Inspection on 17/02/06 for Palm Nursing Home

This inspection was carried out on 17th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Palm Nursing Home 08/08/06

Palm Nursing Home 09/05/05

Palm Nursing Home 20/01/05

Palm Nursing Home 22/09/04

Palm Nursing Home 17/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Palm Nursing Home 79 Glengall Road Woodford Green Essex IG8 ODP Lead Inspector Ms Gwen Lording Unannounced Inspection 10:30 17 February 2006 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 Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 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. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Palm Nursing Home Address 79 Glengall Road Woodford Green Essex IG8 ODP 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) 0208 505 4577 0208 504 0747 Palm Nursing Home Ltd Mrs Marie Lilette Ebrahimkhan Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22), Physical disability (22), Terminally ill (22) of places Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Palm Nursing Home is registered to provide nursing care to 22 older people. There is a registered nurse on duty at all times. The property is an adapted detached house, situated in a residential area of South Woodford, in the London Borough of Redbridge. The home is approximately 1/2 mile from shops, public transport and other community facilities. Accommodation is provided on 3 storeys, with lift access to all floors. Bedrooms include single, double and triple occupancy rooms. Several of the single rooms have ensuite showers and lavatories. The registered providers have recently converted the two triple occupancy rooms to double rooms. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10.30 am. It took place over four hours during the late morning and early afternoon. Discussion took place with the home’s proprietors, one of whom is the registered manager; the head cook, administrative staff and several members of nursing and care staff. The Inspector spoke to several residents in the lounge/ dining room and two residents who were in their rooms. In addition the relatives of a resident visiting the home were interviewed to get their views and comments about the care in the home. The Inspector also took the opportunity to speak to a GP who was on a routine visit to the home. A tour of the home was made and a number of staff and care records were looked at. This was the second statutory inspection visit in the inspection programme for 2005/2006. Over the course of the two visits, all key standards have now been assessed. The Inspector would like to thank the staff, residents’ and their relatives/ visitors for their input during the inspection. What the service does well: What has improved since the last inspection? Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 6 The completion of an extension to the conservatory has resulted in a more attractive living situation and improved facilities for residents. The two triple rooms have recently been converted into double rooms. The additional space has been used to create small seating areas, with lounge chairs, for those residents to use as an additional quiet area for relaxing in their rooms. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 5 were not tested on this visit. However, evidence from the last inspection was that: • Residents’ needs are assessed prior to them moving into the home, using a comprehensive admission assessment format, and care plans are drawn up from this assessment, ensuring that the needs of residents are identified. • Residents’, or their representatives, have the opportunity to visit the home prior to moving in, to help them make an informed decision about moving in. The home does not offer intermediate care. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last inspection, all of the outcome standards were assessed as met. These standards will be re-tested at a future inspection. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 There is a clear and comprehensive care planning system in place to adequately provide staff with the information they need to satisfactorily identify and meet residents’ individual needs. Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. There are clear medication policies and procedures for staff to follow to ensure that residents are safeguarded with regard to medication. EVIDENCE: Individual plans of care were available for each resident and the records of four residents were examined. Staff have recently had additional training in care planning and this was evident from the standard of care plans seen on the day of the inspection. The records for these residents were found to be generally detailed and comprehensive and followed on from a full assessment of the resident’ needs. There was evidence that the care plans are reviewed on a monthly basis and updated to reflect changing needs. The records indicated Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 10 that residents are seen by other health care professionals such as dentists, chiropodists, GP’s and specialist nurses, for example Macmillan Nurse. The registered providers have a system in place for auditing a number of care plans in the home on a random basis and also monitor medication and other health related records. Care plans are well constructed and maintained, making case tracking easy to undertake. Risk assessments are routinely undertaken for all residents around risk of falls, nutritional needs, continence and development of pressure damage. The home has engaged the services of a physiotherapist, who visits the home once a week. This service has led to the increased mobility of individual residents. The Inspector was able to meet briefly with a GP who was on a routine visit to the home. She commented: “ I have been visiting the home for the past 10 years and I am very happy with the care provided. She also considered that odour control in the home was of a very good standard. An audit was undertaken of the management of medications within the home. There are clear medication policies and procedures for staff to follow. Discussions with staff and a review of medication records show that staff are following the policies and procedures. All staff responsible for administering medication undertakes appropriate training. Medication reconciliation checks are undertaken weekly. The registered providers are aware of the recent legislation and requirements with regard to the safe disposal of unwanted medication from a care home with nursing. They are currently in the process of making suitable arrangements for the safe disposal of unwanted medication through the London Borough of Redbridge, Public Protection Unit that deal with clinical waste issues. The registered providers must inform the Commission when these arrangements are in place. Staff talked about and were observed to treat residents’ in a respectful and sensitive manner. They understood the need to respect an individual’s dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Residents spoken to said that staff were respectful and considerate when attending to their personal care. One resident who has lived in the home for several years commented: “ I am well cared for and have everything I need. Staff are kind”. Another resident commented: “The staff help me with things I can’t do myself”. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. There is a limited programme of activities available. Residents especially those with more specialised needs, do not benefit as fully as they might from a sufficiently varied and stimulating range of activities and outings. The meals in the home are well-presented and individual preferences and specialist dietary needs are catered for. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: There is a limited programme of activities available in the home and residents would benefit from a more varied choice of activities. However, during the visit residents were seen to be pursuing their own interests and those spoken to commented: “There is enough for me to do…..I like to spend time in my own room”. Some residents were listening to music, one resident was reading, another resident was completing a quiz wordbook and two male residents were sitting together chatting. One resident had just had her hair washed prior to a regular visit by her family who style her hair. There are regular visits to the home by professional entertainers. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 12 With the extension to the conservatory there is now space for more individual or small group activities or for those residents who wish to participate in activities away from the main lounge. The home needs to review the activities programme to ensure that all residents are provided with a sufficiently stimulating and varied choice of activities. The Inspector observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their daily lives, for example choosing a drink, newspaper, what time they wished to have a bath, or where they wished to eat their meal. Visiting times are flexible and residents are able to receive visitors in the lounge, the conservatory or in their own rooms. A visitor spoken to during the visit commented: “ The staff always make us feel welcome”. The cook has been at the home for a number of years and knows what each resident likes to eat and which residents require a special diet. The home has employed two additional part time, kitchen assistants since the last inspection. This enables the cook to supervise the serving of meals and spend time in the dining room during meal times. Those residents spoken to who were able to express a view said they: “enjoyed the food” and there was always a good variety. Menus were examined and found to be well balanced and a choice is offered each day. The lunchtime meal was being served during the visit and was seen to be well presented and a choice was offered. Several residents were eating small bowls of freshly prepared fruit as a dessert. One resident with a deteriorating health condition had a decreased appetite. Staff were seen to be offering him small nutritious snacks and drinks to tempt his appetite. Food stocks were checked and there was a plentiful supply of fresh fruit and vegetables. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 13 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): Standards 16 and 18. All complaints made, whether verbal or written, must be recorded to ensure that any trends are identified and that residents and their relatives feel confident that their complaints and concerns are listened to and will be acted upon. All nursing and care staff have received training in Adult Protection/ Abuse Awareness. This is now being extended to all staff working in the home, including ancillary staff, to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy/ procedure and the records inspected indicate the number of complaints received and includes details of investigation and any action taken. In discussion with the registered providers and inspection of the complaint record maintained, it was evident that only formal written, or serious complaints are being logged. The Inspector discussed as to what constituted a “complaint” to be logged. This must include verbal complaints via telephone or face to face, and expressions of concern or dissatisfaction with any aspect of the service. The Inspector spoke to relatives visiting the home and they considered that staff were always responsive to any concerns or dissatisfaction raised. One relative commented: “ I speak to the boss (registered manager) and she sorts it out”. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. There is an ongoing programme of training in Adult Protection/ Abuse Awareness and this is now being extended to all staff in the Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 14 home, including ancillary staff. This topic is also covered in the induction programme for all staff. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 15 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): Standards 19, 23 and 26 The environment has improved considerably since the last inspection providing residents with a more comfortable and attractive living environment. EVIDENCE: The completion of an extension to the conservatory has resulted in a more attractive living situation and improved facilities for residents. The extensions main purpose is for use as a small separate dining area, but can also be used for a variety of social and cultural activities; and where residents can meet visitors in private. The two triple rooms have recently been converted into double rooms. The additional space has been used to create small seating areas with lounge chairs, for those residents to use as an additional quiet area for relaxing in their rooms. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 16 A programme of redecoration of bedrooms has begun and some redecoration has taken place in the lounge and the seating changed to create a further small dining area. The building was toured, accompanied by the proprietor/ manager, at the start of the visit, and visited unaccompanied later during the day. Some bedrooms were seen either by invitation of the residents, or with their permission, whilst others were seen because the doors were open or being cleaned. Throughout the visit all areas of the home were found to be clean, tidy and free from odour. (Comments from a visiting GP have already been included in another part of this report) Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 28, 29 and 30 The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Residents benefit from a committed staff team who have the skills and training to meet their needs. Standard 27 was not tested on this visit. However, evidence from the last inspection was that: • Staffing levels are sufficient to meet the personal and nursing needs of the residents. EVIDENCE: Standard 27 was not specifically tested on this visit, as there were no outstanding requirements in relation to this standard. At the time of the last inspection, all of the outcome standards were assessed as met. This standard will be re-tested at a future inspection. Health and personal care needs were discussed with some staff, and staff were observed carrying out their duties during the visit. Those staff spoken to understood and expressed their commitment to fully support the main aims and values of the home. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 18 Regular meetings are held for care staff and qualified nurses to discuss both clinical practice and care related issues. The information on the duty rota was consistent with the names and delegations of the staff on duty. Whilst the registered manager’s name was recorded on the duty rota, it must also record the hours being worked. An examination of the files of three staff employed since the last inspection, showed that the home is undertaking all the necessary checks to ensure the protection of residents. There is an in house training programme for carers, adaptation nurses and qualified nursing staff. Mandatory training in essential areas such as, manual handling, food hygiene and fire safety is being undertaken at the required intervals. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 19 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): Standards 33, 35 and 38. Resident’s best interests are safeguarded by the home’s record keeping. Monitoring visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service provided. Copies of such reports must be sent to the Commission. Standards 31, 32 and 36 were not tested on this visit. However, evidence from the last inspection was that: • A very experienced and well-qualified person, who is also the owner of the home, manages the home. EVIDENCE: Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 20 The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. These standards will be re-tested at a future inspection. Currently the manager does not act as an appointed agent for any resident. Resident’s financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of four residents. Secure facilities are provided for the safe keeping of money and valuables held on residents’ behalf and written records are maintained. A wide range of records were looked at, including fire safety, lift maintenance, accidents/ incidents, recording and regulation of water temperatures and risk of Legionella. These records were detailed, up to date and accurate. A routine visit was made to the home on 26/07/05 by the London Fire and Emergency Planning Authority (LFEPA). The report states: “ The premises were found to be satisfactory”. Regulation 26 visits are undertaken by the responsible individual on a regular basis, to check the quality of care being provided and ensure that care is being delivered in accordance with the individual care plans and wishes of residents. The registered persons must ensure that a copy of each report is sent to the Commission following such visits and not retained in the home. Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 21 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 17/02/06 1. OP29 17 Schedule 4 2. OP12 16 3. OP16 22 4. OP33 26 The duty rota must record the names and hours being worked by all staff in the home, including the registered manager. (Timescale of 09/05/05 not met) The activities programme must be reviewed to provide a wider range of stimulating activities for all residents. All complaints made, whether verbal or written, must be recorded and include details of investigation, any action taken and the outcome for the complainant. The registered persons must ensure that a copy of the report of each Regulation 26 visit undertaken is sent to the Commission. 31/03/06 31/03/06 31/03/06 Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 23 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 Palm Nursing Home DS0000025958.V274180.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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