Inspection on 15/04/08 for Nyton House

This inspection was carried out on 15th April 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Nyton House 13/04/10

Nyton House 30/09/09

Nyton House 03/07/09

Nyton House 23/06/09

Nyton House 06/04/09

Nyton House 15/12/06

Nyton House 31/01/06

Nyton House 24/08/05

Nyton House 01/02/05

Nyton House 29/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL Lead Inspector Val Sevier Unannounced Inspection 10:30 15th April 2008 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 Nyton House DS0000014643.V362224.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. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nyton House Address Nyton Road Westergate Chichester West Sussex PO20 3UL 01243 543228 01243 543039 daviscarehomes.nyton@virgin.net 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) Mrs Mary Davis Mr Philip Norman Davis Post Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (23) of places Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of one person in the category DE(E) Dementia over 65 years 15th December 2006 Date of last inspection Brief Description of the Service: Nyton House is a care establishment registered to provide accommodation for up to twenty-three service users in the category OP (old age not falling in any other category) and one named person in the category DE (E) over sixty five years of age. The establishment is situated in the village of Westergate. Local bus routes are near by. Accommodation is provided on ground, first and second floor level. A vertical lift services each floor. All rooms are generally for single occupancy however there are five rooms that can be used as doubles providing the occupancy levels do not exceed twenty-three. The service is privately owned. The proprietors are Mr and Mrs Davis. The current fees range from £450 to £850. (£850 is for a double room) Nyton House DS0000014643.V362224.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 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assurance Assessment (AQAA) completed by the home, and an unannounced visit to the home, which was carried out on the 15th April 2008, during which the inspector was able to have discussions with staff and have interaction with the residents at the home. During the visit the inspector looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and residents, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. We received 19 surveys: 4 from staff, 6 from relatives or representatives of individuals living at the home and 9 from people who live at the home; on the day of the visit we were also able to speak with three relatives who were visiting. The home has been without a registered manager since 2006, a manager has been appointed and has stated that she will apply to the commission for registration. What the service does well: The home welcomes people who will use the service and their families or representatives, to visit the home and look at the facilities of the home. The manager seeks information from external healthcare professionals as part of the assessment where necessary, to ensure that the home is able to meet assessed needs. Staff treat people who live at the home with respect; they share their companionship and give support sensitively. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 6 Daily routines in the home were flexible and people who use the service being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. People who live at the home were positive about the food that the home provided and were pleased with the activities in which they could participate and the condition of the accommodation that they occupied. What has improved since the last inspection? What they could do better: Care plans must detail the care and support needs for individuals where support has been identified so that staff are aware what they need to do for people who live at the home. Risk assessments must be carried out where a risk has been identified with action to minimise the risk for people who live at the home as far as possible. Medication records must be kept of medication received into the home and when administered. Where medication is ‘as required’ a record must be kept of the reasons why, how much and the outcome for the individual. An assessment for individuals who wish to look after and administer their own medication must be in place. The procedure for recruiting staff must ensure that there are CRB, POVA first and references before employment commences, to protect those people that live at the home. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 7 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. Nyton House DS0000014643.V362224.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 Nyton House DS0000014643.V362224.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves others as needed. However the current assessment record would prove more beneficial to the assessment and care plan process for the individual if there a record of the information by which to make a decision as to whether the home can meet identified needs. EVIDENCE: We received the AQAA for the home which stated that: “we do a pre assessment and trial /settling in period to ensure that we have the right facilities for each new client”. It was seen in the ‘how we have improved in the last twelve months that the home has promoted a 4-6 week trial period to ensure that people wish to stay at the home and that the service provided at Nyton is appropriate. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 10 This was supported by evidence in the records at the home and with talking with relatives of individuals who had moved to the home in the last year. One survey commented that the manager and proprietor had travelled a 5 hour round trip to assess prospective persons and to reassure them about the move. The assessment includes the following areas: a contact names sheet, personal details, medical details for example doctor and health issues; social information for example previous occupation, children and social history; allergies; next of kin. This information is also included on another assessment sheet with larger spaces to write and includes medication. We looked at three care plans which included these assessment sheets, not all had been completed the manager said that one individual was uncommunicative when she went to see them, and further information was gathered from family and health professionals. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 11 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records and systems within the home do not always ensure that the personal and healthcare needs of people who use the service are met safely and effectively. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. EVIDENCE: The home’s AQAA told us that: “A care plan is set up for each individual care needs – set out on the reviewed bi monthly or more often for example daily, if necessary. We believe that people have rights in everyday life - for example privacy, freedom of expression”. We sampled three care plans of people who use the service that had moved to the home in the last year. The care plans sampled were being used in Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 12 conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals. The care plans are pre typed on three sheets of paper with options that are circled for the individual with some space to record individual needs and issues. One individual’s care plan gave information for staff that they were to “assist with washing and dressing – clothes suitable for the day”. For diet and food it said “High calorie, observe when eating choke risk”. For this individual it was seen that there was a discharge letter from the dietician, which had recommendations for example ‘monitor weight weekly’. The discharge letter from the hospital suggested that the individual have their heels elevated and had assistance to change their position regularly. The information on the care plan related to mobility stated, ”needs help to transfer”, there was no information for staff on how they should do this. This individual had had a fall, which had resulted in a fractured femur, the care plan had not been reviewed to reflect any changes in their needs following the fall. It was noted that the care plan said that the individual was at risk of falls and bed rails had been put into use, there was no risk assessment in place on how falls could be reduced. It was seen on the second care plan that the individual had fallen and fractured their wrists and there was a question of self-harming. The information on the care plan for staff was related to work and leisure activities, there was no information on care needs. On the third care plan seen there was evidence that the individual had fallen and had sustained a fractured femur and that they had short-term memory loss, there was no information for staff on how to support the individual with their memory loss. The care plan stated that there was a risk of falls with staff action as “supervise”. In the mobility section, hoist was circled, with no other information. We asked the manager about this and were told that staff rarely use a hoist and that if it was circled it was in relation to the bath hoist. This individual had a pressure-relieving mattress on their bed as they were at risk of skin breakdown and had had a small broken area in January that had been seen by the district nurse, there was no record whether this had healed. The same individual had damaged their legs in April 2008. There was a note “moved to larger room up two steps which restricts freedom requires assistance to get up and down”. The manager showed us a treatment care chart which the home uses if they have concerns about an individual, the staff are able to record, fluid intake and output, and turns. For one individual we saw sheets dated 4/4/08 to 6/4/08 and 8/4/08 and 10/4/08. This document stated that the individual had an open pressure area on 2nd April 2008 “which looks healthy”. We were shown three books where staff write observations and records of events, for example “medication patch renewed”, “bottom has sore area Cavelon applied”, “put olive oil in ears manager will syringe”. “Manger will cut Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 13 nails”. We asked the manager about this and she stated that she carries out nail cutting, and takes blood for the local surgery when needed. It was seen that these notes did not relate to any information in the care plans for the individuals whose plans we saw. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. As there had been some time since we visited the home we asked for two months of medication administration records (MAR). It was noted that several individuals were recorded as ‘self medicating’, some for all their medication others for one or two whilst the home administered the rest. One individual is on eight different tablets; they look after and take their own Amitriptaline and Temazepam while the home administers the others. There was no assessment for the individual in taking the medication safely, or a record of how this medication is kept. For individuals where they have as required medication such as Paracetamol for pain relief, there was not always a record of how many tablets were given if there was a choice of one or two, there was no record of why the medication was given and the outcome of receiving the medication for the individual. It was seen that there were handwritten MAR charts for one individual who was new, there were 17 prescribed medications there was no record of the quantity that had been received at the home, date or signature. It was noted that this was the case also on all printed MAR charts. Two individuals have been prescribed GTN spray; this was all that was written on the MAR chart, there were no instructions for staff to follow. There was a record on the MAR chart that one individual had eye drops and Ibuprofen gel, there were no signatures to say that these had been administered. It was seen for two individuals where medication had been prescribed for them to take an ‘X’ had been recorded with no information as to why the medication may not have been given. One individual had been prescribed Co Codamol 2 to be taken four times a day there was no record of whether these had been given or not. In looking at the previous months MAR charts in addition to the ones being used at the time of the visit it was noted that the issues as described above were present in the previous months Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 14 Staff were observed speaking and assisting individuals with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. People we spoke with at the home had high praise for the staff and management saying that nothing was too much for them and that they felt well cared for. Relatives of those that live at the home also spoke highly of the staff and the care they see is given, and would recommend the home to anyone. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. EVIDENCE: The home has several areas where people can choose to sit for example a room with a piano and one with books. Some choose to stay in their rooms to watch television for example one couple have had satellite television fitted, many people have their own phones. There are regular visits from the hairdresser and mobile library, monthly church visits if individuals wish to participate. Activities taking place in the home were seen posted on the notice board in the hall. Activities provided include crosswords, musical afternoons and trips out. One couple spoken with on the day of the visit had been out for a drive with a member of staff which they had enjoyed particularly as they were new to the area. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 16 The home operates an open visiting policy and maintains family ties, the home enables regular visits and has arranged for family meals in a small dining area. People living at the home are encouraged to exercise control over their lives and it is their choice to participate in social activities if they wish. Visitors spoken with said that staff try to help the people living at the home to maintain their rights and for them to be able to make informed choices around daily living. The AQAA sent by the home stated that they felt improvements cold be made in social activities and they plan to encourage people who live at the home to participate in more social events and exercises and to encourage participation in education, with one individual recently attending a first aid course that had been provided for staff. People who use the service who passed comment on the day were complimentary about the food provided. The meals seen looked nice and were presented in a way that looked appealing. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals and diabetics. People who live at the home could choose where to eat and some preferred to eat in their rooms. It was observed that staff asked individuals what they wanted for the next meal and if it was not on the menu then they had what they wanted, for example on the day of the visit supper was cheese and potato pie, salmon sandwiches with a starter of soup or fruit juice, one individual wished to have boiled eggs instead. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 17 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 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staff’s knowledge and understanding of safeguarding and protection issues. EVIDENCE: The homes complaints procedure was seen to be available in the information given to people who use the service. There have been no complaints received by the commission. The manager advised that the home promotes an open door approach to relatives and people who use the service, to help resolve complaints and issues effectively. The home uses West Sussex safeguarding adult policy and staff were seen to have training in adult protection as part of their induction as well as yearly updates. The home’s AQAA stated that over the past twelve months staff have used the ‘whistle blowing policy, which although it has been hard to maintain it has improved’. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 18 People who use the service and their representatives have commented in the surveys we received and on the day when we spoke with them, that the home staff are approachable and that they feel listened to. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 19 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 & 26 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. EVIDENCE: We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures, to make it feel like home. Nyton House is situated in its own large, well kept grounds. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 20 are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The AQAA for the home stated that maintenance has been carried out on equipment such as the boiler and the lift has been refurbished. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 21 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 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have received the mandatory training that is expected each year, however it was not clear that staff have received training to meet all the needs of people who use the service. The lack of checks in the current recruitment process places people who use the service at risk. EVIDENCE: The staffing structure at the home consists of: manager, support workers, kitchen staff, laundry and housekeeping. Additional staff are on duty in the mornings when the home is busiest. Two waking night staff are on duty throughout the night. Other health care professionals support the team from outside the home as needed. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. There was evidence that staff have received training in mandatory areas such as food hygiene, first aid and manual handling, health and safety and safeguarding adults. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 22 The AQAA for the home stated that staff receive a 12-week induction. Of the three staff surveys received one stated that the member of staff had received induction and other training to help them support people that live at the home. The person also stated that they employer had undertaken recruitment checks. The other surveys however stated that they were aware that checks are not always undertaken, that the induction did not fully cover everything they felt they needed to do the job, and that they have not received training which is relevant to their role or which helps them support individual needs. The proprietor said that they are looking at the training and how this can be monitored, staff request training currently that is in addition to the mandatory courses. Although one survey stated that they had requested moving and handling training, which they had not yet received. When we looked at staff recruitment files there were certificates regarding the training that has been given recently in first aid. It was seen that staff had been reissued with induction checklist and a fire questionnaire in July 2007 where staff were advised to get another member of staff to sign and witness them for the knowledge and understanding. We looked at five files of staff that had joined the home since our last visit. We found that three of them had no references and there was no CRB or POVA First check for one. Since the visit the proprietor has written stating that the CRB was at the home in a different file, however the references were not there and were being requested. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 23 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 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of risk assessments and information in the care plans; current medication administration and recording, and recruitment practices may place people who use the service at risk. There are however other systems and procedures in place, which monitor and maintain the quality of the service provided and which, promote the safety and welfare of those living and working in the home. EVIDENCE: The manager is a nurse although she is not employed as a nurse at the home, which provides personal care. The manager has completed her NVQ 4 and has said that she intends to apply to the commission to be registered. The Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 24 manager is hands on carrying out tasks such as taking bloods and cutting nails. The manager will need to evidence her competencies in these areas. There is a clear Management structure with policy & procedures reviewed as necessary. There were a range of written policies and procedures available for staff to refer to as guidance and to inform their practice. These included the following: • Admission, discharge and transfer of residents • Human Rights • Confidentiality and access to personal records • Abuse of the person • Drug administration • Self administration of medication • Infection control • Complaints procedure • Whistle-blowing • Sexuality • Health and safety at work The people who use the service and their relatives or representatives and the staff, are able to discus all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident, relative and staff meetings, and in questionnaires, which are sent out regularly. Individual monies & valuables can be locked in lockable boxes in the resident’s room. It was noted that the home’s equipment, plant and systems were checked and serviced or implemented at yearly, or six monthly or as manufacturers require for example; passenger lift and hoists; fire safety equipment portable electrical equipment; and hot water system. The lift has been refurbished since the last visit in 2006. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. There was a fire risk assessment for the premises; tests of equipment and regular risk assessments of the premises and working practices were undertaken regularly with fire alarms set off weekly and monthly checks of fore equipment.. Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Sch 3 (1)(b) 13 (4) (b)(c) Requirement People who use the service must have clear individual care plans describing the support that staff give to meet identified needs Where it has been identified that people who use the service are at risk from falls, a risk assessment must be put in place to lessen those risks. Individuals who have been identified with potential risks to their pressure areas or with actual skin breakdown must have a risk assessment in place, be reviewed by the GP and the care plan updated to include how the risks are to be reduced and specify how wound care needs are to be met. Individuals records must state the amount of medication given where there is a choice of dose for “as required medication” The records must also state the reason medication was given and any effect it had. Individuals must be assessed to ensure safety for selfadministration of medication. DS0000014643.V362224.R01.S.doc Timescale for action 15/07/08 2 OP8 15/07/08 3 OP8 13 (1)(b) 15/07/08 4 OP9 13 (2) 15/07/08 5 OP9 13 (2) 15/07/08 Nyton House Version 5.2 Page 27 6 OP9 13 (2) 7 OP29 19 Sch 2 (5)(6)(7) This must include the assessment and safe storage of Schedule 3 medication – Temazepam where people selfadminister. Medication records must show the amount of medication received at the home, by whom and when. A thorough recruitment of staff must include references, CRB and POVA First checks to protect people who use the service. 15/07/08 15/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nyton House DS0000014643.V362224.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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