CARE HOMES FOR OLDER PEOPLE
Miranda House Nursing Home High Street Wootton Bassett Wiltshire SN4 7AH Lead Inspector
Tim Goadby Unannounced Inspection 24th February 2006 09:25 – 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 Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Miranda House Nursing Home Address High Street Wootton Bassett Wiltshire SN4 7AH 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) 01793 854458 01793 953951 Quality Care (Wiltshire) Limited Mrs Gillian Gray Care Home 68 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (68), Mental disorder, excluding learning of places disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (68) Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons less than 45 years of age may not be accommodated. No more than 2 persons not less than 50 years in receipt of day care at any one time. Where the total number of persons accommodated exceeds 43, a maximum of 4 additional persons per week may be admitted during the following period 08/12/2005 to 26/01/2006 8th June 2005 Date of last inspection Brief Description of the Service: Following a recent expansion, Miranda House now provides care with nursing, and accommodation, for up to 68 adults. These may be people with dementia, or other mental health problems. The homes registration conditions enable it to offer a place to anyone over the age of 45. But the majority of service users tend to be older people. The home is therefore inspected using the standards for this group. The service is also able to offer two day care places for people, aged 50 and over. The home is operated by a private company, Quality Care (Wiltshire) Limited. The responsible individual is Mr Peter Saunders. He lives locally, and has regular contact with the service. The registered manager is Mrs Gill Gray. Miranda House is in Wootton Bassett, near Swindon, Wiltshire. It opened in 1996, and was extended in 2005. The purpose built accommodation spreads over two floors, with passenger lifts between them. Most bedrooms have ensuite toilet facilities. Three double rooms are available. The rest are singles. Baths and showers are provided in various locations throughout the building. There is also a range of communal space, including lounges, dining rooms and a conservatory. Activity areas include a sensory room, which has a range of equipment to offer relaxing and calming experiences. Externally, there is a pleasant, accessible garden. The service also offers adequate parking spaces. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in February 2006. A total of 5.5 hours was spent in the home. The following inspection methods have been used in the production of this report: indirect observation; pre-inspection questionnaire, completed by the provider; sampling of records, with case tracking; sampling a meal; discussions with service users, visitors, staff and management; survey of service users and relatives; tour of the premises. Comment cards were received from eight service users. All indicate general satisfaction with the care provided. The majority state that they feel well cared for and safe at all times. Similarly, responses from three families raise no concerns. What the service does well: What has improved since the last inspection?
Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 6 Since the inspection of June 2005, there has been various regulatory contact with Miranda House. This included an additional inspection visit in October 2005, at which ten of the requirements issued in June were found to be met. The home is now able to demonstrate effective support to service users with complex and challenging needs. Key issues are addressed more fully in individual records. The approaches for management of these uphold expected principles, including positive approaches to addressing needs that might otherwise be perceived as problems, such as ‘wandering’. Documented guidance recognises the rights of service users, and seeks ways to uphold these, looking for ways to promote constructive engagement by adapting existing behaviours. Key health needs for any service user are also set out in greater clarity, to promote the delivery of effective care. Service users benefit from regular evaluations of care, with input from relevant professionals. There is evidence of regular and meaningful review of individual care plans. Support is being received at least once a month from a local mental health consultant and his team. Service users can be confident that the home is open and transparent in responding to issues of concern, and involves other agencies in following up on these. The importance of recording and reporting any significant event, including the notification of other agencies, is clearly stressed in care plans. Various incidents affecting the well-being and safety of service users have been notified to the Commission, and other relevant persons, over the months since the previous inspection. Recruitment and selection practices uphold all statutory requirements, to safeguard the welfare of service users. Records show that the appropriate level of Criminal Records Bureau Disclosures have been obtained for all nursing and care staff. There is also evidence that new employees do not commence working at the home until a satisfactory result has been received from a check of the national list of those deemed unsuitable to work with vulnerable adults. A bathroom with an adapted bath is back in use, enhancing the facilities available to service users to ensure their personal hygiene needs can be met. Arrangements for fire safety have been enhanced, to uphold the safety and welfare of all users of the building. All necessary checks are now being carried out and recorded at the prescribed frequencies. All designated fire exit routes are being kept free of obstructions. A further five requirements were met at this inspection. All nursing and care staff have received training in the use of physical interventions. The training is also to be provided for all new staff. This ensures that service users and staff are protected when such interventions may be necessary, as they are only practised by people with the appropriate knowledge and skills.
Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 7 Notification of any accidents involving service users is being made to the CSCI. People can feel confident that the home is open and transparent in the reporting of significant events. There have been improvements in record keeping, to ensure that these systems support the delivery of effective care to service users. There are clear and objective descriptions of behaviours of concern. Records are updated to reflect current issues and progress. Practices in the recording for medication have been amended, to ensure that service users are protected from possible harm by minimising the risk of errors or confusion. Any alterations to medication charts are made clearly. They are initialled and dated; and the original entry remains visible. All additions to the charts are also signed, including any printed labels. The new extensions to the property have provided several areas of additional storage space, which can be used for equipment when it is not in use. This means that areas such as bathrooms can be kept free of such items, making them more readily accessible to service users and staff. What they could do better:
Service users are still placed at some risk by deficits in the planning for management of behavioural needs. Clearer definitions are needed of the support to be given by staff. Some discrepancies in guidance need to be removed. The parameters for the use of certain restrictions, such as asking people to remain in their own rooms for a time, need to be made explicit. Decisions about the use of bed sides for individual service users are not always supported by the necessary documented risk assessments and evidence of consent. This places people at risk that the practices in place may not be demonstrably suitable or safe for them. Some safety gates have been fitted in doorways. This practice is not supported by documented risk assessments. Service users may be at risk of harm if they are likely to fall over these gates. The kitchen floor is noticeably discoloured in a number of places, compromising effective hygiene in this area. Thorough cleaning is necessary to establish whether or not these markings can be removed. A decision can then be made on retention or replacement of the existing covering. Some service users have money held on their behalf in a ‘pocket money’ account. Care home regulations mean it is generally not permitted for services to pay money belonging to users into an account, other than one in their own name. But this rule does not apply if the money is paid in respect of services provided by the home, as appears to be the case for this arrangement. The
Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 8 service should clarify this area. Relevant advice has been provided on this issue. Miranda House’s quality assurance system currently relies mainly on an annual audit of a full range of indicators. With the substantial increase in the size of the home, it will be more sensible in future to spread the quality assurance process across the year. Care should also be taken to show the evaluation of progress on any goals which have been set, to demonstrate that service users benefit from an ethos of continuous improvement. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Service users have their needs assessed before they move into the home. Service users have their needs and aspirations met by the home. EVIDENCE: Initial assessment of prospective service users takes place before admission. This continues over the period when somebody first moves in. Beyond this, there is ongoing monitoring. People are assessed by senior staff of the home. Relevant input is also obtained from the user, where possible, their family or carers, and any professionals who have been involved. Mostly people will be visited in their present setting. This might be their own home, or a hospital or other care home. If people are transferring from another part of the country, then assessment might have to be done through telephone discussions. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 11 Miranda House provides for service users with dementia, or other mental health problems, who are over the age of 45. The majority of service users tend to be older people. People at the younger end of the home’s age range, perhaps with early onset of dementia, are likely to have other significant needs. For instance, many of the user group may also have associated physical health difficulties. Various adaptations and equipment are in place, to make the environment suitable for service users. There are also certain security arrangements, to assist with promoting safety. Miranda House has qualified nursing staff on duty at all times. Nurses work alongside carers. The service also has links with other local health professionals. Where people’s needs change significantly, decisions about whether placement at the home can continue are made in consultation with all concerned. The substantial increase in registered places at the home, from 43 to 68, is being managed carefully. New admissions are being introduced in a phased manner, with suitable staff increases being put in place first. 13 service user places remained to be filled at the time of this inspection. A relative visiting the home during this inspection commented that they do so regularly, and at varying times of day. They have always found the standard of care to be good, and they expressed confidence in the quality of service provided. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Service users have their abilities, needs and goals reflected in their individual plans. EVIDENCE: There is a primary nurse for each of the areas in the home. They have lead responsibility for the care plans of the service users in that part. Standard practice is to denote in records that people have been unable to contribute to planning their own care, due to their reduced mental capacity. This should be kept under review, as it is not necessarily always true of all individuals. There are template care plans for some common areas. The relevant individual details can be entered into these. They are also expanded with further information, where necessary. Beyond this, for each service user more specific care plans are also devised, as indicated. Related risk assessments may also be put in place. These cover various topics, such as moving and handling, mobility, falls, pressure area care and dementia. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 13 People’s rights of access to care plans are set out in the home’s policy. This includes information about the arrangements if it is a service user’s representative who wishes to see the documentation. Arrangements are in place for the regular review of care plans. There is evidence that this system is being applied effectively. Medication practices were not inspected fully at this visit, but relevant requirements and recommendations of the June 2005 inspection were followed up. These have been addressed satisfactorily. Any alterations to medication charts are made clearly. They are initialled and dated; and the original entry remains visible. All additions to the charts are also signed, including any printed labels. The procedure for administration of medication on the ground floor has been reviewed, to reflect the increased size of the home. A medicines trolley is now used. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 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): 14 & 15 Daily lives for service users have an appropriate balance between necessary routines, and individual choice. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Individual choice is facilitated wherever possible. People are able to personalise their own rooms by bring in items which are special to them. One service user has their own pet dog. Service users’ care plans include guidance on any support they may require in the areas of diet and nutrition. Nutritional risk assessments are also carried out. During this visit, the inspector joined service users having their midday meal in the main ground floor dining room. The food served was seen to be attractively presented, and of suitable portion sizes. Any service users needing staff support during the meal had this provided appropriately. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 15 The kitchen and food storage areas were also viewed. A number of new appliances and pieces of equipment have been obtained since the previous inspection. There is also more space now within the revised layout of the building. Systems are operating effectively for delivery of prepared meals to all areas of the enlarged home. The cook is supported by a kitchen assistant. Menus are drawn up over a four week cycle. These are being adjusted to reflect the differing needs of some of the home’s newer residents. Specialist dietary needs are supported, such as people with diabetes, or those with difficulties in chewing and swallowing. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 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): 18 Service users are safeguarded by the home’s policies and procedures for protection from abuse. Service users are placed at some risk by deficits in the planning for management of needs associated with behaviour and mental state. EVIDENCE: Miranda House may support some service users who present with disturbed or aggressive behaviour, associated with their mental health needs. The prevalence of such issues has decreased over recent months. When incidents have occurred, they have been recorded and reported appropriately. This has included the consideration of some events under local multi-agency adult protection procedures. The home has worked co-operatively and effectively within the required protocols to uphold the protection of its vulnerable service users. Physical interventions may be required with some service users. Sampled records show that there are definitions of the techniques to be applied with any individual. All staff have received training in these, and this instruction will also be provided to any new employees. Guidelines in service user records for the management of behavioural needs have shown significant improvements over recent months. However, at this inspection, some further areas for attention were identified. Clearer definitions are needed of the support to be given by staff. Some discrepancies in
Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 17 guidance need to be removed. The parameters for the use of certain restrictions, such as asking people to remain in their own rooms for a time, need to be made explicit. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 18 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 & 26 Service users live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: Miranda House is a purpose built care home. Service user accommodation is over two floors, served by lifts and stairs. A security lock system is used on the doors to stairwells and exits, to reduce risk to any service users who are confused. There is a large garden to the rear of the property, and several off road parking spaces are available at the front. The home has a full time handyman. There is ongoing maintenance and redecoration for the older part of the property. Rooms are usually refurbished whilst they are vacant. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 19 Work on construction of two extensions, on either side of the original property, was completed in late 2005. One of these is single storey. Variation to the home’s registration was approved by the CSCI, increasing the number of registered places to 68. Some decorative items remained to be finished at the time of this inspection. For instance, some blinds and curtains were still awaited. The majority of service users have single bedrooms. Three larger rooms are available, so that the option to share is possible for anyone wishing to do so. Rooms are personalised to reflect the tastes of their occupants. People are able to bring in their own items of furniture and ornaments. As well as increasing the number of bedrooms, the extension to the property has provided additional communal areas, bathrooms and showers, staff office space and break areas, and storage space. There are lounges and dining areas on both floors. The ground floor also has a conservatory, and a sensory room. Externally, Miranda House has a pleasant garden area, which service users enjoy accessing when weather permits. Some space was lost to the building work, but the remaining grounds still provide a valuable resource. Some landscaping work is taking place to restore them to use. All bedrooms have en-suite toilets and handbasins. Bathrooms and showers are also provided at various locations throughout the home. The home was generally clean and tidy in all areas seen at this unannounced inspection, and free of odours. The kitchen floor is noticeably discoloured in a number of places. Thorough cleaning is necessary to establish whether or not these markings can be removed. A decision can then be made on retention or replacement of the existing covering. There are appropriate systems in place for the management of laundry in the home. All items are washed on site, and Miranda House employs its own staff to carry out this task. The reallocation of space following completion of building work will include the provision of a second laundry room. This will create more space for ironing and pressing of items. It is also hoped to provide an extra washing machine and drier, which would mean that the home then has three of each. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 20 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 Service users are supported by suitable numbers of staff. EVIDENCE: Miranda House is registered to provide nursing care. This means that a qualified nurse is on duty at all times. Staff are allocated to both of the two floors. Each shift on each floor is led by at least one nurse. They are supported by senior carers and other care staff. Numbers on duty are being increased, in line with the larger number of service users now being cared for. On the ground floor, at full capacity of 33 service users, cover will consist of seven nursing and care staff on duty for all daytime hours. At night, there will be four staff, all of whom work a waking shift. On the first floor, caring for up to 35 people, there are a minimum of seven nursing and care staff on duty for daytime hours. This is usually supplemented by an extra carer on the early shift. Night time cover again consists of four waking staff. Staff are usually allocated to a specific floor, except for night staff, who may work on either. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 21 The home generally enjoys a stable staff team, with low turnover. Any gaps in cover are filled by staff working additional hours, or by relief workers. Agency workers may also be used, if necessary. Recruitment was ongoing around the time of this inspection, to fill the additional posts needed to enable the home to admit service users to all the new places. The home also employs staff for other key tasks, such as catering, cleaning, laundry and maintenance. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 22 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, 37 & 38 The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Quality assurance measures underpin service developments, and include actions based on the views of service users. The home should clarify how service users’ financial interests are safeguarded by the systems in place. Effective record keeping is maintained, upholding service users’ best interests. Service users are placed at risk by a failure to have appropriate evidence to support the use of equipment such as safety gates and bed sides. EVIDENCE: Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 23 Miranda House has a quality assurance system which is based around an annual audit of the service. Outcomes are measured under a range of headings – service user care; system structures; quality improvement; and organisational fitness. Each of these in turn has a number of sub-sections. Performance is compared with previous audits. Any reasons for noncompliance are identified. Goals and targets are set. Alongside the internal management checks, feedback is also obtained from a relatives’ questionnaire. Service user input to the process is difficult to achieve directly for the majority of the group at Miranda House. But there is a focus on issues which are relevant to them, via the measurement of outcomes. With the substantial increase in the size of the home, it will be more sensible in future to spread the quality assurance process across the year. Care should also be taken to show the evaluation of progress on any goals which have been set. The home attempts to limit direct involvement in the management of service users’ money. Most people have their affairs managed by relatives or other representatives. If any amounts are held in safekeeping on site, there are suitably secure arrangements for this. Appropriate records are also maintained, including the retention of receipts. Some service users have money held on their behalf in a ‘pocket money’ account. Care home regulations mean it is generally not permitted for services to pay money belonging to users into an account, other than one in their own name. But this rule does not apply if the money is paid in respect of services provided by the home, as appears to be the case for this arrangement. The service was recommended to clarify this area, and relevant advice was provided following the inspection. Sampled service user records contain appropriate detail and description about any significant events which have occurred. Child safety gates have been fitted in some ground floor doorways, for differing reasons. In one case, it is to prevent service users entering an office area and perhaps removing important papers from desks. In another, it is to ensure that a resident’s pet dog remains in their bedroom. There are no documented risk assessments in place for the use of this equipment. There are potential safety issues, as confused or disoriented people may come to harm if falling over these gates, which are around waist height for most adults. Bed sides are in place for a number of people. Sampled records showed that risk assessments and evidence of consent are in place in appropriate detail in some cases, but not yet all. Conversely, for another individual, a decision has been reached not to use bed sides, because this might increase the risk of Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 24 harm for that person. So an alternative approach to minimise risk is in place. But there is no documented information about this decision. Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 25 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 3 X X 3 3 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 26 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 OP18 Regulation 12-1 13-6,7,8 Requirement There must be clear, objective guidelines for staff management of potential disturbed behaviour from service users. In particular, any use of physical interventions must be applied appropriately, to ensure suitable individual approaches. (Timescale of 30/11/05 not met) This part of Regulations also applies to the above Requirement. The persons registered must ensure that documented risk assessments, and written evidence of consent, are in place for any decision about the use of bed sides. (Timescale of 19/08/05 not met) Suitable risk assessments must be in place to support the use of safety gates. Timescale for action 30/04/06 1 2 OP18 OP38 17-1a Sch3-3p,q 12-1,2,3 13-7,8 30/04/06 30/04/06 3 OP38 12-1 13-4 30/04/06 Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 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. 1 Refer to Standard OP7 Good Practice Recommendations Decisions regarding the capacity of service users to contribute to their own care planning should be kept under review. COMMENT: This recommendation of the previous inspection was not checked at this visit. There should be thorough cleaning of the kitchen floor, to establish whether the covering is in need of replacement. The application of the quality assurance system should be reviewed, to make this more manageable over the course of the year. The home’s system for management of service users’ money should be checked to ensure it falls within approved guidance. 2 3 4 OP26 OP33 OP35 Miranda House Nursing Home DS0000015930.V284827.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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