Inspection on 28/04/05 for Nairn House

This inspection was carried out on 28th April 2005.

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

Nairn House 28/11/07

Nairn House 04/07/06

Nairn House 05/09/05

Nairn House 25/11/04

Nairn House 14/06/04

Nairn House 19/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE NAIRN HOUSE 7 Garnault Road Enfield Middlesex EN1 4TR Lead Inspector Tony Brennan Announced 28 April 2005 @ 09.55 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 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. NAIRN HOUSE Version 1.10 Page 3 SERVICE INFORMATION Name of service Nairn House Address 7 Garnault Road, Enfield, Middlesex EN1 4TR Telephone number Fax number Email 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 8367 9513 020 8367 9514 kanes@bupa.com Robin Comerford for BUPA Care Homes (AKW) Ltd Vacant Post Care Home with Nursing 61 Category(ies) of Old age, not falling into any other category registration, with number of places NAIRN HOUSE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specified service user who is under 65 years of age may be accommodated in the home. 2. The home must advise the registering authority at such times as the specified service user attains 65 years of age or vacates the home. Date of last inspection 25th November 2004 Brief Description of the Service: Nairn House is owned by BUPA. Nairn House is a large purpose-built care home providing accommodation for 61 older people who require residential and nursing care. The service is provided on three floors and is serviced by a passenger lift. Each service user has a single bedroom with en-suite facilities. An office, nurse station, lounge and dining room are situated on each floor, in addition to toilets and bathrooms. The home is located close to shops and with access to public transport. NAIRN HOUSE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the eleven areas for improvement found at the last inspection were addressed. The inspection took place over one day. Sue Kane the manager assisted the inspector. The inspector spoke with nine service users, three relatives and four staff. The inspector toured the building and examined a range of records relating to the care and management of the home. The standard of care continues to improve. Since the last inspection a new manager has been appointed and will be applying to become the registered manager for the home once her probation period is complete. What the service does well: What has improved since the last inspection? What they could do better: There are eight areas where the home needs to make improvement from this inspection. Some needs that had been identified before an individual was admitted to the home had not been explained, so that staff could provide the care that is needed. Information on the needs of those living in the home had not been set out in enough detail and continence needs had not been identified in sufficient detail. There also needs to be more detailed information on the care provided of people with pressure sores. A range of activities, which reflect NAIRN HOUSE Version 1.10 Page 6 the varied needs and preferences of the people at the home needs to be agreed. Fire doors must not be wedged open. People living at the home said that there need to be more staff throughout the day. The staffing level needs to be reviewed to ensure that all the needs of those living at the home are being met. All staff need to receive regular supervision from their manager. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. NAIRN HOUSE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection NAIRN HOUSE Version 1.10 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 standard(s) 1,2,3,4 Service users and prospective service users are provided with comprehensive information about the service. Service users obligations and rights are set out in a statement of terms and conditions. Not all service users assessed needs are being met. EVIDENCE: Service users spoken to say that they had information on the service provided at Nairn House. The statement of purpose and the service users guide were found to contain all the required information. Both were clearly written and easily accessible. The statement of purpose had been updated to include information on the new manager. The inspector found that all service users had a signed contract. Service users said they felt that staff had the necessary skills to meet their needs. The inspector saw that the files of recently admitted service users contained initial assessments by the home and from social workers. The inspector saw that the assessments highlighted needs that had not been identified in care plans or professional involvement. NAIRN HOUSE Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Service users have insufficient information on how their needs are met. Service users medical needs were not being met. Service users are protected by safe procedure for handling medication. EVIDENCE: Service users said that they felt that the standard of care was good. The manager explained that since the last inspection she has started to develop more detailed care plans that provide more information on how needs should be met. Care plans seen still needed to include more information detailing the actions to meet the needs of service users. The inspector examined the falls assessments for service users and found that where risks had been identified that a falls prevention plan had not been put in place. Care plans were being reviewed monthly. Service users and their representatives had signed to show they had agreed them. Service users spoken to said that personal care is provided which meets their needs and this is done sensitively. Staff spoken to could explain the specific needs of service users and how these are met. Although there was a waterlow assessment for tissue viability in place, the care plans on this area were not detailed to the dressing and treatment required. Equipment was seen to be in place for the prevention and treatment of pressure sores. At the last NAIRN HOUSE Version 1.10 Page 10 inspection the home was required to develop the continence management plans. The inspector found this needs to be done. More detailed information available on how the continence needs are being met must be made available. Nutritional assessment and weight monitoring is being carried out. The records of medicines received, administered and returned were found to be complete. The inspector was able to observe staff administering medicines and found that this was done in a safe manner. Controlled medicines were recorded and the necessary storage was provided. The records showed that staff had received medication training. NAIRN HOUSE Version 1.10 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 standard(s) 12,15 Service users are not provided with sufficient activities. Service users are provided with a choice of varied and balanced meals. EVIDENCE: Service users said that since the activities organiser left there have been fewer activities organised for them. A service user commented that what is provided does not interest her. The inspector did not see any activities taking place on the day of the inspection. The manager explained that staff have been told to provide activities. The manager explained that an activities organiser has been recruited and is awaiting CRB clearance. The inspector also found that there are no activities provided for service users who have a degree of memory loss. The needs of these service users should be included in the planning of activities in the future. Service users commented that the food was good and choices were provided. The menu showed that varied and balanced meals were offered. Service users said they were consulted daily about the choices being offered. The inspector saw that meals were well presented and they were provided in a relaxed environment. NAIRN HOUSE Version 1.10 Page 12 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 standard(s) 16,18 Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Service users said that they felt confident in making their concerns known to staff. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. Service users said that they felt safe and could approach staff if they had any concerns regarding how they were treated. There were comprehensive policies on handling abuse and protection. Staff spoken to were clear about the signs of abuse and how suspected abuse should be handled. NAIRN HOUSE Version 1.10 Page 13 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 standard(s) 19,24,26 The home provides a safe and well-maintained environment for service users. Service users are put at risk by fire doors being wedged open. Service users bedrooms are comfortable and they have their personal possessions. Service users are safe-guarded against cross infection. EVIDENCE: Since the last inspection the hallways on all three floors have been redecorated. The manager showed the inspector a letter from the fire prevention officer to confirm that the self-closure devices on bedroom doors were appropriate. The inspector checked a number of the closure devices and found that they did not cause the doors to close completely when activated. The inspector also saw that bedroom doors were wedged open. This was called to the attention of the manager who removed the wedges. The gardens were seen to be safe and attractive. Service users said that their bedrooms were comfortable. Service users bedrooms are appropriately decorated, furnished and carpeted. The bedrooms seen were personalised. Service users commented that they had chosen the items they wanted in their bedrooms. The manager explained that nursing beds for those service users who don’t NAIRN HOUSE Version 1.10 Page 14 have them have been ordered. The inspector was able to confirm this by seeing evidence of the purchase. The inspector found that the home was clean and hygienic. Staff spoken to understood how to prevent cross infection and equipment was provided for this purpose. NAIRN HOUSE Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Sufficient staff are not available at all times to meet Service users needs. Staff have the skills and knowledge to meet the needs of service users. Service users are protected by the homes recruitment practices. EVIDENCE: The rota was seen and showed that a consistent staffing level was being maintained. Service users commented that staff were not always available first thing in the morning. Also staff commented that there were occasions when they should have two workers to operate a hoist and they did not. This was discussed with the manager who agreed that a review of the staffing level should be carried out. Five staff files were checked. These were found to contain all the required information. Training records showed that 50 of staff had achieved NVQ in care. Training records showed that since the last inspection, first aid training had been carried out. An appropriate induction programme was in place and staff spoken to confirmed that this was being used. All other statutory training had been provided. NAIRN HOUSE Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37,38 The home is managed effectively so that the needs of service users are met. Staff are motivated. Staff are not appropriately supervised. Records are maintained as is required. Service users and staff health and safety is promoted at all times. EVIDENCE: The manager has recently taken up post. The manager explained that she has nursing experience and has worked in management of other BUPA homes. The manager has started her registered managers award. The manager will be applying to the Commission for registration as the manager for Nairn House once she has completed her probation period. Staff and service users spoken to said that the manger was approachable and worked with them to improve the home. A service user and a relative said that the home had improved since the new manager had come, and that she had a ‘very positive way of doing things’. The inspector saw minutes of staff and heads of department meetings that showed that a clear view of how the home should operate was being communicated to staff. Staff spoken to said that they had not had NAIRN HOUSE Version 1.10 Page 17 regular supervision. The inspector found that records of supervision showed that supervision was not taking place six times a year. All records seen were up to date and accurate. The inspector found that staff had training on health and safety topics. The hoists had been checked and all first aid boxes had all the necessary items. The necessary records of food temperatures and of the fridge and freezers had been maintained. Gas and electrical certificates were seen and in date. Fire records were checked and showed that drills and testing was ongoing. The home had all the necessary policies and procedures in place to ensure the safety of service users and staff. There was a record of accidents in place and a regular audit was carried out to establish if there was any pattern or important factor that might be causing accidents. NAIRN HOUSE Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 3 x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 2 3 3 NAIRN HOUSE Version 1.10 Page 19 yes Are there any outstanding requirements from the last inspection? 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. Standard 4 7 Regulation 14, 15 15(1) Requirement The registered manager must ensure that all assessed needs are being met. The registered persons must ensure that care plans cover all the idenified needs of service users and how these will be met. The registered persons must ensure that service users contenence needs are identified in care plans. (This requirement is restated from the last report). The registered persons must ensure that there are tissue viability care plans that detail the treatment and preventive action regarding pressure sores. The registered persons must ensure that a range of activities that meet the needs of service users is in place. The registered persons must ensure that fire doors are not wedged open. The registered persons must ensure that a review of the staff level is carried out using the staffing assessment tool to establish that there are enough staff to meet the assessed needs of service users. Version 1.10 Timescale for action 1/8/05 1/8/05 3. 7 15(1) 1/8/05 4. 8 15(1) 1/8/05 5. 12 16(2)(n) 1/8/05 6. 7. 19 27 23 18(1)(a) 1/6/05 1/8/05 NAIRN HOUSE Page 20 8. 36 18(2) The registered persons must ensure that staff supervision takes place six times a year and that this is recorded. 1/8/05 9. 10. 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 Good Practice Recommendations NAIRN HOUSE Version 1.10 Page 21 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 NAIRN HOUSE Version 1.10 Page 22 - 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. 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