used by the home. Residents would benefit more if a nonjudgemental ‘Person Centred Care’ approach. The medication procedures used by the home do not properly protect the resident group. The staff appeared to respect the privacy and dignity of the resident. But there were some instances identified when this did not happen. EVIDENCE: The care of four residents was looked at. Each resident has a care file in place that provides staff with details as to how each individual’s care needs are to be met. Evidence showed residents are nutritionally assessed and that their pressure areas are assessed also. Members of the multi disciplinary team are involved with resident care when needed. Equipment is also provided when needed. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 12 Positive feedback was obtained from relatives about the care provided and they were confident that the standard of care was good. However, there were a number of areas that were identified during the inspection that are in need of review in order that care provision is assured. Although residents had care plans in place, they contained insufficient detail for staff to ensure these needs would be met. This was identified for care needs in areas such as anxiety, mobility, communication, personal cleansing, and continence. The absence of this detail does not ensure the care needs of the resident will be met. Care plans contained statements such as: • • • • • • Full assistance needed Personal hygiene needed when rising Ensure toileted through day Promote compliance Not able to maintain hygiene Ensure diet and fluids are taken The above examples give staff little detail as to how they are to ensure this happens, or where they are to record the evidence to show that it took place. The care plans seen were very much focussed around the activities of daily living, trying to make sure the mainly physical needs of the residents are being met. Good practice in dementia suggests residents would benefit more from a ‘Person Centred Care’ approach being adopted; this would assist staff to meet their needs in a more holistic way. The care plans and risk assessments contained little evidence to show residents or their representatives were involved with the development of the care plans and risk assessments. Discussions were held with staff regarding the care plan documentation. They were not able to identify exactly what the care needs of the residents they were looking after that day. The person in charge confirmed carers were able to review and change care plans monthly. The inspector saw this and no signatures of a qualified nurse agreeing to the change were recorded. This is poor practice. Concerns about some staff attitudes were identified during the inspection. Vocabulary used in care plans to describe residents was viewed as labelling and judgemental. Examples of this were, “Mrs.. cannot say anything meaningful.” “ Mr. is disruptive and does not comply.” “Mrs. … is resistive, non compliant and aggressive.” Some staff, two of which were senior, referred to Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 13 residents that needed assistance with eating their meals as ‘feeders’. This is poor practice. The care plans showed residents are risk assessed in areas such as continence, pressure area care, falls and nutrition. The care plans were reviewed on a monthly basis but risk assessments were not. This is poor practice. Relatives spoken to were unsure as to whether they were involved with the care plans, but they were confident that the home was providing the correct care for their relatives. The home supplied the commission with a copy of its medication policy. This document was a copy of the British Royal Pharmaceutical Guidelines for Medication. This information is guidance and the home must incorporate it when developing its medication policy. The medication charts for four residents showed that there were a number of unexplained gaps and therefore it was unclear whether the residents had had their medication at that time. One resident was exhibiting aggressive and agitated behaviour had been prescribed two different medications to try and alleviate the symptoms. The records showed that the resident had not been receiving the medication as it wasn’t available and the other one had been prescribed inappropriately. This is poor practice and places the resident and others at risk. The registered nurse on duty at the beginning of the inspection administered all the medications to residents and then signed all the charts in the office. The person in charge was informed that this is poor practice and must stop. There were a number of residents receiving Controlled Drugs in the home. The records for these medications were checked and were found to be correct. However, the system used by the home for recording that the drug has been administered is inconsistent. In a number of cases only one signature had been recorded to provide evidence that the drug had been administered. Two signatures must be obtained to ensure the drug has been correctly administered. From the information gathered during the course of the inspection it was evident that the staff try hard to maintain the privacy and dignity of the residents living in the home. Staff were seen to knock and wait before entering resident bedrooms. Residents were assisted to mobilise with dignity. Those residents that needed assistance with eating their meals were provided with this help in a dignified manner. Relatives said that the homes laundry system is good and that the clothes are always returned as they expected them to be. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. The home provides regular outings and leisure outlets for residents. More individual and group activity focused around the specialist needs of those with dementia is needed. Residents and their families feel that the standard of food provision within the home is good. EVIDENCE: The home employs a part time activity coordinator to help plan and devise structured activities for the residents. The home also has a group of relatives that actively raise money to provide leisure activities for the resident group. Planned activities are displayed at the entrance of the home for all to view. Good feedback was obtained from relatives with regards to this activity provision. The home has a variety of films that are provided on a regular basis. The home plays music for the residents over the course of the day. This music was found to be quite loud at times and relatives also commented on its loudness and appropriateness. One resident that was able to comment said, “It always Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 15 seems to be the same music every day. No one asked me if I wanted to listen to it. I don’t think the choice of the music is very appropriate and it is very loud.” Some staff observed were quite attentive to the needs of the residents. Some residents who appeared quite distressed were spoken to in a calming manner and staff sat and chatted with them in an attempt to reassure them. This was good practice. All relatives spoken with said that there is a good standard of entertainment provided but there is a lack of daily activity provided. Some comments made were, “ There is never anything going on when you visit.” “There doesn’t seem to be any group therapy provided. You don’t see any reminiscent activity work with the residents.” “ More stimulation could be provided to the residents.” One resident that was able to comment said,” There is no form of activity provided as far as I can see.” A record is kept in each resident care plan and it shows what activities that person has been involved in. The activities coordinator said that more work and training is needed in relation to dementia care to ensure the needs of residents in this area are appropriately met. All those spoken to were very happy with the visiting hours and the friendly reception they received from the staff. They felt the home enabled them to maintain links with family and friends. Relatives said that they could go to bedrooms for privacy if they wanted to. Relatives said that they were able to bring personal possessions if they wished and evidence was found throughout the home to show this did happen. Mealtimes were observed during the inspection. These were found to be unhurried events and those that needed assistance were given it. The food looked appealing and relatives gave good positive feedback regarding the meals provided. It was noted that the evening meal is provided very early. It starts being served at 15.45. Bearing in mind lunch only finishes for some at 13.30; this is a very short gap. It was unclear whether residents are provided with another snack in the late evening to ensure the length of time between meals is not longer than twelve hours. One resident said, “ I think the reason why it is provided so early is just to get it out of the way.” If meals are to be given this early then evidence is needed to show residents are given a substantial snack later in the evening. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. The complaint process used by the home appropriately protects residents. Residents would be better protected if the staff group received appropriate training in adult protection. EVIDENCE: Relatives said they were confident about making a complaint to the home if they needed to. They said the management team were approachable and they were confident that the complaints would be investigated appropriately. The complaints procedure is well displayed within the home and the records were appropriately kept. Staff had an understanding of Adult Protection issues and were able to highlight what signs they would look for that would indicate abuse may have taken place. Some carers have received training in adult protection but there are still a high number that have not received training from a person trained to do so. The records showed that an incident occurred that involved one resident slapping another. This should have been referred to the adult protection team for advice but it was not. The person in charge assured the inspector that this would be done. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. Residents’ lives would be further improved if the physical environment was reviewed and adapted to meet the needs of residents with dementia. The home is kept clean and tidy. EVIDENCE: The grounds of the home are well kept and attractive. There is access to gardens for residents if they wish. Two relatives said they seldom saw the grounds being accessed and used by residents. They said the gardens should be used more often especially for residents who had a previous interest in gardening. The environment of the home was seen as clean and tidy and this was the view of all residents/relatives. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 18 Although the home is registered to provide care for residents with dementia, there was little evidence seen to show how the environment has been adapted to meet the needs of the residents. Some good practice regarding this area was discussed with the person in charge. It was recommended that the home explore this area and examine the good evidence based practice that has been developed to improve the lives of people with dementia. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. Improvements with the home’s recruitment procedure are needed to ensure residents are properly protected. More relevant and structured training programme is needed to ensure resident needs are being properly met. EVIDENCE: The home has a rota system that highlights which staff are on duty over the course of the week. There is no staffing notice in place for the home but the person in charge gave firm assurances that sufficient staff are on duty at all times of the day. The numbers of staff on duty at the time of the inspection appeared appropriate. Internal bank staff are used to fill any gaps in staffing levels. The home does have a recruitment policy in place. Three recruitment files were looked at. The evidence obtained showed that the home’s recruitment policy is not being followed correctly, as some staff were employed without having the correct references or Criminal Record Bureau check obtained. One member of staff had recently been employed using references she had brought with her. This is poor practice and must stop. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 20 A large proportion of the carer group are now trained to NVQ Level 2 or above. The person in charge said that they have not reached the 50 mark but hoped that they would soon have 50 or more of the carers trained to this level. This will help to ensure residents are in safe hands. The home keeps training records that provide evidence as to what training each individual has obtained. A small number of staff has received training in palliative care, foot care and dementia. The overall evidence obtained showed staff receive training in mandatory areas such as moving and handling and fire training. However, they confirmed that there is an absence of training in other areas relevant to the care needs of the residents. The records provided showed no evidence that staff are trained in areas such as nutrition, continence, pressure area care and first aid. More training is being provided in the area of dementia. The inspector found it hard to evidence where the existing dementia training had been implemented within the home. This was fed back to the person in charge. Carers confirmed that they did receive an appropriate induction programme. Evidence was provided to show this did happen. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made following a site visit, checking records and speaking to relevant groups. The manager has systems and processes in place to help improve resident care. These are in need of review to ensure the quality of the care provided is assured and residents are protected. EVIDENCE: The registered manager is a qualified nurse with many years experience. He has been trained to NVQ level 5. The manager said that they depend a lot on feedback they receive from relative groups to assist them in improving the quality of care. Staff review the physical environment they are responsible for and are supposed to refer any issues to the home manager. The manager said that they are responsive to the Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 22 environmental needs of the home, but he has not yet developed an annual maintenance plan for refurbishment and improvement. The manager said the home was committed to quality assurance but it has not yet adopted a tool to provide evidence that this is carried out. Falls, accidents, complaints and incidents of wounds in the home are recorded but there is no formal process developed to identify how improvements can be made in resident care. The manager said that they are quality assessed by an outside agency. The home takes no responsibility for resident monies. They are happy to purchase items for residents and bill the next of kin for the monies spent. This appears to work well and relatives said they were happy with the system. The records showed the environment of the home is risk assessed on a yearly basis. This is good practice. Water temperatures are checked regularly and when they need altered this is done. Moving and handling training is provided to staff on a regular basis. This was confirmed through staff conversations. The home arranges for an outside agency to check equipment such as hoists, bath hoists, porter chairs and bed rails. The person in charge confirmed that there were gaps with the fire training and they are in the process of ensuring this is rectified. A number of health risks were identified with the domestic activity within the home. The domestic staff left unattended cleaning fluids in two areas of the home. A highly toxic disinfectant had been left in one of the toilets and was quite accessible. The domestic staff were unable to provide the inspector with a knowledge of the cleaning fluids they were using or how to protect themselves and others from harm. The domestic staff spoken to did not have a good command of English and were not appropriately trained in infection control or controlling substances harmful to health. This is not good practice. Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x x 2 Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 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 OP1 Regulation 4 Requirement The registered person must make sure the Statement of Purpose includes all the necessary information needed so that prospective residents and their relatives can make an informed choice. The registered person must ensure that the care plans contain all the necessary details needed to ensure staff can meet the care needs of the residents. Timescale for action 31/01/07 2 OP7 15 31/01/07 3 4 OP7 OP8 15 12,15 5 OP9 13 The registered person must ensure the residents or their representatives are involved with the development of care plans and risk assessments. The registered person must 31/12/06 ensure Registered nurses review all nursing documentation. The registered person must 31/01/07 ensure all the health care needs of the resident group are provided for within care plans and risk assessments adopted by the home. The registered person must 31/12/06 develop a Medication policy that DS0000042291.V299239.R01.S.doc Version 5.2 Page 25 Ivy House Nursing Home includes guidance for selfadministration and homely remedies. The registered person must ensure the administration of medications within the home meets the guidance set out by the British Royal Pharmaceutical Guidelines and the Nursing Midwifery Council. The controlled drugs records must be completed correctly and a suitable individual must undertake a regular audit of the drugs records.(The previous timescale of 18/5/06 had not been met.) 6 OP10 12 The registered person must ensure residents’ dignity is upheld within the care plan documentation and also with the attitudes held by some staff members. The registered person must provide more opportunities to stimulate residents within the home. This must focus on the residents specialist dementia needs. The registered person must ensure residents are offered a substantial snack in the evening time to ensure the gap between meals is no greater than twelve hours The registered person must ensure staff receive appropriate training in Adult protection. The registered person must ensure that all abusive incidents are reported to the appropriate authorities. The registered person must DS0000042291.V299239.R01.S.doc 31/12/06 7 OP12 14,16 31/01/07 8 OP15 16 31/12/06 9 OP18 13 31/03/07 10 OP19 23 31/03/07 Page 26 Ivy House Nursing Home Version 5.2 11 OP28 18 review the environment and make it more suitable for the specialist needs of the resident group. The registered person must ensure at least 50 of the carers working in the home are trained to at least NVQ level 2 standard. The registered person must provide carers with a more structured training plan that is focused on the care needs of the resident group. The registered person must protect residents from possible harm by ensuring the required information is obtained before an employee starts work. The registered person must implement a system for reviewing and improving the quality of care in the home. This should me made available to the CSCI and residents. The registered person must provide all carers with appropriate fire training. The registered person must ensure all staff working with hazardous substances are provided with appropriate training in that area to help protect the residents and themselves. 31/03/07 12 OP29 19 31/12/06 13 OP33 24 31/03/07 14 15 OP38 OP38 23 13 31/03/07 31/03/07 Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 27 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 Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Ivy House Nursing Home DS0000042291.V299239.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!