Inspection on 09/05/05 for Palm Nursing Home

This inspection was carried out on 9th May 2005.

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

Palm Nursing Home 08/08/06

Palm Nursing Home 17/02/06

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 0DP Lead Inspector Gwen Lording Unannounced Inspection 09 May 2005 07:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Palm Nursing Home Inspection report OP.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Palm Nursing Home Address 79 Glengall Road, Woodford Green, Essex IG8 0DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8505 4577 020 8504 0747 Mrs Marie Lilette Ebrahimkhan Mrs Marie Lilette Ebrahimkhan CRH Care Home 22 Category(ies) of OP Old age (22) registration, with number PD Physical disbaility (22) of places TI Terminally ill (22) Palm Nursing Home Inspection report OP.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20 January 2005 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 provider has proposals to convert the triple occupancy rooms to single rooms, although there is no date for the work to commence and the proposals have been under discussion for many years. Palm Nursing Home Inspection report OP.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors and commenced at 7.30 am on a Monday morning. The visit ended approximately 4 1/2 hours later at midday, and was cut short due to the ill health of the registered proprietor/manager. The inspectors spoke to the proprietors and manager, 7 residents, 2 visitors and 9 members of staff. A tour of the premises was undertaken and a number of records were examined. Action in relation to outstanding requirements and recommendations was discussed with the registered persons. The inspectors continued to take into account issues concerning the quality of the service, which had been raised as a result of a number of complaints made to the Commission, during the previous 6 months. What the service does well: Due to illness and incapacity, few of the residents were able to give informed comments on what they consider the service does well. Those who were able, reported that most of the staff were kind to them. Visitors who arrived during the inspection reported that they were always made to feel welcome, even when they arrived unannounced, and that staff were ”always friendly and always had time for a chat”. These visitors also said that the manager and several members of staff were very responsive when they had raised concerns in the past, and that they were kept informed about changes in their relatives condition. Case recording was generally found to be comprehensive. There is a pleasant rear garden with access for people who have impaired mobility. Wound and pressure care is well managed. Palm Nursing Home Inspection report OP.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The premises are in need of repair and redecoration, to make the home more comfortable for residents, and attention must be given to reducing the triple occupancy rooms to provide greater privacy and choice for residents. Attention must be given to the arrangements for meals, to ensure that residents receive a varied, balanced and nutritious diet and that residents are able to have an opportunity to exercise a real choice about what they eat. Fluid charts must be completed accurately, and not retrospectively as found during the inspection. There is a lack of mental, physical and social stimulation for residents, with several stating that they were bored. A more varied range of activities must be provided, focusing on the interests and abilities of the residents. Staffing arrangements must be sufficient to enable residents to exercise choice about the activities that they are involved in, including the opportunity to go out of the home and visit the local community. More evidence is required to demonstrate that residents who lack capacity to express their views, are being given the same opportunity as those who are Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 7 more able to be involved in, and to contribute to, the choices and decisions which affect their lives. 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 G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 5 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. EVIDENCE: The admission process was discussed with one resident who had recently moved into the home for a period of respite care. This person was already familiar with the service being provided at Palm and was satisfied that she had sufficient information on which to base her decision. Records demonstrated that service users, where capable, their relatives or representatives and other professionals are involved in the assessment process. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 & 10 Service users’ health and personal care needs are set out in individual care plans, but not all plans accurately reflect current need. Service users were generally satisfied that staff treated them kindly, although some people felt that more attention could be given by some staff to ensuring that their individual preferences were taken into account. Where the monitoring of fluid input/output is required, records must be accurately maintained by staff to insure that the information available on the chart at any time is accurate, in order to be confident that health care needs are met. EVIDENCE: Individual plans of care were available for each resident, and those examined were found to be generally detailed and comprehensive, and followed on from a full assessment of the resident’s needs. Visiting relatives were aware of care plans being in place, although most of the residents spoken to had no recollection of being involved in discussions about planning to meet their individual care needs. Although the care plans were available to staff, feedback from carers indicated that information about meeting care needs was Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 11 shared verbally by the qualified nurses. Although the inspectors were satisfied that the needs of residents, as identified in the care plans, were being met, as directed by the qualified staff, it was not clear whether the unqualified carers fully understood the reasons why they were undertaking certain tasks. Good delivery of care relies on good memory and communication between staff. Service users could be at risk of not having their health and personal care needs met, if this system breaks down. If carers are not involved in the care planning process and do not access the written care plan, it is possible that information about meeting care needs could be misinterpreted, or missed, resulting in poor delivery of service. More work needs to be done with the carers to ensure that they are involved in and understand the care planning process. The care plans were not always up to date. For example, one resident was stated to have suffered deterioration in memory and physical dexterity, as a result of arthritis or rheumatism. The resident expressed her concerns at the pain she was suffering, as well as the distress that increasing incapacity caused her. However, there was nothing in the care plan to indicate the action being taken by the staff to address this, or to demonstrate if any other health care professionals had been consulted. Residents, who were able to express a view, commented that most staff were caring and kindly when helping them with intimate personal care, although some residents said that they felt rushed by some staff. One resident said that staff did not always take care to ensure that the water temperature of the shower was suited to their preference. One of the inspectors had previous knowledge of a recently admitted resident, whilst resident in another nursing home. It was apparent that, whilst his general health had deteriorated, the staff team had worked effectively to improve his mobility and the management of his diabetes, epilepsy and dependence on cigarettes, which in turn had improved his overall health and well being. Staff were noted to be completing the recordings of fluid intake/output charts for two service users retrospectively. It is essential that all monitoring records are maintained accurately and contemporaneously, to ensure that the needs of residents are appropriately met. Examination of the Medication Administration Charts (MAR Charts) showed that they were generally being completed satisfactorily, demonstrating that residents were receiving medication, as prescribed. However, there was one entry where correction fluid had been used to delete/amend an entry. Guidance from the pharmacy inspector is that this practice is not acceptable. The MAR chart is a legal document, and incorrect entries must not be eradicated. The original and amended entry must both be visible. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 15 Social activities and arrangements for meals are aspects of the service which require considerable improvement, in order that residents experience a stimulating lifestyle and a balanced, varied and nutritious diet which reflects their individual preferences and cultural needs. Some service users may not always be encouraged to exercise choice and control over their lives. EVIDENCE: Several residents stated that there was nothing for them to do, other than to watch television or sleep. Some said that staff were often too busy to talk to them, or read to them. Residents who said that they were generally satisfied were those who were more alert and who chose to stay in their own rooms, had large print books, as well as television and radio, and were able to entertain their visitors in their rooms. There was no choice of activities provided during the inspection, with the only source of stimulation being the television in the combined lounge/dining room, which was subsequently turned off and replaced later in the morning with music. Many of the residents were seated in armchairs, which were situated so as to prevent them from seeing the television. Staff were engaged in Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 13 meeting some residents’ personal care needs, for example taking them for baths or showers, but there was insufficient staff to sit and talk to other residents or to engage them in meaningful activity. Visiting times are flexible, and visitors on the day of the inspection said that they were always made welcome, even if they arrived without an appointment. Service users are able to receive visitors in their rooms or in the lounge/dining room. However, the restrictions on space in this room impact on privacy and comfort, with visitors having to sit directly in front of a resident, in the general circulation route through the room. The inspectors were concerned that the arrangements for meals did not ensure that all residents’ choices were taken into account, and did not demonstrate that a balanced and nutritious diet was being offered. On arrival at the home, the inspectors examined the arrangements for breakfast, the menu and food stocks in the home. There was no menu, other than a pro-forma sample menu, produced for inspection purposes. A book used to record food eaten by the residents had no entries for the previous weekend. The inspectors were told that the breakfast had been already prepared by the night staff at 4 am, and consisted of bowls of dry cereal and either jam or marmalade sandwiches. The preparation of breakfast by staff did not enable residents to choose an alternative should they wish, and there were no ingredients to prepare a cooked breakfast other than eggs, had a resident requested this. The cook subsequently stated that ingredients such as sausages or bacon would be purchased, if requested. However, this does not allow for residents to be provided with an alternative at the time they request it. One resident said that in the past, he had asked for toast and this had been given to him, demonstrating that staff were willing to provide alternatives. Residents stated that they had not been offered either a drink or anything to eat before breakfast, and that they never had anything to eat or drink before the breakfast was served, even though several residents had been awake and in the lounge for up to 3 hours before breakfast was served. The lunch served at the close of the inspection was adequate, and did include fresh carrots, purchased after the inspectors had raised their concerns. Food stocks comprised mostly frozen vegetables and a small quantity of frozen convenience food. There was no evidence of any fresh vegetables, other than approximately 1 dozen potatoes. The only fresh fruit comprised 1 apple and 2 bananas, and these were in the fridge and not accessible to residents. Discussion with the manager and staff indicated a lack of understanding of the importance of providing choice to all residents, either in the provision of food, or the provision of activities, or that a stimulating environment and nutritious food can be a significant factor in improving mental and physical well-being. The explanation was that these foods were what residents liked, which is Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 14 acknowledged by the inspectors, but there was a lack of understanding of the need to regularly review with the residents their views on the meals they received, as they may not wish to have the same breakfast every day of the week. There was a lack of evidence to indicate that the manager and staff use opportunities to introduce new or alternative menu choices, or to discuss with the residents the preferences that they may have enjoyed in the past. For example, the VE Day celebrations the previous weekend would have provided an ideal opportunity for residents to have had meals that reflected that period of their lives, as well as an opportunity for social activities and reminiscence reflecting that occasion. The cook did not demonstrate an understanding that, to meet the nutritional needs of older people, the menu needed to be more varied and to include fresh products and home cooking, rather than to rely on convenience food. Neither was there evidence of an understanding of ways in which choice could be offered to people who have dementia or limited capacity to express their views. Very few of the residents were able to express detailed views on the arrangements for meals, other than that they would like a drink when they first get up. One person said that concerns about the availability of fresh fruit, served in a manner suitable for older people, had been raised with the manager, but very little had been done to address their concerns. Whilst some of the residents, or their representatives, were able to express their views, the majority had varying degrees of dementia or difficulty with communication. Where residents were able to express their views, their nutritional choices were generally met. However, the inspectors were concerned that those less able were not being helped to exercise choice and control over their lives, in relation to meals and social activities. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a satisfactory complaints procedure, although not all of the residents would be able to use a formal, written process. Nursing and care staff receive training in adult abuse awareness, but this training needs to be extended to ancillary and administrative staff, to ensure that the whole staff team are aware of the indicators of abuse and that there is a proper response to any concerns about the welfare of residents. EVIDENCE: There is a satisfactory complaints procedure. However, many of the residents would not have the capacity to use a written, formal process. Visiting relatives said that they were generally confident that their concerns and complaints were taken seriously by the manager and staff, and acted upon, and that they had not had to use a formal process to make a complaint. An outstanding issue regarding the provision of fresh fruit on a daily basis had been addressed, but improvements had not been sustained. Few of the residents were able to express a view as to whether they were aware of what to do if they were dissatisfied with the service that they were receiving. Those who were able, were aware that they could speak to the registered persons and felt able to do so. Over the past year, a number of complaints have been received about the service at Palm. Some of these complaints refer to the service provided 4-5 years ago and it has not been possible to investigate the issues thoroughly, Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 16 because of the time that has elapsed. However, the issues of the complaints were taken into account when conducting this and previous inspections. Very little evidence has been found to substantiate the complaints, although there is room for improvement in the delivery of the service, as stated elsewhere in this report. The registered persons have worked co-operatively with the Commission to address these issues, and are aware that the service will be monitored more closely until the Commission is confident that the welfare and safety of service users is being promoted. There is a written policy and procedure for the protection of vulnerable adults and ‘Whistle blowing’ and those staff spoken to during the inspection were aware of the action to be taken if there were concerns about the welfare of service users. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25 &26 The environment is generally adequate to meet the needs of the people who live there. However, the home is in need of redecoration and repair, to improve the comfort, privacy and safety of the residents, and some parts of the building are very cramped. EVIDENCE: There has been no progress over several years to reduce the number of multiple occupancy bedrooms, despite the registered providers stating that plans to adapt the premises were being developed. The inspectors were told that the triple bedrooms are now only used by two people. As the home was operating prior to the introduction of the current minimum standards, the Commission cannot require the registered persons to improve these facilities, unless they impact on the safety and welfare of residents. However, the current multiple occupancy bedrooms are not considered to be in line with best Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 18 practice, and do not offer sufficient privacy and choice to people who are accommodated in these rooms. There was no evidence of any redecoration of the premises in the past year, and the registered persons were asked to provide a programme of redecoration and repair. Many of the bedrooms were adequately decorated, although some were lacking possessions reflecting the interest and personalities of the residents. Two or three rooms visited were more personalised, and these were rooms where residents were more alert, and had exercised more choice in relation to where they spent their time, or where their relatives had invested effort to make the rooms homelike. At the beginning of the inspection, there was a strong odour of urine, but this was rectified as beds were stripped and changed. Alarms in residents’ bedrooms were not always within their reach, particularly during the daytime, when residents were seated away from the alarm cord located near their bed, even though many had lengthened cords. It is important that staff regularly check to ensure that residents have the means to summon assistance, should they need it. There is a combined lounge/dining room, but the space is insufficient to enable residents to eat together at dining tables. They therefore eat separately at over the chair tables. This denies residents the opportunity for a change of environment or the opportunity to have some gentle exercise in moving from one place to another or the opportunity to engage in conversation and social interaction with other people. The registered persons have stated that they have plans to extend a small conservatory, which will provide alternative seating for residents, although is unlikely to be sufficient to provide a designated dining area for all residents. Choice is respected for those residents who prefer to eat in their own rooms. A french window opening into the conservatory provides the ventilation for one ground floor bedroom. This has to be closed when private conversations are taking place in the conservatory, thereby denying the resident choice in the ventilation of their room. One of the bathrooms on the first floor was being used to store equipment such as a hoist, vacuum cleaner, mattress and other sundry items of equipment. Therefore the bath and toilet is not available to residents who might be able to use them independently. Staff would have to empty the room on to the landing before the room could be used, thereby creating a risk hazard. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Staffing levels are sufficient to meet the personal and nursing needs of the service users. Satisfactory policies and procedures are in place for the recruitment of staff. However there was missing documentation from one staff file, including reference and CRB checks, thereby reducing confidence that service users are safeguarded by the home’s recruitment procedure. EVIDENCE: The information on the duty rota was consistent with the names and delegations of the staff on duty. An additional carer arrived at 9 am, but was not recorded on the rota as being required to work. The carer stated that the previous day, he had been contacted and requested to work, in order to cover for a new member of staff undertaking part of her induction. Whilst it was good management that the work of the new member of staff was being covered, the duty rota should have been amended to reflect this. Staffing levels of qualified nurses and care staff were sufficient to meet the personal care and nursing needs of residents. In addition, there was a cook, domestic assistant and an administrative officer, providing support to ensure that the home ran smoothly. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 20 The registered persons arrived during the inspection, although the manager’s hours were not reflected on the rota. The inspectors would expect the rota to include all persons working in the home, including the registered manager. The files of three members of staff employed since the last inspection were examined. Two were satisfactory. One had no record of written reference checks or a check from the Criminal Records Bureau. One of the proprietors stated that the information might have been held at the sister home, where staff interviews often take place. However, the lack of evidence of sufficient recruitment checks could indicate that residents are not being protected by the home’s recruitment procedure. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 & 36 A very experienced and well-qualified person, who is also the owner of the home, manages the home. More needs to be done by the manager to ensure that the routines of the home are flexible and that staff encourage residents to be involved in choices and decisions, thereby ensuring that the home is being run to promote the welfare and best interests of the residents, and so that residents are not seen to be fitting into the routines of the home. Residents who are alert and able to express their views are more likely to receive a satisfactory service, resulting in some people’s rights and best interests not being adequately promoted. The registered persons have demonstrated willingness and commitment to discuss and address concerns about the service, which have come to the attention of the Commission. EVIDENCE: Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 22 Records examined, for example, the minutes of staff meetings, indicated that the manager reinforces policies and procedures, making reference to information from inspection reports. The registered persons also have a commitment to staff training. Although staff meetings do take place, there were minutes of only two meetings having occurred in the past 6 months. The inspectors would expect staff meetings to occur more frequently, to ensure that issues relating to good practice are identified, and aspects of the service, which require attention, are addressed. The minutes indicated that the meetings are used mainly for the purpose of passing on information from the registered persons to staff, rather than to involve staff in discussion about ways in which the service can be reviewed and developed. As previously stated, the formal supervision of staff has improved since the last inspection. One new member of staff, during her induction period, is allocated to work under the supervision of a senior carer, and also receives supervised practice by the registered manager, thereby ensuring that she is familiar with the practice of the home and the needs of the service users. As previously stated, the management of the preparation and serving of breakfast on the day of the inspection, and the overall management of meals and nutrition, indicated that more could be done to promote healthy living, choice and independence for service users. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 2 3 2 x 3 x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 2 x x x 3 x x Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement All residents must have a written care plan in sufficient detail to provide staff with clear guidance on the actions required by staff to meet, health, personal and social care needs. The care plan must be regularly reviewed and updated to reflect changing needs. Where the monitoring of fluid intake/ output is indicated, staff must ensure that these records are accurately maintained and up to date. Correction fliud must not be used to delete/ amend any incorrect entries on Medication Administration Record (MAR) charts. It is a requirement that residents interests are recorded and that they are given opportunities for stimulation through leisure and recreational activities in and outside the home, which suit their individual needs, preferences and capacities. The registered provider must ensure that those residents who lack capacity to express their G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Timescale for action 30/06/05 2. 8 12 9/05/05 3. 9 13 9/05/05 4. 12 16 30/06/05 5. 14 12 30/06/05 Palm Nursing Home Version 1.30 Page 25 6. 15 16 7. 18 13 & 18 8. 19 23 9. 10. 11. 21 21 29 23 23 17 Schedule 4 19 Schedule 2 12. 29 views, are helped to exercise more choice and control over their lives. The registered provider must ensure that residents are provided with suitable, wholesome and nutritious food which is varied and properly prepared and available at such times as may reasonably be required by residents. It is a requirement that training in Adult Protection/ Abuse Awareness is extended to include all ancillary and administrative staff working in the home. The registered provider must produce an action plan with timescales, for a programme of routine maintenance and renewal of the fabric and decorartion of the premises. This action plan must be sent to the Commission. The bathroom on the first floor must be accessible to residents at all times. Suitable provision must be made for the appropriate storage of aids and other equipment. The duty rota must record the names and hours being worked by all staff in the home, including the registered manager. The employment checks and references for all staff employed must be maintained on file and retained in the home. 9/05/05 31/07/05 31/07/05 31/05/05 31/05/05 9/05/05 31/05/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 26 Palm Nursing Home 1. Standard 32 It is a recommendation that staff meetings occur more frequently, to ensure that issues relating to good practice are identified, and aspects of the service which require attention are addressed. Palm Nursing Home G55_S0000025958_Palm Nursing Home_V226015_090505_Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex 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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