CARE HOMES FOR OLDER PEOPLE
Nazareth House 162 East End Road East Finchley London N2 0RU Lead Inspector
Rebecca Bauers Unannounced Inspection 09:00 12 & 13th October 2005
th 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 Nazareth House DS0000010519.V251162.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. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Nazareth House Address 162 East End Road East Finchley London N2 0RU 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 8883 1104 020 8444 3691 The Congregation of the Sisters of Nazareth Ms Anne Fenlon Care Home 89 Category(ies) of Old age, not falling within any other category registration, with number (89) of places Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Fifteen specified service users who have dementia may remain accommodated in the home. The home must advise the regulating authority at such times as any of the specified service users vacate the home. 5th May 2005 Date of last inspection Brief Description of the Service: Nazareth House is a long established residential care home providing a home for eighty-nine people over the age of 65. It is owned and operated by a Roman Catholic order of nuns The Congregation of the Sisters of Nazareth who are the registered providers. There is a very strong Catholic ethos in the home, including a chapel where Mass is celebrated daily. Service users from other religious and cultural groups are admitted and assisted to maintain contact with their religious and/ or community groups. Nazareth House is a large home split into a number of annexes named after Saints. There are a number of bedrooms with en-suite facilities and those bedrooms without en-suite facilities have bathrooms facilities close by. Nazareth House with its spacious grounds offers peace and tranquillity and it is practically situated with ready access to shops, post office and local transport. Ample space is available in the grounds for a leisurely stroll along specially made pavements around the garden, providing an atmosphere where independence is encouraged. The home is light and bright with appropriate adaptations and equipment. The home is divided into a number of separate units. Staff generally work on the same unit so service users receive care from the same staff. Each unit has a separate dining area and lounge. Nazareth House DS0000010519.V251162.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 on the 12TH and 13th of October 2005 as part of the annual inspection programme to identify progress with previous requirements and to check standards of care against the core standards. The inspection took eight and half hours over two days to complete. A partial tour of the home took place; five service users were spoken to on an individual basis. Care records, staff records, quality assurance audits and health and safety records were examined. Five staff were spoken to individually and the inspector was able to have discussions with the registered manager and the registered person during the feedback session. An adult protection issue in May concerning a service user who had lived in the home was jointly investigated by the Commission and Barnet Older Peoples Mental Health Team. Five recommendations had been made directly relating to the home, these have been referred to in the relevant section of this report. Good progress had been made with addressing these recommendations. In addition, four recommendations had been made for health professionals to work toward to improve their practices. These have not been addressed in this report. What the service does well:
The home has a comprehensive pictorial statement of purpose and service guide to enable prospective service users to make decisions about the home. The service users benefit from having detailed assessments of need in place, individual plans are reviewed monthly. These are comprehensive providing a holistic view of the individual that staff are able to follow and provide continuity in care. This is supported by service users who said ‘the staff are very kind, caring and know what I like’. Risk management strategies are detailed ensuring the safety of service users. Social and personal health care needs are met by a variety of health care professionals. The food provided in the home is fresh, hot and well balanced to meet the needs and preferences of service users. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 6 Service users know how to complain and have been given the relevant contact information to enable them to complain both internally and externally. Quality assurance audits ensure service users views are listened to and acted upon. Staff morale is good which promotes good positive team working and consistent practice for service users. The environmental conditions are calm and serene. The health, welfare and safety of service users are protected through regular health and safety checks. Service users benefit from a competent organised manager and staff team. What has improved since the last inspection?
Eight of the nine requirements and all three recommendations made at the last inspection had been satisfactorily addressed. The registered manager and staff must be commended for this achievement. Service users are now receiving dental checkups with regularity, particularly those with dentures. This has aided eating, drinking, talking and general positive self-esteem for service users. Service users wishes in the event of their death have now been recorded with sensitivity in their individual plans of care to ensure that their wishes are respected. Staff are now aware through discussion at team meetings of the need to call for medical assistance in the event of a service user becoming unwell or displaying symptoms not peculiar to their specific condition. Staff spoken to are confident to do this independently to ensure that service users health and welfare is safeguarded. The summer evening activities have been reviewed to ensure that service users are stimulated to meet their recreational needs. Surveys indicated that service users are consulted and are very satisfied with the activities available in and outside of the home. The recommendation made for the ‘home delivery library service’ to be promoted to ensure that all service users are aware that it exists had been
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 7 addressed in the service users meeting. Service users stated ‘ I now use the home delivery library service since it was mentioned in a meeting we had’. The quality assurance audit has been developed to include the views of external stakeholders such as health professionals and care managers. The results from the audit carried out in March 2005 have been summarised and are available to interested parties. Staff have now been trained in mental health issues such as depression in order to meet the needs of some of the service users living in the home. A recommendation made for staff supervision records to be more detailed and reflect actual discussion with regard to work practice has been actioned. The complaints book now contains a clear outcomes section and the fire check pro-forma is being filled in correctly to reflect if a fault is found with the fire equipment. Documented evidence now states that the batteries in the newly fitted door guards are checked and are in good working order. The fire risk assessment had been reviewed to ensure the safety of service users, relatives and staff. Progress with the recommendations made during the joint investigation in May included; the home not accepting service users outside of their category of registration, staff no longer taking service users blood pressure as it is a care home and not a nursing home and for medical assistance to be called for in all cases if a service users medical health is seen to be deteriorating. What they could do better:
Six requirements were made at this inspection this included one restated requirement and two recommendations made from a joint investigation in May 2005. One recommendation was made. The two recommendations made following the joint investigation that have now been made into requirements are as follows: Service users daily notes must be written to reflect actual observations to ensure that an accurate picture of an individuals symptoms are recorded to so that the appropriate support and attention is sought by staff and received by the service user. All staff must receive training in the awareness and management of MRSA to ensure that they are best equipped to deal with and work consistently within agreed guidelines to support a service user, which may develop MRSA. Further requirements were made for all service users to have annual reviews to ensure the continued appropriateness of the placement. For the staff member who is still waiting for a CRB not to work alone and for a copy of the CRB certificate to be sent to the Commission. This is a restated requirement. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 8 Requirements with regard to health and safety concerned the need to review the night-time care plans and risk assessments for two service users who have had a number of minor falls in the last four months to safeguard them and to ensure all risks have been minimised. In addition the fire risk assessment must be revised and redeveloped in line with the advice given by the local fire department to safeguard the wellbeing of service users and staff in the event of a fire. A recommendation is made for the initial assessment prior to placement in the home to be signed by the service user, relative and /or social worker as confirmation of agreement with the assessment information as being correct and a true indication of the individuals needs. 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. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 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 Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 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): 1,2,3,4,6 Service users are given detailed information they need to make an informed choice about the home. Each service user is assessed prior to admission and express confidently that their needs are met. Each service user is provided with a contract eight weeks after admission. Intermediate care is not provided in the home. EVIDENCE: Service users records demonstrated that service users had visited the home prior to admission. Three service users have moved into the home since the last inspection in May. Service users confirmed the receipt of the service user guide and statement of purpose stating that they ‘gave a clear indication of what is provided in the home, what the rooms look like, where they can eat, activities provided and the staff provided. The service users spoken to expressed their delight with regard to the staff understanding their needs following an initial assessment and through further conversations with them. The five files examined all contained detailed assessments of need. None of the initial assessments had been signed by a
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 11 relative service user or placing authority to agree that the assessments were realistic and portrayed the needs of the individual fully. It is recommended that this is a considered practice to benefit clarity of agreed needs for service users. Each service user has a contract with a statement of terms and conditions. New admissions do not receive a contract until eight weeks after admission following a follow up review to ensure the home is still able to meet their individual needs. The home does not provide short-term intensive rehabilitation. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 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): 7,8,10,11 Service users health, personal care and social care needs are set out in the comprehensive individual plans. However daily notes do not always accurately reflect observations of service users health needs which are then misleading with regard to the care needed. Service users can feel confident that staff will respond appropriately in the event of their health deteriorating by calling for medical assistance. Service users feel that they are treated with dignity and respect. Service users wishes in the event of their death are now in place to ensure that their wishes are respected. EVIDENCE: The five service users files examined demonstrated that service users benefit from the home having a clear, consistent understanding of their health, personal and social care needs. Individual plans were excellent, they were detailed, reviewed monthly and intervention had been sought from multidisciplinary teams. Appropriate detailed risk assessments were in place to safeguard service users, for example risk of falls, nutrition, mobility,
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 13 pressure care and water-low assessments. Service users spoken to were very positive with regard to the care provided and the staffs understanding of their needs. Feedback from survey’s completed by health care professionals were positive with regard to care practice in the home and this included key workers ability to update individual plans to reflect changes in care. Daily notes detailed a holistic understanding of the individual’s day and evening life. However during a recent adult protection investigation in May 2005 it was identified that in some cases notes recorded observations of a service users condition using broad terms such as ‘having a fit’ when it was in actual fact a dizzy spell, in addition during this inspection notes demonstrated that staff had written that a service user was ‘depressed’ even though there had been no clinical diagnosis of depression to describe someone that was feeling low or fed up. This must be rectified immediately to ensure that accurate indicators of an individual’s real needs are evidenced in their daily notes to ensure appropriate intervention. Five service users were spoken to and said that they are reassured that their personal and health care needs are met by the staff team in a consistent manner. Some of the comments made were as follows ‘staff are very thoughtful’, ‘I couldn’t be more content here’ and ‘its splendid living here’. It is evident from the signed and dated records that individual plans are developed with service users, family, friends and other professionals. This is an example of good practice. Staff were seen talking to service users in a respectful and kind manner. Service users said that their privacy and dignity is always maintained whilst personal care is given. A requirement made at the last inspection for a referral to be made to ensure that all service users receive annual dental treatment had been satisfactorily addressed. There was evidence in the minutes of service users meetings that they had been informed that a visiting dentist had been booked for the 22/7/05 and the30/9/05. Fifteen service users had seen a dentist on each occasion, more sessions have been booked to ensure all service users receive treatment particularly those who require support with denture care. The service users wishes in the event of death are now being recorded consistently, all files examined contained information with regard to this. A requirement made at the last inspection for staff to always call for assistance for example a GP or dial 999 when a service users health deteriorates or if they experience new symptoms not recognised as part of their medical history had been fully addressed. There was evidence in staff meetings dated the 25/5/05 that the issue had been addressed fully with staff. Staff spoken to confirmed that they felt confident to call for medical assistance or to dial 999 with or without their line manager’s knowledge. Daily notes indicated that
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 14 some service users have weekly reviews with their GP to monitor any health concerns, this intervention had also been documented in the individual care plans. All accidents and incidents had been recorded appropriately with risk assessments being reviewed accordingly to safeguard service users. All reportable incidences under regulation 37 had been submitted to the CSCI. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Service users say that they are fully satisfied with their lifestyles in the home and feel that their social and all of their cultural needs and interests are being met. Service users maintain good contact with family and friends who are welcomed by the home. Service users exercise choice and control over their lives on a daily basis and more formally through two monthly meetings. Service users are provided with good home cooked food in pleasant surroundings with flexibility. EVIDENCE: All five service users spoken to express that the home met their expectations and preferences to satisfy their cultural, religious and recreational interests. Service users spoke of their enjoyment of the recent day trips to the cinema, to Woburn Park and Hatfield house. Discussion ensued with regard to future day trips to Regents Park, museums and classical concerts such as Kenwood in the summer. These discussions had taken place during service users meetings and had been minuted. Recent surveys returned by service users concerning general activities during the day and night indicated that many were content to follow their own interests in the evening such as seeing visitors and watching
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 16 TV soaps. One service users comments were ‘ I think things are as perfect as they can be.’ Others stated ‘ I don’t want to do anything organised after 2.30pm I like to follow my own interests.’ Service users expressed positive comments in relation to the new shop that opens twice a week in the home for service users to purchase small items such as toiletries. The home also asks service users if they want particular items stocked. Service users interests and preferred activities had been fully documented in their individual files in some detail. Information also included likes and dislikes with regard to food, sensory needs, activities and how staff need to approach and encourage service users to participate. The inspector found that service users are being informed of recreational activities on offer through notices and during the two monthly residents meetings. Service users seemed to be far more knowledgeable with regard to activities organised on certain days and nights. A recommendation made for the home to promote and supports service users to access the home delivery library service had been fully progressed and discussed during a service users meeting. A requirement made for activities provided in the home to be reviewed especially with regard to evening activities during the summer months had been fully addressed. Two service users who had indicated an interest in taking evening walks had been allocated a member of staff at least three times a week to go out for a walk during the summer evenings in the homes grounds. Consideration is currently being taken with how this will be replaced during the winter months. As mentioned previously the home has done exceptionally well in being proactive in the review of activities within the home and outside to ensure that service users views are listened to and acted upon to enable them to actively pursue their own interests. Service users are supported to practice their religious beliefs through attendance at the on-site chapel or if preferred in their own rooms. Feedback from surveys demonstrated that family and friends were complimentary with regard to the care provided in the home and the flexibility to visit. Service users confirmed that their visitors are welcomed by the home and often offered tea and home made cake, or visitor’s sometimes access the local community with their relative or friend. The service users benefit from an experienced cook and kitchen assistants who always use fresh meat and vegetable to prepare wholesome meals to meet the service users preferences and dietary requirements. Again service users comments included ‘the food here is very good,’ ‘we have good choices’ and Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 17 ‘the food is always hot.’ ‘ I sometimes eat in the dining room or in my own room depending on how I feel.’ Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 18 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 Service users and relatives are confident that their complaints are listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: One complaint had been made since the last inspection; which concerned a service user complaining about another this had been documented and resolved. A requirement made at the last inspection for the complaints book to contain a clear ‘outcome section’ to indicate the result of the actions taken by the home, had been added to the existing complaints record. Again consistent with the last visit service users were very open with regard to complaining, ‘I always speak my mind, otherwise no-one knows what is troubling me.’ Other views expressed were similar. An openness and calmness was evident in the home where service users are able to express themselves freely. There has been one adult protection issue since the last inspection concerning a service user who had lived in the home. A joint investigation was carried out by the Commission and Barnet older peoples mental health team. The investigation concerned issues raised by a social worker from Barnet ‘s older peoples team in May 2005 concerning the alleged neglect of one service within the home and the alleged unnecessary isolation of the same service user due to MRSA. The social care aspects of the care provided by the home and by health professionals involved in the service users care were investigated. In addition an investigation was carried out by the PCT medical director for Barnet
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 19 into the GP and district nurse input. The police also conducted their own investigation. There findings were that it was not a criminal case and that there was no case for prosecution. The recommendations concerning the home only made following the joint investigation conducted by the Commission and the Barnet older peoples team were as follows: 1. Full training must be undertaken by all staff in the home as a priority in the awareness and management of MRSA from Barnet’s professional health team. 2. The home must not accept service users outside their category of registration. The home must contact the CSCI as soon as they become aware that this may be the case. 3. Staff at Nazareth House must not take service users blood pressure. The home is a care home for older people not a nursing home. 4. The home’s case notes must ensure that observation are recorded accurately and reflect what is actually observed. The home must not use broad terms to describe conditions for example, do not record a service users as having a ‘fit’ when they are actually having a dizzy spell which is known and has happened previously. 5. The home must ensure that medical assistance is called for in all cases if a service users medical health is seen to be deteriorating. The recommendations outstanding that have been made into requirements in this report under the relevant sections concerned the training for staff in the awareness and management of MRSA. The second recommendation concerned the observations noted in the service users case notes. The home demonstrated extensively that all other recommendations had been addressed appropriately and will continue to be monitored. Four recommendations were made to improve the practice of health care professionals. The full investigation report is held on file with the Commission. The registered manager and senior carers in the home had attended a conference arranged by the Commission on preventing abuse through good practice. Staff spoken to were knowledgeable in the reporting procedures of any allegation of abuse and knew how to identify signs of abuse to protect service users from potential harm. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 20 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): 19,23,26 Service users live in a safe well-maintained environment; bedrooms are spacious and personalised to meet individual needs. The home is warm, clean, pleasant and hygienic. EVIDENCE: Service users benefit from a safe, serene well maintained environment. Service users were seen walking around the home freely or being supported by staff. Some service users were in their own bedrooms; others were in the communal lounges or dining rooms. Bedrooms seen were nicely decorated and had been personalised by the service users themselves who explained that they had been able to bring some of their own furniture into the home. There was evidence that bedrooms are redecorated each time a new service user moves into the home. Bedrooms were generally very spacious. The home was warm, clean, fresh, light and airy.
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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): 27,29,30 Service users needs are met by the numbers of staff on duty. Service users feel safe and are protected by the homes recruitment policy and practices in all cases except for one new staff who have transported their CRB checks. Staff have been trained to meet the needs of most of the service users including those with elements of depression. Training in the awareness and management of MRSA is currently lacking although this is not affecting the current service user group. EVIDENCE: The staffing rotas showed the number and designated roles of staff on each floor in the home across a 24-hour period. The rota appeared to indicate that the staff numbers meet the needs of the service users. Staff spoken to stated that there is always enough staff on duty. Staff were seen supporting service users throughout the inspection. Seven staff files were examined for new staff employed to work in the home in the last five months. These records confirmed that staff have been trained to do their jobs. All seven files contained evidence of completed induction and mandatory training to protect service users. All had received practical first aid and manual handling and lifting. The four staff spoken to on an individual basis said that they had all received a thorough induction and regularly attend refresher courses. Recently these have included fire training, manual handling and lifting, food hygiene and epilepsy. Following a requirement for staff to
Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 23 receive training in mental health issues such as depression most staff have now received this training during August, a second training session is planned for 28th of October. Staff awareness of dementia, nutrition and weight management, medication, infection control and manual handling and lifting was good. The home must be commended in the achievement of seventeen staff obtaining NVQ level 2 in care. Four staff have enrolled to undertake NVQ level 2, one has enrolled to undertake NVQ level 3 and one staff member has started the assessors course. This will be of great benefit to the service users who can feel confident that staff are competent and that they are able to understand and meet their needs in line with current good practice. Staff files indicated that service users are protected by the homes recruitment policy and practices. All seven staff files contained CRB checks. The requirement made at the last inspection for three new staff member’s CRB checks that had been transported from their previous place of employment to be reapplied for had been partially progressed. All three CRB checks had been applied for however only two CRB certificates had been obtained so far. The outstanding staff member who is still awaiting a CRB must not work alone. All other records were in place including the two references. Service users have a good rapport with staff that they can trust and feel safe with. Staff morale remains very high and good team working is evident. Staff reflected that ‘service users speak very highly of the staff here’ All service users have a key worker who they know and who works with them consistently. Staff stated ‘ the best part of the job is sitting down and talking with service users’. As mentioned previously following an investigation in May a recommendation was made for all staff to receive training in the awareness and management of MRSA from Barnet’s professional health team, this has been made a requirement at this inspection. A training package is currently being developed by Barnet’s professional health team. However there are currently no service users living in the home with MRSA. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 24 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): 31,32,33,36,38 Service users continue to benefit from living in a home, which is run in an organised and open manner by a competent manager. Service users are consulted regularly to ensure that the home is run in their best interests. Additional feedback from external stakeholders and a summary of the audits is benefiting service development. Staff are appropriately supervised. The health, safety and welfare of service users is promoted and protected although fire risk assessments do not always reflect this fully to demonstrate the safety of service users. In addition, the monitoring of minor accidents and incidents is not fully demonstrated to safeguard service users or to demonstrate that risks are further minimised. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 25 EVIDENCE: The four staff spoken to individually expressed that the registered manager and their direct line managers were open, approachable and always welcomed discussion about the service provision. Staff stated ‘ I like working here, it’s a bit like being in a family’. ‘We work in a friendly atmosphere and any issues get addressed quickly’. Staff confirmed that they receive supervision every two months, supervision records indicated this. A recommendation made for more detailed work practice based notes to be in place had been fully progressed. The five supervision files examined contained two monthly supervisions and the notes reflected individual performance and progress, action and training issues. The registered manager is competent and experienced and has created a very well run and organised home. The best interests of the service users are promoted by the home. They undertake two monthly service user meetings and annual audits (March 2005), which ask, service users what theirs and relative’s views are about the home. As mentioned previously service users had been given a questionnaire with regard to activities they wished to pursue during the day and evenings which had produced good responses to further ensure that the service provided reflected their wishes. A requirement made at the last inspection for the results to be summarised and for the audit to include the views of other health professionals and care managers had been progressed. A summary of results was available for the audit carried out in March 05 and further surveys had been developed and were seen for professionals, some of which had been returned. A summary had not yet been written as further surveys were waiting to be received to enable influence on service development and to achieve a wider perspective of the service provided. Service users comments on questionnaires included the following, ‘ I have nothing more to say except to say a big thank you to management for all the care and attention’. All relevant health and safety checks had been carried out to protect the welfare of service users. For example, electrical, gas, insurance and fire certificates were in place. A requirement made at the last inspection for all fire door guards fitted to service users bedroom doors to be checked during weekly fire point checks to ensure that they close; and for a clear record to be in place indicating these specific checks occurred had been fully progressed. Records indicated that the Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 26 batteries in the fire door guards are checked weekly and are fully operational. Fire maintenance check forms indicated correctly if a fault was found or not. The homes fire risk assessment was last reviewed in February 2004. A recommendation made for the fire risk assessment to be reviewed had been progressed although the actual risk assessment did not reflect this. The registered manager must seek advice from the local fire department with regard to what should be included in a fire risk assessment and what the night -time procedure should be in the event of a fire. This must be prioritised to safeguard service users, visitors and staff. The accident and incident reports for the last four months indicated a large number of minor slips or falls during the early hours of the morning for two particular service users. Appropriate actions had been taken at the time by staff. However to ensure the the safety of these and other service users a review of their nighT-time careplans and risk assessments must be undertaken. As a matter of good practice; accident and incident reports should be monitored to identify any patterns in the occurrence of incidents and ensure that all measures are in place to address these and to safeguard the service users. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 27 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 4 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 2 Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 28 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 OP29 Regulation 19(1) Sch 2(7) Requirement The registered person must ensure that one staff member who has transported their CRB from their previous employer, reapply for a CRB. In the meantime they must not work alone. A copy of the new CRB check must be sent to the CSCI. This requirement is amended and restated from the last inspection. Timescale for action was 1/6/05. The registered person must ensure that observations are recorded accurately and reflect what is actually observed. The home must not use broad terms to describe conditions for example, do not record a service user as having a ‘fit’ when they are actually having a dizzy spell which is known and has happened previously. Or do not label someone as depressed when they have not been clinically diagnosed as suffering with depression. This requirement is made as a result of the recommendations made during a joint investigation with
DS0000010519.V251162.R01.S.doc Timescale for action 01/12/05 2 OP7 12(1)(a) 31/10/05 Nazareth House Version 5.0 Page 29 3 OP7 12(1)(a) 4 OP30 12(1a) 18(1c)(i) 5 OP38 13(4)(c) 6 OP38 23(4)(5) Barnet mental health team on the 24/5/05. The registered person must ensure that all service users have a multidisciplinary annual review regardless of whether they are placed by a local authority Or privately funded. The registered person must ensure that all staff undertake training in the awareness and management of MRSA from Barnet’s professional health team once the full training programme has been developed. This requirement is made as a result of the recommendations made during a joint investigation with Barnet mental health team on the 24/5/05. The registered person must ensure based on incident reports of the last four months that a review of the night-time careplan and risk assessments for two specific service users who have had a number of minor falls at night is undertaken. The registered person must ensure that the homes current fire risk assessment is reviewed and revised in line with advice from the local fire department. 31/01/06 01/01/06 01/11/05 01/11/05 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 OP3 Good Practice Recommendations It is recommended that following the initial assessment of a service user that the registered person ask either the
DS0000010519.V251162.R01.S.doc Version 5.0 Page 30 Nazareth House service user, relative or placing authority to sign and date the initial assessment document to agree that the assessment reflects the realistic needs of the service user. Nazareth House DS0000010519.V251162.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Southgate Area Office 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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