CARE HOMES FOR OLDER PEOPLE
Nairn House 7 Garnault Road Enfield Middlesex EN1 4TR Lead Inspector
Tony Brennan Unannounced 5 September 2005 @ 11.00 am 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 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 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 8357 9514 Robin Comerford for BUPA Care Homes (AKW) Ltd Ms Farida Khan N Care Home with Nursing 61 beds Category(ies) of OP Old Age registration, with number of places Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 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 28 April 2005 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 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the eight 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 five service users, two 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. What the service does well: What has improved since the last inspection? 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. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 6 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 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 7 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) 4 Service users assessed needs are being met. EVIDENCE: Relatives and service users said that the staff understood their needs. Since the last inspection care plans have been updated to include more information on the needs of service users. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 8 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 10 Service users have sufficient information on how their needs are met. Service users medical needs are being met. Service users privacy is maintained. EVIDENCE: The manager explained that care plans are being updated. The inspector saw examples of these care plans, which contained more details of the needs of service users. Professional involvement in the management of pressure sores was recorded. There were detailed care plans on the treatment and prevention of pressure sores and continence promotion. Service users said that staff respect their privacy and always knock on their bedroom doors. Service users also said that staff took time to ask how they wished to be assisted. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 9 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 13 14 Service users are provided with sufficient and varied activities to meet their needs. Service users are supported to maintain contact with relatives and other representatives of their choice. Service users are not always able to make choices about how they live in the home. EVIDENCE: Service users said they had been provided with activities and entertainment. The activities organiser who has been recently appointed explained that she was organising a range of activities and also doing one to one work with service users. The inspector saw that an activities programme is in place and the interests of individual service users are recorded. The inspector saw staff interacting with service users and providing activities. Relatives spoken to said that visitors were always made welcome and kept informed of the needs of service users. Service users spoken to said that they were offered a choice of food and could choose to take part in activities run in the home. One service user told the inspector that night staff were unresponsive to her when assisting with personal care. This was discussed with the registered manager who agreed to take this issue up with the night staff concerned. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 10 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) These standards were inspected at the last inspection. EVIDENCE: Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 11 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 Service users live in a safe environment. EVIDENCE: The inspector saw that all fire doors were either closed or held open with a self-closure device. All areas of the home were well maintained. Redecoration of the home is continuing. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 12 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 Sufficient staff are available at all times to meet service users needs. EVIDENCE: The registered manager explained that since the last inspection a review of the staffing level had been carried out. The staff have been organised so that there is a greater mix of skills. Service users spoken to felt that there were more staff available throughout the day. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 13 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) 33 36 38 Service users are consulted about the quality of the service provided and encouraged to make suggestions for improvement. Staff are appropriately supervised to ensure that service users receive the care and support they need. The fire safety risk assessment needs to include how all fire risks in the home will be responded to. EVIDENCE: The inspector found that there were systems in place to ensure that service users and relatives are consulted about the quality of the service provided. Actions to improve the service are identified. The inspector spoke with staff who confirmed that they had supervision regularly. The inspector saw notes of supervision and found that these showed that supervision provided the support staff needed. The inspector found that the fire risk assessment did not contain detailed information on how fire risks were to be prevented. Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 14 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x x 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 Standard No 16 17 18 Score x x x x x 3 x x 3 x 2 Nairn House 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 15 no 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 14 38 Regulation 13 23 Requirement The registered persons must ensure that night staff respect the wishes of service users. The fire risk assessment must be reviewed to ensure that all fire safety risks are assessed. Timescale for action 1/11/05 1/11/05 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 20050905 Nairn House X00015 UN Stage 4 S27817 V244930 G59.doc Version 1.40 Page 16 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
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