Inspection on 18/06/08 for Eton Park

This inspection was carried out on 18th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Eton Park 19/12/07

Eton Park 22/08/07

Eton Park 26/04/06

Eton Park 04/01/06

Eton Park 11/10/04

Eton Park 21/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE North View Care Home Owthorpe Road Cotgrave Nottingham NG12 3PU Lead Inspector Meryl Bailey Unannounced Inspection 18th June 2008 09:30 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 North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 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. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service North View Care Home Address Owthorpe Road Cotgrave Nottingham NG12 3PU 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) 0115 989 9545 0115 989 9311 Mr David Hetherington Messenger Care Home 82 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (76), Physical disability (4), of places Terminally ill (2) North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 82 (OP) That include 4 (PD), 2 (TI) & 50 (DE 55 years & Over) Date of last inspection 19th December 2007 Brief Description of the Service: North View is a large purpose built home on the outskirts of the village of Cotgrave, five miles to the south of the city of Nottingham. The home provides accommodation, personal care and nursing for up to eighty-two people. There are seventy-eight single rooms, of which eighteen are en-suite. There are two double rooms, without en-suite facilities. The accommodation is provided within two linked units, upper and lower, but both have level access and the premises are fully accessible by wheelchair users. There are no amenities within walking distance of the home, which is situated at the top of a hill, not far from the A46. North View has a Mini bus and a transport service is provided to and from the home for residents’ families for a small fee. In the village there is a library, health centre, shopping precinct, restaurants and café, churches and a leisure centre plus other sporting facilities. Current fees range from £330 to £385 per week. This is dependent on the level of care required. An additional £10 per week is charged where ensuite facilities are provided. Copies of inspection reports are available to residents and other stakeholders upon request. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection involved three inspectors. Two inspectors visited on 18 June 2008 and a Pharmacy Inspector visited on 20 June 2008. We were able to see people who currently live there in both units of the home and we also spoke with some relatives. Inspections focus on outcomes for people that use the service and in order to do this, the main method of inspection used at the site visit was ‘case tracking’. This meant three people from each unit were selected and their support was tracked through some discussion with them. Also, we checked their care records and observed their interactions with staff. Five staff members were spoken with. A sample of staff records were looked at to make sure staff members had been checked before commencing employment and were trained to meet people’s needs. The Pharmacist Inspector made a detailed examination of the recording, handling, safekeeping, administration and disposal of medicines within both units of the home. The current acting manager for this service was available during both the inspection days for discussion and feedback. Information about a home that is collected before the site visit is also used as evidence to make judgements. Services are now required to fill in a document called an AQAA (Annual Quality Assurance Assessment) in which the acting manager identifies from their own quality monitoring what the service does well and what they need to improve. We received the completed form at the Commission soon and this had helped in the planning the visits. What the service does well: The service makes sure people’s needs are assessed before they move into the home. This is so people know their needs can be met there. People told us the staff treated them well, “ They’re very helpful when I need help.” Staff are helping each person to develop a file called, This Is My Life. One that was seen had photographs and information provided by the family about significant events in the persons life. This promotes respect and dignity for individual people at the home. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 6 There are opportunities for all people at the home to choose and take part in appropriate social activities. The activities coordinator was working full time and there were activity boards displayed around the home. There were plans for ten veterans to receive badges from the captain of the local barracks at a garden party arranged at the home. One person we spoke with was a veteran and was very much looking forward to this event. There is a range of lounge areas in each of the units of the home and people told us they can choose to sit with others or in quiet areas. There was a file in the entrance hall showing the result of surveys and giving feedback. The acting manager had responded to requests for changes. What has improved since the last inspection? What they could do better: There are further specific improvements to be made with medication administered at the home: Review the Medicines policy to reflect good practice and so that all staff will ensure the safety of people receiving medication at the home. Retain recent copies or reference to the original prescriptions on the premises to ensure people receive the correct medication and dosage as prescribed. Administer medication directly from the original dispensed labelled container into a small receptacle, so that it is hygienically handled and the risk of cross infection is reduced. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 7 Reduce the surplus stock of medicines and maintain appropriate stock to reduce the risk of administering incorrectly. Store medication within the temperature range recommended by the manufacturer to ensure the quality of medicines in use is maintained and to protect people accommodated from harm. There are other improvements that must be made within the home: Cover all holes in bedroom doors and fit appropriate locks to all bathroom and toilet doors to ensure the privacy and dignity of people living at the home. Review arrangements at meal times to ensure people are given sufficient assistance to enable them to have adequate quantities of wholesome and nutritious food. Make all staff members fully aware of their responsibilities to alert the acting manager of all allegations of abuse. This includes allegations made against other people living at the home. This is to ensure everyone accommodated is adequately protected from abuse. Ensure personal toiletries, prescribed creams, continence pads and shavers are not left out in communal bathrooms and ensure the sluice room is locked at all times to ensure people are safeguarded against cross infection. Provide sufficient numbers of staff at meal times to ensure needs for assistance with eating are met. Fit an appropriate lock to the laundry door to ensure the safety of people living in the home. Ensure assessments of risks involved with the use of bed rails are fully completed stating actions needed to reduce risks of trapping people to promote the safe use of equipment. We have asked the provider to produce a plan of how all the above requirements will be met in order to continue to make improvements in the service provided at this home. 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. The summary of this inspection report can be made available in other formats on request. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 8 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 North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable to this service) Quality in this outcome area is good People’s needs are appropriately assessed before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full information pack is available for prospective residents and gives information about the home and the company. This states that the matron will visit to assess and discuss requirements before admission. We looked at the files of seven people that live at the home. All of these contained assessments carried out prior to moving in and further specific assessments included a social history questionnaire as well as mental health assessment, nutritional assessments, continence assessment, falls risk assessment, medication assessment and information concerning activities. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate Care is planned, but more attention is needed to ensure individual health and social care needs are fully met. Medication procedures and practices could be further improved to protect people. Staff show respect, but privacy is not always upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files looked at contained individual plans, giving staff direction in how to meet specific needs. They highlighted the problem and gave direction to solve this. For example, for night wandering the direction was, “offer a drink and ensure dignity is maintained. Within one person’s original mental health assessment there was a comment about occasional aggressive behaviour, “Needs to be approached gently and calmly – ensure he is safe and leave him to settle before going back to him.” This had not been transferred into an action plan, so it was not clear if all staff were made aware of the appropriate action to take. However, some staff said they were dealing with aggression with this approach with several people. One person living at the home told us North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 11 of fears relating to aggressive behaviour displayed by other people living there (See protection section of this report). There was, generally, a considerable amount of care planning information within the files and this included information about preferred activities and sensitive end of life plans. During this inspection and at the random inspection carried out in April 2008, the acting manager explained that staff had recently attended person centred planning training and the next step was to talk with people concerned in order to complete the person centred care planning documentation. This had commenced and examples were seen. The document used was called, values, beliefs and feelings and included individual strengths, abilities, maintaining control and the expression of needs. In April 2008, the acting manager said that it would take 6 weeks for every person to have a person centred care plan in place. However, the process is taking longer and, at this inspection, she estimated a further 3 months was needed. There were records of visits from health professionals and people we spoke with said they had visits from General Practitioners when they requested it. There was always a nurse on duty in each unit during the day and one during the night to cover both units. Visits from other health professionals were recorded on files. At the last key inspection we were concerned about how medication was handled and on this occasion we asked a specialist Pharmacy Inspector to make an assessment. We found that the trained nurses had made improvements in completing the Medicine Administration Record (MAR) sheets. They were being completed more accurately to show that people living at the home had received their medication correctly. There were separate records available of external preparations and fortified drinks administered to people by care staff. The acting manager said all relevant staff had recently received medication training and certificates were seen on files. However, one staff member was observed popping out tablets into her hand before placing them into a medicine pot, which poses a risk of infection. There was no detail in the Medicines policy about the handling and process of medicine administration by care staff including any “when required” medication and homely remedies. This needs to be added to ensure all staff follow good practice in administering medications to the people accommodated. There were no copies or references to the original prescriptions retained on the premise and there was extra stock of several medicines. Some medicines had expired and must be disposed of. There were clear records of previous medicines that had already been returned or disposed of. We found the temperature of the downstairs medicines room to be above the safe storage temperature of 24°c. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 12 People told us the staff treated them well, “ They’re very helpful when I need help.” One person described help with bathing in a way that demonstrated full respect was given. On files we saw signed forms clarifying if people wanted to have a key for their bedroom door. However, we noticed holes in many of the bedroom doors where locks had been removed, showing a lack of respect for privacy. The acting manager was working towards every person having a file in their room called This Is My Life. One that was seen was excellent, with photographs and information provided by the family about significant events in the persons life. This will promote respect and dignity for individual people at the home. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. There are opportunities for all people at the home to choose and take part in appropriate social activities. Appropriate meals are provided, but the way dining is organised means that not all people receive the assistance they need with eating. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A lot of work had been carried out to extend the range of social activities available since the last key inspection. The activities coordinator was working full time and there were activity boards displayed around the home. Colourful and imaginative words and pictures were used to show what was planned. There was a beauty club, craft circle, cookery group, music sing-along, regular outings, motivation class every eight weeks, games group, monthly church service. A veterans event had been organised and there were plans for ten veterans to receive badges from the captain of the local barracks at a garden party arranged at the home. One person living at the home was a veteran and was very much looking forward to this. Invitations had been sent to families to be involved in this event. The home had also tried to involve the local community and had contacted the local school to organise a teddy bears North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 14 picnic, and the local allotment Society were due to visit to help to plan a vegetable patch. There was a photo file available for people to see past activities. There was a VE day display in the hallway and a ‘residents arts Gallery’ of photos that had been drawn or coloured. The activities coordinator completed an evaluation form after each event recording who was involved and what they gained from this. A menu displayed the days food in each dining room. The midday meal was chicken pie or cod bake followed by rice pudding or ice cream. There was also a five weekly menu displayed. Staff asked people in advance what they would like and we saw staff offering each pudding for people to choose at the time the meal was served. In the upper unit in a room where people needed assistance with eating one carer was giving one to one help and another carer was giving help to two people at once, but the second person’s food was becoming cold whilst the first person was being assisted. A third worker was trying to assist and moved around to encourage several people at once and a nurse was administering medication at the same time. Staff rushing around affected the atmosphere and people were not able to relax during the meal. Some people who needed more attention were not eating and food was going cold. The shape of the tables meant that chairs could not be pushed close into the table. Another carer was giving support to someone in their bedroom. In another dining room there was one staff member serving people who were able to eat without assistance. In the lower unit, some had individual help with eating, but most ate independently and told us they always enjoyed their meals. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate Complaints are taken seriously, but people cannot always be sure their concerns are passed on to the acting manager. This means that action may not be taken to fully safeguard people in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager had a record of complaints. One person told us they knew how to complain and had done so. This person had complained about people wandering into the bedroom at night and requested a lock for the door. The acting manager was waiting for this to be fitted by a new handyman. However, the person also alleged that another person had been abusive. We found that this was written down in the daily records, but the acting manager was not aware. When we told the acting manager she arranged urgent fitting of a lock that day. The local authority was satisfied that this was sufficient action for the acting manager to take. The acting manager had a copy of the local procedures for Safeguarding Adults and had used them when necessary. There were records that staff had completed training in what constitutes abuse and actions needed to safeguard people. Care staff we spoke with understood the need to report staff or visitors if they had any suspicions or witnessed any abuse, but they had not considered that if one person who lives at the home harms another, they should report the matter for investigation. They described good practice, North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 16 though, of moving the aggressive person away and calming them down, whilst a second member of staff sits with the person that may have suffered abuse. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 26 Quality in this outcome area is adequate A comfortable environment is provided for people who live at North View, but more attention to tidiness and maintenance is needed to reduce risks to people’s health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found there was a range of lounge areas in each of the units of the home and people told us they can choose to sit with others or in quiet areas. There were additional dining areas. All areas were pleasantly decorated and people said the communal areas and their bedrooms were always kept clean. There was a safe enclosed courtyard for people to sit outside and a further secure outside area, but this needed attention to make the lawn and paving level. There were personal door plaques on each bedroom door so that people could identify their own rooms. People had been supported to choose a picture that was relevant to them, for example a ship for someone who had been in the North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 18 Navy. Another had a picture of a Labrador dog and another had horse show jumping. All rooms that were seen as part of case tracking were comfortable and generally well decorated although there were some minor decoration needed, for example chipped paint. There were some signs around the home with words and pictures and arrows pointing in the direction of dayrooms and dining rooms. This was found very helpful to people who may forget which way they needed to go. In one bathroom we found several items of toiletries, a used disposable razor, and several used bars of soap. There were also unused incontinence pads left in bathrooms and toilets. Two people’s prescribed creams were also left in a bathroom. These all pose a risk of cross infection to people. As already reported under standard 10, privacy and dignity were not promoted by there being no locks on some toilet, bathroom and bedroom doors. The acting manager said that several locks had previously been removed and, for some locks that were provided, there were no keys available. Portable hoisting equipment was provided to assist with bathing and there were handrails in all corridors to assist people, although some of these were quite scuffed and in need of painting. Sluice rooms were provided to deal with soiled items, but one had been left unlocked and was unclean. There was a laundry room at the bottom of a steep flight of stairs. There were two handles for the door but no lock and this posed a risk of serious injury to anyone wandering that may be able to use the handles. The acting manager had assessed the risk and said she had requested a keypad lock on this door, which was not yet in place. The laundry was well equipped and well organised with a full time laundry person employed. There were separate doors for clean and dirty laundry. Clean laundry was placed in separate named drawers or on hanging areas ready to be returned to people’s bedrooms. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate Staff are mostly supplied in sufficient numbers, but are not always effectively deployed. Recruitment practices are appropriate and staff are supported in their training in order to meet the needs of people at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota showed that there were usually ten care staff and two nurses for the greater part of the day. However, two care staff were not available for work that day. For this particular day during the morning there were outside “Motivation” staff. The rota showed that at night there was one nurse for the whole home and three care staff in each unit. Separate staff were employed for cleaning and in the kitchen. From our observations there were sufficient staff to meet people’s general care needs and people told us that they did not have to wait long when they asked for help. The level of people’s dependency had been taken into account in deciding how many staff were needed on shifts. However, as reported under standard 15, there were not enough staff at lunchtime, due to the number of people in one room needing assistance at the same time, which does not promote their dignity and meet their diverse needs effectively. Also, from the rota we noticed nurses were covering extra shifts and working long hours. The acting manager explained that they were recruiting more nurses. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 20 A sample of records showed that nurses were qualified and registered with the Nursing and Midwifery Council, but none of the 28 care staff have completed their National Vocational Qualification at level 2 in Care. The acting manager told us that all care staff were currently being supported to attain the qualification. This means that Standard 28 is not met, but we are not making any requirement or recommendation about this as appropriate action is being taken. We found evidence that appropriate checks were made on staff before they commenced employment. There were copies of staff training certificates on files and the staff we spoke with confirmed the training they had received. New staff had received induction training including Dementia Awareness and some other staff had completed various Dementia Care courses. All staff we spoke with said that there had been recent improvements at the home, with better organisation and training so that staff knew what was expected of them. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate Management arrangements and systems are in place to provide a suitable home for people with nursing and care needs, but attention is needed to detail in order to maintain health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has not yet assessed the acting manager’s fitness, but she has commenced the process of making an application to register. Therefore, although standard 31 is not met there is no need for us to require action on this. There was a file in the entrance hall showing the result of residents’ surveys and giving feedback. The acting manager had responded to some comments, North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 22 for example, people had said that the downstairs communal areas needed to be more cheerful and lighter. The response was that new curtains and furniture had been purchased. The Commission requested that an Annual Quality Assurance Assessment (AQAA) be completed and this was sent to us at the right time, giving us all the information we requested. We did not look in detail at the arrangements for looking after people’s money during the visit to the home, but, within the AQAA form, the acting manager has explained that people are supported to handle their own finances. When their money is looked after, it is stored individually in a secure safe with very few staff having any access. A staff member confirmed that two signatures are always needed to take out or receive money and copies of all receipts are kept. Staffing records held some relevant certificates and staff told us that they had received training in Moving and Handling to safely move people, also Fire Safety, First Aid and Infection Control. However, as reported in the Environment section, we found several items that pose a risk of cross infection to people in a bathroom and an unclean sluice room had been left unlocked. There were records of electrical maintenance and fire safety equipment had been checked. However, the absence of locks for doors as already reported poses safety risks. At the last key inspection of this home we found that some people had bed rails to stop them falling from their beds, but the risk associated with using them had not been assessed. On this occasion we saw examples of appropriate risk assessments, but we also saw some assessments were only partly completed and were not signed. For one person there was an assessment in March stating that there was a risk with bed rails, but the person was at greater risk without. Therefore bed rails were to be put back in place. Three months later there was a note in the daily record stating “legs caught in bed rails”. There was no full assessment that led to action to be taken to reduce the risk. North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 23 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Review the Medicines policy to include good practice procedures for the handling and administration of medication by care staff including any “when required” medication and homely remedies. The medicines policy must be signed with a review date. This is so that all staff will know how to ensure the safety of people living at the service with respect to medicines. Retain recent copies or reference to the original prescriptions on the premises to ensure people receive medication and dosage as prescribed. Administer medication directly from the original dispensed labelled container into a small receptacle, so that it is hygienically handled and the risk of cross infection is reduced. Reduce the surplus stock of medicines and maintain appropriate stock to reduce the risk of administering incorrectly. Store medication within the temperature range DS0000060190.V366809.R01.S.doc Timescale for action 31/08/08 2. OP9 13(2) 31/08/08 3. OP9 13(2) 31/08/08 4. OP9 13(2) 31/08/08 5. OP9 13(2) 31/08/08 North View Care Home Version 5.2 Page 25 6. OP10 12(4)(a) 7. OP10 12(4)(a) 8. OP15 16(2)(i) 9. OP18 13(6) 10. OP26 13(3) 11. OP27 18(1)(a) 12. OP38 13(4)(a) 13. OP38 13(4)(c) recommended by the manufacturer to ensure the quality of medicines in use is maintained and to protect people accommodated from harm. Cover all holes in bedroom doors in order to ensure the privacy and dignity of the people in those rooms. Fit appropriate locks to all bathroom and toilet doors to ensure the privacy and dignity of people living at the home. Review arrangements at meal times to ensure people are given sufficient assistance to enable them to have adequate quantities of wholesome and nutritious food and their dignity maintained. Make all staff members fully aware of their responsibilities to alert the acting manager of all allegations of abuse. This includes allegations made against other people living at the service to ensure everyone accommodated is adequately protected from abuse. Ensure personal toiletries, prescribed creams, continence pads and shavers are not left out in communal bathrooms and ensure the sluice room is locked at all times to ensure people are safeguarded against cross infection. Provide sufficient numbers of staff at meal times to ensure needs for assistance with eating are met. Fit an appropriate lock to the laundry door to ensure the safety of people living in the home. Ensure assessments of risks involved with the use of bed rails are fully completed stating DS0000060190.V366809.R01.S.doc 31/08/08 31/08/08 31/08/08 31/08/08 18/06/08 18/06/08 31/08/08 31/08/08 North View Care Home Version 5.2 Page 26 actions needed to reduce risks of trapping people and to promote the safe use of equipment. 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. 2. 3. Refer to Standard OP7 OP9 OP9 Good Practice Recommendations Complete the revised person centred plans for all people at the home. A duplicate book should be used to record return/disposal of all medicines. Consider having a supporting protocol for the administration of ‘when required’ occasional use medicines to ensure they are administered as the doctor intended, endorsed by a clinician. The purchase of a maximum, minimum thermometer is advised to accurately read the maximum, minimum and current temperatures on a daily basis to ensure that the medicines held in the medication refrigerators are stored in compliance with their product licence to maintain their stability. Doors to bedrooms should be fitted with suitable locks that are accessible to staff in emergencies 4. OP9 5. OP24 North View Care Home DS0000060190.V366809.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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