CARE HOMES FOR OLDER PEOPLE
Meera House Nursing Home 146-150 Stag Lane Kingsbury London NW9 0QR Lead Inspector
Julie Schofield Unannounced Inspection 29th September 2005 10:50 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 Meera House Nursing Home DS0000022933.V253076.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. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Meera House Nursing Home Address 146-150 Stag Lane Kingsbury London NW9 0QR 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) 020 8204 9140 020 8206 2205 directors@meeranursing.com Meera Nursing Home Limited Anil Kumar Sohun Care Home 52 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (17), Old age, not falling within any other of places category (34) Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Up to 1 person over the age of 65 who requires personal care. Up to 51 persons over the age of 65 in need of nursing care. Within the nursing care places up to 17 persons over the age of 65 years who require dementia care. Temporary variation agreed for one named individual (Mrs MJ) aged 63 years EMI for the duration ofher stay. 4th January 2005 Date of last inspection Brief Description of the Service: Meera House provides personal and nursing care for up to 52 residents who are elderly. The home predominantly provides a service for Asian elders, who are vegetarian. The home is located within a short drive from shops and amenities in Kingsbury and Edgware. It is also close to local transport facilities. There is parking on site and it is possible to park in the street close to the home. The home has stood on the site since 1989 and has been extended over the years. The last extension in 2003 increased the maximum numbers of service users from 34 to 51 places. An application for registration of another bedroom was approved in 2005. The home now has 42 single bedrooms (25 of which have en-suite facilities) and 5 rooms occupied on a shared basis (4 of which have en-suite facilities). Bedrooms are situated on ground, first and second floors and there are passenger lifts to assist movement. Bathing and toilet facilities are situated on each floor. There are 2 large open plan lounge and dining areas. The home has a well-maintained enclosed and accessible garden, which includes a paved patio area. At the time of the inspection 49 residents were accommodated in the home. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 2 unannounced visits to the home. The Inspector would like to thank the deputy manager and the administrative staff for their assistance during the first inspection visit, which started at 10.50am and finished at 1.10pm. During this visit records were inspected and the serving of the midday meal was observed. A partial site inspection took place. The Inspector would like to thank the manager, staff and residents for their assistance during the second visit, which started at 8.35 am and finished at 11.20 am. During this visit records were inspected and discussions took place. What the service does well: What has improved since the last inspection?
Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 6 The home has printed copies of its action plan in response to the inspection that took place in January 2005 and these are available to visitors to the home. The home has complied with the statutory requirements identified in the report of the last inspection. The home has continued to develop a comprehensive programme of activities, in consultation with residents that are appropriate to their age, cultural background, level of understanding etc. A daily record is kept of the meals consumed by each individual resident. The home keeps a record of the hours worked by their staff in other care homes/hospitals to ensure that staff are not in breach of the Working Time Directive and not compromising the welfare of residents in Meera House. The home has complied with the requirements identified in the report of the inspection carried out by the pharmacy inspector on the 11th January 2005. 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. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 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 Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 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): 5, 6 Residents and their families are involved in the process of choosing a care home that can meet the needs of the resident and make their decision after an introductory visit to the home. EVIDENCE: Three of the residents who took part in the inspection had been admitted to the home during the previous 6 months. A resident said that they had visited the home before their admission. They had visited the home with their relative. They had formed a good first impression and had liked the Asian food, the bhajans and the activities. They had been able to see the room that they would occupy after admission and had met staff and the residents already living in the home. Another resident said that they had a good feeling when they first visited the home. The deputy manager said that that prospective residents and their family are encouraged to visit the home, prior to admission, as part of the pre-admission procedure. The home does not offer an intermediate care service.
Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 9 Meera House Nursing Home DS0000022933.V253076.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): 9, 10 The storage of medication, its administration and record keeping promotes the general health of residents. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. EVIDENCE: During an inspection by the Pharmacy Inspector in January 2005 a number of requirements were identified and these have now been met. It was noted during the inspection that assistance with personal care was offered in a discreet manner. Private visits by healthcare professionals are carried out in the privacy of the resident’s bedroom. Visits by relatives can also be made to the resident’s bedroom. Staff knock on bedroom doors before entering. Residents are able to make and to receive telephone calls in private. It was noted that members of staff addressed residents in a respectful manner. Screening is provided in rooms that are occupied by 2 residents. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 11 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, 15 Providing activities for residents offers residents an opportunity to develop their social and communication skills and to enjoy an interesting and stimulating lifestyle. The support of staff enables residents to maintain family contact. Residents have a varied and balanced diet and said that they enjoyed the meals served in the home. EVIDENCE: During the first visit there was a keep fit session taking place in one of the lounges and staff were standing in front of the residents and were exercising to the music and were encouraging the residents who were taking part. During the second visit bhajans were taking place in one of the lounges and residents said that they enjoyed these. Participation in the bhajans was enthusiastic. Celebration of festivals was respected and the lounges had religious pictures and artefacts. Activities were also taking place and some of the residents enjoy artwork. One of the deputy managers showed the Inspector pictures made by the residents. Some residents had learnt how to knit and one resident had made a shawl for a religious statue. A resident said that they had pains in their legs and that staff massaged the legs. The resident also
Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 12 described doing some exercises and said that the physiotherapist helped them to maintain mobility. The deputy manager who is responsible for the EMI unit is also the activities co-ordinator and said that the programme of activities included opportunities for discussions, yoga, keep fit, painting, knitting, cards, games and reminiscence sessions. During both visits relatives of residents visited the home. Residents confirmed that their visitors were made welcome to the home and that visits could take place in the lounge areas or in their bedrooms. Most visits take place at the weekends and the activities co-ordinator said that most activities are arranged Mondays to Fridays so that residents are able to enjoy their visits. Residents described the meals served in the home and agreed that the menu was varied and that their favourite vegetables were served. The standard of cooking was praised. During the first visit lunch was served and it consisted of rice, chapattis, curried sweet corn and kidney beans, dhal, poppodoms, buttermilk, salad and pickles. There was a milk-based dessert, similar to semolina. During the second visit the Inspector saw the kitchen. The lunch was being prepared and there was a good selection of fresh fruit and vegetables. The menu was available for inspection. The home provides meals suitable for diabetics. Some residents do not eat root vegetables. Although the main meal is served at lunchtime there were hot dishes on the menu for the evening meal, if residents wished. Records are now kept of the meals consumed by individual service users, on a daily basis. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The welfare of residents is promoted and protected by having a complaints procedure in place. Residents said that there was someone that they could talk to if they had any concerns. An adult protection policy and in depth protection of vulnerable adults training for staff contribute towards the safety of residents. In-house training needs to be supplemented by access to external training. EVIDENCE: The complaints procedure was on display in the home and a copy is contained in the service users’ guide. It is written in both English and Gujarati. The procedure informs the complainant of their right to contact the CSCI, local councillor and the Ombudsman. It includes timescales for the acknowledgement of a complaint and for notifying the complainant of the outcome of the investigation. Six complaints have been recorded since the last inspection and the records included the outcome of the investigation and details of the response given to the complainant. A resident said that if there was a problem “everyone listened including the owner” and other residents confirmed that if they had any concerns they could speak to someone in the home. The home has an adult protection policy, a whistle blowing policy, a countering bullying procedure, a harassment policy and an aggression towards staff policy. The deputy manager said that no allegations or incidents of abuse have been recorded since the last inspection and confirmed that staff have received in house training in adult protection procedures and this is recorded in their
Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 14 files. The home has a training video for use with adult protection training. She said that the home does not practice restraint. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 15 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): 20, 24 With access to comfortable lounge and dining areas and their bedrooms, which residents said they were pleased with; residents had a choice of socialising or enjoying their privacy. EVIDENCE: There are 2 open plan lounge/dining areas in the home. Both have access to the garden and patio areas, which are attractively landscaped. On the first visit it was noted that some old cabinets had been placed on the patio area near the lower ground floor. It is proposed that over time the lounge on the lower floor will accommodate residents with dementia but at the moment residents have the choice of where they wish to sit. It was noted that some residents like to use both lounges. These areas are comfortably furnished and provide a “homely” environment. Religious observances take place in the lounge areas. The communal space meets the spatial standards specified in the National Minimum Standards. Residents said that the home was kept clean and tidy.
Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 16 Residents said that their privacy was respected when they wished to pray in their bedrooms or to rest in their bedrooms. They described their bedrooms as comfortable and those whose rooms were on the first or second floor confirmed that the passenger lift was suitable for their needs. Some residents like to leave their bedroom doors open and it was noted that bedrooms were comfortably furnished and clean. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 17 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 The rota demonstrated that there were always sufficient members of staff on duty to support the residents and to meet their needs. Residents were satisfied with the quality of care. NVQ training enhances the quality of care provided to residents and the home needs to ensure that staff complete this. EVIDENCE: There are separate rotas for each of the 2 units in the home. Each rota has a separate section for nurses and for carers and day staff and night staff are shown separately. There are sections for support staff e.g. domestic and catering staff. The deputy manager said that 4 carers are allocated to each unit, on each shift during the day. At night 2 carers are allocated to each unit. A nurse is in charge of each unit on each shift during the day and the night. Most of the carers in the home are Gujarati speaking and are able to talk with residents in the residents’ first language. Many carers share the religious and cultural backgrounds of residents and understand and respect these needs. Eight carers applied for enrolment on NVQ level 2 training courses and 3 were accepted. The other 5 staff are studying English language courses prior to commencing NVQ training. Two staff have been interviewed for NVQ level 3 training courses and are due to start their studies soon. One of the residents said that the care given in the home was “exceptionally good” and other residents described staff as “helpful”. The manager acknowledged that the
Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 18 timescale of 31 December 2005 for 50 of carers achieving an NVQ level 2 qualification would not be met. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 19 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, 38 The registered manager continues to develop his knowledge through further training and this contributes towards understanding the needs of residents and staff. There is a commitment to complete the NVQ level 4 training. There are systems in place in the home for residents and their relatives and members of staff to be involved in the running of the home. Fire precautionary systems and equipment help safeguard residents, staff and visitors and these have been maintained and serviced to a satisfactory standard. Maintaining and servicing equipment used in the home to a satisfactory standard promote the safety of residents and there are certificates to demonstrate this. The temperature of the hot water supply to wash hand basins needs to be monitored so that residents do not use water that is above the recommended safe temperature. Security in the home benefits both residents and staff and arrangements for giving access to visitors needs to be reviewed. EVIDENCE: Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 20 The manager already holds a DMS, has a masters’ degree in social policy and administration and is a qualified RGN. The college has advised him that he only needs to complete 2 of the modules of the RMA to meet the requirements of the course. However he acknowledged that the timescale of 31 December 2005 for achieving the RMA would not be met. There are clear lines of accountability within the home and a sound management structure. Residents (and their relatives) and staff have the opportunity to give their comments on the running of the home during meetings with the management team. The minutes of the last relatives meeting, held on the 3rd September, were available. Eighteen of the residents were represented by one of their relatives. Minutes of staff meetings were also available. The minutes for the staff meeting were produced. These are held for each unit, on a monthly basis. The proprietors visit the home on a regular basis and they speak to residents during their visits. Information about the home is printed in both English and Gujarati. When the first visit commenced a relative opened the front door to the Inspector and the Inspector walked around the ground floor until they saw the deputy manager, without being challenged by a member of staff. Records of weekly fire alarm tests and of monthly fire drills were available. They were up to date and complete. There were certificates for the regular servicing of fire precautionary systems. There was evidence of regular servicing of the lifts, hoists water tanks, nurse call system, portable electrical appliances and the electrical installation. The date of the Landlords Gas Safety Record was the 11th September 2004. There was written confirmation from the LFEPA and the environmental health office that recent visits had found satisfactory standards in the home. Contracts were in place for the disposal of waste and the disposal of clinical waste. The temperature of the water leaving the hot water taps in the bedrooms was recorded as reaching 44.9 degrees centigrade. This is above the recommended temperature of 43 degrees centigrade. Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 21 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X 2 X X X 3 X X STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X X X X 2 Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 22 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 2 3 Standard OP18 OP20 OP28 Regulation 13.6 23.2 18.1 Requirement That staff have access to external training courses on adult protection procedures. That the cabinets on the patio area near the lower ground floor are removed. That 50 of carers achieve an NVQ level 2 qualification. (Previous timescale of 31 December 2005 not met). That the manager achieves an NVQ level 4, or equivalent, in management and care. (Previous timescale of 31 December 2005 not met). That the home reviews its security system in respect of visitors to the home That the home forwards a copy of the certificate for the Landlords Gas Safety Record test carried out in 2005. That the supply of hot water to the bedrooms is adjusted so that the temperature does not exceed 43 degrees centigrade. Timescale for action 30/06/06 01/02/06 31/12/06 4 OP31 9.2 30/06/06 5 6 OP38 OP38 12.1 13.4 01/02/06 16/01/06 7 OP38 13.4 16/01/06 Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 23 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 Meera House Nursing Home DS0000022933.V253076.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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