Inspection on 02/10/07 for Primrose House Nursing Home

This inspection was carried out on 2nd October 2007.

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

Primrose House Nursing Home 01/10/08

Primrose House Nursing Home 27/04/06

Primrose House Nursing Home 13/10/05

Primrose House Nursing Home 20/04/05

Primrose House Nursing Home 03/12/04

Primrose House Nursing Home 06/05/04

Primrose House Nursing Home 15/05/03

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 Primrose House Nursing Home 765-767 Kenton Lane Harrow Weald Middx HA3 6AH Lead Inspector Judith Brindle Key Unannounced Inspection 2nd October 2007 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Primrose House Nursing Home DS0000022936.V351689.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. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Primrose House Nursing Home Address 765-767 Kenton Lane Harrow Weald Middx HA3 6AH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8954 4442 020 8954 5376 hassam.cader@btinternet.com Hassam Cader Mrs Raziya Banu Cader Hassam Cader Care Home 23 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (23) of places Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide nursing care and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories:Old age not falling within any other category (Category OP) (no more than 23 persons) Service users with dementia who are over 65 years of age (Category DE(E)) (no more than 7 persons) Date of last inspection 27th April 2006 Brief Description of the Service: Primrose House Nursing Home provides nursing care for up to 23 elderly persons. The care home is registered to provide places for up to seven service users needing dementia care. The home was first registered in September 1994. Mr H Cader, who is also the registered manager, owns the nursing home. . The home is a large detached house close to Harrow Weald. The home has three floors, with lift access. There are 17 single rooms, and 3 shared rooms. There are bedrooms on each floor. The proprietor has agreed that service users with the diagnosis of dementia are offered single rooms on the ground, and first floor only. Four bedrooms have either an ensuite toilet or an ensuite toilet and bath. Communal rooms are located on the ground floor. The fees are £615 a week. Information and documentation about the service is available from the care home. The home has a large accessible enclosed garden. There is parking for several cars on the forecourt of the care home. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout a day in October 2007. There were two vacancies at the time of the inspection. I completed the inspection with Sue Mitchell who is a Regulation Manager. She was present for a significant part of the inspection. I was pleased to meet and talk with people living in the home, a visitor, and with staff on duty. Staff were very helpful during the inspection, and supplied all documentation, and information that I requested. The registered manager/provider was present during most of the inspection. The key unannounced inspection focussed on spending a significant period of time with people living in the care home, and observing interaction between residents and staff. Several of the people using the service, due to their needs have limited vocal communication abilities and/or are unable to respond to questions other than to a limited degree, so observation was a significant tool used in this inspection. Documentation inspected included resident’s care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether requirements from the previous random inspection (that took place 7th February 2007) had been met also took place during the inspection. 25 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the registered manager/owner supplied the Commission for Social Care Inspection a completed Annual Quality Assurance Assessment (AQAA) document. This includes required information from the owner /registered manager about the quality of the care home and the plans to improve the service. All sections of this document were comprehensively completed. Reference to some aspects of this AQAA record will be documented in this report. The inspector thanks all the people living in the care home, visitors, and the staff for their assistance in the inspection process. What the service does well: Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 6 The care home has a very welcoming atmosphere. Residents live in a homely environment. People living in the home and a visitor were positive about the care home and staff. There is close liaison with healthcare professionals and other specialists as and when required/needed by the residents. Residents’ contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. Recorded and verbal feedback from relatives and others was generally positive about the service provided by the care home A caring, appropriately trained, and generally competent staff team demonstrate knowledge, and understanding of the varied needs of people living in the care home. The home has an attractive accessible garden facility. A resident spoke of enjoying this facility. Records and staff confirmed that the manager/owner is keen to continue to improve and develop the quality of the service to residents. What has improved since the last inspection? What they could do better: The registered manager/provider needs to ensure that all people living in the care home are given the opportunity to be involved in meaningful daytime activities of their own choice, and according to their individual interests and capability. Night staffing levels need to be reviewed to ensure that there are sufficient staff on duty at night to provide required care and support to people living in the care home. There could be further development and improvement in the format of some records to improve the accessibility of the information to residents. Initial assessment information of prospective resident’s needs could be better developed, and an initial care plan could be put in place more quickly than four days. The management of resident’s monies could be reviewed, to ensure that there are transparent and safe systems in place. The kitchen environment needs to be improved. Primrose House Nursing Home DS0000022936.V351689.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. Primrose House Nursing Home DS0000022936.V351689.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 Primrose House Nursing Home DS0000022936.V351689.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): Standards 1,3 and (6 is not applicable) People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users to have the information that they need to make an informed choice about where to live, but some documentation could be further developed. Arrangements are in place to ensure that residents have their needs assessed prior to moving into the care home. These assessments could be further developed. EVIDENCE: The care home has a combined statement of purpose and service user guide, which provides information about the service provided. The format of this documentation should be further developed to improve its accessibility to people using the service, particularly those that have difficulty reading or whose understanding of English is limited. The manager confirmed that prospective residents and others are supplied with a copy of this documentation. AQAA (Annual Quality Assurance Assessment) records supplied to the Commission from the manager informed the inspectors that a Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 10 ‘Welcome Pack’, which includes relevant policies and procedures, is now supplied to residents and their relatives. Two care files of the most recent admissions were inspected in detail. One of the nurses was spoken to regarding an issue about the admission of one of the residents. Both files contained the homes pre admission information and hospital discharge information. The home’s own pre admission information was quite limited, and did not specify the type of needs, and care needed for that individual. The hospital discharge information was more comprehensive and could have been incorporated into the admission form to provide an interim care plan until all assessments had been carried out and the care plan written. There could be more evidence that assessment information from the hospital; particularly mental health reports is linked with the development of the individual care plans of people living in the care home. One person was admitted on 4/9/07, the assessments undertaken on 6/9/07, but the care plan not completed until 10/9/07. The home’s guidance stated that the care plan must be completed 4 days after admission to the home. This is of concern and the manager and senior staff must ensure that all care plans are completed within the stated timescales. This timescale needs to be reviewed to ensure that there is an initial immediate care plan (following admission) which includes recorded action to be taken by staff to meet basic and significant needs such as pressure area care, nutritional assessment, medication needs, moving and handling assessment, and risk of falls. It is strongly recommended that the home develop a more comprehensive pre admission document, which could incorporate all information provided by health professionals, family and significant others. This could then be used by staff as an interim care plan until all assessments had been undertaken. The care plans inspected were very detailed, and covered all aspects of care and include a section on maintaining privacy and dignity. Both had been signed either by the resident or their representative. All assessments had been carried out covering all aspects of the two residents’ health, personal and emotional care needs. One resident had been admitted needing a referral to the local clinic regarding their medication. As this person was an out of borough placement the GP needed to make the referral not the home. The home requested this referral within 24 hours of admission but the GP took 6 days to make the referral. This was of concern to the inspectors and will be taken up with the appropriate health authority. There was evidence that the staff had pursued this matter with the GP. The resident was not unduly affected by the delay and by the time of the inspection contact had been made with the clinic. The lead inspector spoke with a senior nurse about the admission assessment procedure for managing the care of people admitted to the home, who are prescribed this particular medication. She reported that generally there is not an issue in its management, including accessing required blood tests. She confirmed that this procedure had been discussed with all nursing staff ,and she confirmed that all were now fully aware of the appropriate admission procedure to be carried out. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 11 It was positive to note that for one person staff had begun a life history, which detailed the person’s early life and activities up to the time of their admission to the home. This is seen a very good practice and should be carried out for all residents. It is recommended that staff record who gave the information i.e. family, friends etc. One of the new admissions spoke to the inspector and said she was very pleased with the care and said “the girls were lovely” and the “ governor always popped into see me”. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9, 10 and 11 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each person using the service has a plan of care, but these could be further developed to improve their accessibility to residents with communication needs. Arrangements are in place to ensure that resident’s individual personal and healthcare needs are generally met, though there could be improvement in some areas. Residents are respected and their right to privacy upheld. Medication is stored and administered safely. EVIDENCE: The care plans for six people who had been in the home for a longer period of time were assessed. There was some evidence that these care plans had been improved since the previous key inspection, with the inclusion of more comprehensive staff guidance to meet the identified needs of people using the service. It is evident that people using the service (and/or relatives/significant others) are more involved in the care plans, and their review. AQAA (Annual Quality Assurance Assessment) informed the Commission that staff have begun (with advice from the Alzheimer’s Society) to develop, and implement Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 13 improve the care plans for residents with dementia care needs. Two previous inspection requirements in regard to this were judged to have been met. Development of care plans into a more ‘person centred’ format was discussed with the manager. The manager should continue to further develop care plans into a format that ensures that people using the service, experience the life that each person wants. The care plan files could be reorganised so that all information is easily accessible.. The assessment of the files focused on the care plans, and health care needs of the individuals and how these were addressed by the home. The preadmission information was found to be limited, and care plans could be completed more promptly (see Standard 3 in previous section). The care plan files recorded moving and handling, pressure area need, nutrition, falls, swallowing difficulties, oral health care, continence and dependency level risk assessments. There was generally comprehensive staff guidance to ensure that these needs are met, but this guidance was sometimes located in the file in an area away from the risk assessments. The fluid monitoring charts were generally intermittently completed. These need to be more closely monitored by senior staff. There were records of visits made by the GP, chiropodist, optician, dentist, tissue viability nurse and continuing care assessor. Some pressure area position changing (‘turning’) charts were in place for those people who had pressure sores. These charts were completed by staff and some of those seen were not consistent as to the frequency of the position change. The care plan needs to state clearly the frequency of ‘turning’ and staff must adhere to this to ensure people’s tissue viability is maintained. The home’s pre assessment information also detailed whether someone had been admitted with pressure sores with body maps and a record of treatment administered. One person had a record of being treated by the tissue viability nurse, and their skin had now healed. One new admission had come in to the care home with pressure sores. There was a detailed body map and a record of the treatment required including ordering appropriate pressure relieving equipment for this person. The home has three pressure relieving mattresses. One of the nurses stated that equipment is ordered when the residents are admitted and delivery is quick. In order to be more proactive it is advised that this equipment is ordered at the point of the preadmission assessment. The manager informed me that the home has 22 hospital beds, which has made it easier and safer for staff to assist people in and out of bed. There are three hoists,(used for transferring residents with mobility needs) which are serviced every 6 months. Records confirmed that care plans and risk assessments are reviewed regularly. Residents weight is monitored. ‘Daily’ and night records are completed by staff in regard to the progress of each person living in the care home. Residents who kindly spoke with the lead inspector were positive about the staff, and a resident confirmed that their privacy was respected. Staff were observed to respect resident’s privacy during the inspection. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 14 Staff and records including AQAA (Annual Quality Assurance Assessment) information confirmed that staff have knowledge of the ethnic and diversity needs of residents. A staff member spoke of a resident’s particular cultural needs. The medication storage and administration systems were inspected. Medication is stored securely, and the care home has a medication policy/procedure. The medication policy should be easily accessible. Registered nurses administer the medication to residents. The lead inspector was informed by records, and by a visitor that a person using the service had difficulty in swallowing, particularly their medication. This resident’s prescribed medication was inspected with a senior nurse. It was concluded from this that though most of this resident’s medication was in liquid form there was still some medication that could be supplied in liquid form, but had not been. The registered person needs to ensure that the resident receives all their medication (if possible) in a form that makes it easier to swallow, and so minimise the risk of choking. AQAA (Annual Quality Assurance Assessment) information informed the inspectors that ‘refresher’ training in medication administration is planned to be given to staff. The manager showed the lead inspector a record of a resident’s death and dying wishes, and said that all future people admitted to the care home would have these wishes documented. The manager should ensure that this information is documented for all residents (with support from their relatives if needed) and include obtaining resident’s views regarding possible future admissions to hospital from the care home. Primrose House Nursing Home DS0000022936.V351689.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): Standard 12,13 14 and 15 People who use this service experience good outcomes in this area This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents have the opportunity to participate in some activities, but there needs to be further development in the provision of daytime activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so that residents have the opportunity to develop and maintain important relationships. Residents are supported to make choices. Meals provided are varied and nutritious, and meet the varied needs of people using the service. EVIDENCE: There is an activities programme that is displayed in the communal sitting room. It records activities, which include ball games, arts and crafts, and ‘pastoral care’. This is recorded in fairly small written format. The format of this information should be improved (for example large pictorial format) to ensure that the information is accessible as possible to people using the service, so that they are aware of each day’s planned activities. It is recommended that residents have the opportunity (i.e. it be an agenda item) to discuss preferred activities during resident’s meetings. The activities programme recorded that the activities for the day of the inspection were exercises and hairdressing. There was no hairdresser seen during the Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 16 inspection. The lead inspector was informed that the hairdresser is presently coming to the home every two weeks. The activity programme needs to be amended as and when necessary, to ensure that residents have access to the correct information. AQAA (Annual Quality Assurance Assessment) information recorded that the care home plans to further develop the activity programme for residents. There was an activities person who did dancing and some gentle exercises with those residents who were generally fairly mobile (most residents were observed to have significant mobility needs). A television in the communal room was turned off during this session. Some residents were observed to enjoy singing along to some ‘old time’ music. Though it was evident that some development of activities for people using the service had been started there needs to be further action taken by the registered person to ensure that all residents including those with multiple needs such as dementia care needs have a choice of varied and preferred activities. Staff could be more proactive in getting people to be more active such as moving, from their seat, and being supported (if they wish) in going on walks within, and outside of the home. Staff need to ensure that regarding activities and leisure pursuits there is close monitoring of those people who choose to stay in their room, to ensure that there is evidence that these residents each have the opportunity to participate in preferred activities, and that staff spend some meaningful time with them. There was little evidence of individual activity/leisure needs being comprehensively identified in the care plans inspected. A care plan did document some staff guidance to meet a residents ‘social stimulation’ needs. There was a record of one person ‘s Holy Communion visits. A library service regularly visits the home. During the inspection observation by both inspectors of social interaction and activities took place. Most residents due to their significant communication needs were unable to express their views about the variety and choice of activities provided by the care home. A number of people were left to sit in the same chair for a significant part of the inspection, and some people only occasionally were seen to be assisted to the toilet. During the afternoon a resident was observed to be restless, and attempted, at times to stand up. I asked a staff member if they had considered that she might wish to have a walk or use the toilet. I was informed that there were particular times of the day when people using the service were assisted to the toilet, and that the resident had been to the toilet after lunch. It is strongly recommended that staff review the individual ‘toileting needs’ of residents and ensure that the guidance documented in the care plan is based on the individual assessed needs of each resident. This is of particular importance to those who have difficulty because of their needs in communicating their wishes. Following this discussion with the staff member this resident was supported by staff in going for a walk within the home. I was informed by staff that most residents during the day generally sit in the same chair in the communal sitting room, and following my discussion with a visitor, it should be considered (with residents and/or significant others) that all residents have more opportunity to sit in chairs of their choice possibly next Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 17 to other residents if they so wish. One resident who was fairly mobile was seen to choose where to sit. There were a number of people who were in their rooms when an inspector toured the premises with the manager. Those spoken too, said they preferred to stay in their bedrooms. One person said she liked listening to the radio all day, and that she liked to hear what was going on in the world. She informed me she was blind and wouldn’t get much out of being downstairs in the communal area. She said that the staff always come to see how she is, and chat to her regularly. Some people had their bedroom doors open, which made it easier for staff to pop in and see how they were when passing by. The visitor’s record book confirmed that there were frequent visitors to the care home. A visitor spoke of visiting the care home at different times of the day. Residents kindly spoke of receiving visitors. Several secondary school children visited (one of a number of regular visits)the care home during the inspection, and interacted in a positive and sensitive manner with the residents. It was evident from observing the residents that they thoroughly enjoyed this visit. Staff informed the inspector of examples of how the care home meets cultural and religious needs of residents. Residents have access to a telephone. Staff were observed to offer choices to residents during the inspection. Since the previous inspection there have been significant improvements in the variety of meals provided to residents, and it was evident that people using the service have more opportunity to be involved in choosing their preferred meals. The chef has been employed since the last key inspection. She spoke with the inspectors in some detail about the changes she has made to the menu, and the meal choices for the residents including providing a pictorial guide for ethnic meals. She was very enthusiastic about working with the people in the home describing how she lets each person know what is on the menu for the day and asking them if they would like something else if that wasn’t to their taste. This was observed by the inspectors throughout the day. During the inspection, the cook was observed to ask residents what type of fruit they wanted to eat. There is a daily record of the residents’ meal choices. The cook puts the menu on the board in the lounge. The cook is building up a portfolio of photographs of meals and foods to use when she talks to the residents about their meal choices. She spoke of developing this guide. This is recommended. She spoke of the importance of involving relatives and others in finding out the particular food preferences of residents, who because of their needs have difficulty in communicating this information. The cook described how she and the husband of an Afro Caribbean lady cooked some dishes for his wife which originated from her native country. Residents spoke of enjoying the meal that was provided during the inspection. One lady visited in her room was supported to have her meal, as she was blind. The carer was observed to ask the person where she wanted her tray and assisted her by cutting up her food when asked to by the resident. The Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 18 carer then stayed to chat with her and to provide any further assistance if needed. The person also said the food was very good, that it was pie today, which she had ordered. The cook said that all meals are freshly made and that she orders fresh food from regular suppliers. Meal times are regular, supper is at 5pm but the cook said she makes sandwiches, and leaves cakes and biscuits out for the residents to have later in the evening. She was knowledgeable of the particular dietary needs (including diabetic needs) of residents. She works Monday to Friday but has trained a staff member to cook the weekend meals. There was a record of hers and the other cooks qualifications. Food eaten by each resident is recorded. The kitchen was seen to be very clean, and has been recently painted, but is in need of refurbishment. (See environment section for further details) Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled objectively. The format of the complaints procedure could be developed to improve its accessibility to people using the service. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints procedure. This is documented in the service user guide. AQAA (Annual Quality Assurance Assessment) information recorded that the complaints procedure has been recently revised. The format of the complaints procedure could be developed to improve its accessibility to people using the service. Complaints were judged to have been responded to appropriately. A visitor spoke of having an awareness of how to make a complaint. Feedback confirmed that most relatives knew how to complain, but two relatives were not aware of the complaints procedure. The manager spoke of the action to be taken to resolve this issue, and that the complaints procedure is included in the ‘Welcome Pack’. He should ensure that all relatives and significant others are aware of the complaints procedure. There should be evidence that the registered person supports and encourages residents and others to communicate any ‘concerns’ that they might have. This was discussed with the registered person. Staff who spoke with the lead inspector knew the procedure for responding to complaints from people using the service and from visitors. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 20 The care home has a safeguarding adults procedure, and a whistle blowing policy. Staff who spoke with the lead inspector had knowledge and understanding of how to respond appropriately to any suspicion or allegation of abuse, and confirmed that they had received protection of vulnerable adults training. Training certificates seen evidenced that staff had had adult protection training. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 21 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): Standard 19, 23 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose, resident’s bedrooms are individually personalised, and meet their individual needs. EVIDENCE: The front external walls of the home are well maintained and recently painted. There are several hanging baskets with attractive plants and flowers located at the entrance of the home. There is parking for seven or more vehicles on the forecourt of the home. The AQAA (Annual Quality Assurance Assessment) record supplied to the Commission confirmed that feedback informed him that there were views that residents did not spend enough time outdoors. In response to this the manager re-landscaped the garden to create a new seating area. The garden is accessible by residents who use a wheelchair. A water feature and flower beds have been included in the garden improvements. A resident spoke of Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 22 spending time in the garden during sunny weather. The garden is a pleasant environment to sit in or look out at. It is recommended that the lounge seating be reorganised to ensure that the residents can have a good view of the garden if they so wish. The net curtains could be rearranged to facilitate this. My colleague carried out a tour of the premises with the registered manager, and spoke to a number of residents who were in their rooms at the same time. The home was clean, tidy and free from odours. There was a domestic member of staff working throughout the day of the inspection. Doors of the bedrooms had pictures of the resident displayed on them. The home has made efforts to improve the signage in the home, taking in account of residents varied needs. Resident’s bedrooms were personalised with photos, ornaments and some had their own furniture. The rooms were well decorated and looked welcoming. The manager informed me that they had been given a capital grant towards improving the home’s environment. He said this was to be spent on the lounge, providing new carpets and curtains. The conservatory glass roof had been painted to prevent strong sunlight and heat from possibly harming the residents. A previous requirement in regard to this was judged to be met, but the temperature of the conservatory area should be closely monitored. As stated earlier the kitchen in need of total refurbishment. The manager’s son in law produced a design of the proposed new kitchen, which was to be in stainless steel. The inspector discussed the issue of providing hot meals for the residents whilst the work is going on, she also reminded them that a risk assessment needed to be carried out to ensure the safety of staff and residents during the work. The laundry facilities are located away from food storage and food preparation areas. Soap and paper hand towels are accessible, and staff were observed to wear protective clothing such as disposable gloves, as and when required. The home has an air freshener system. AQAA (Annual Quality Assurance Assessment) information confirmed that staff had received infection control training. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 23 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): Standard 27,28 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities. Training records could be improved. Most staff have achieved or are in the process of achieving a certified appropriate qualification to ensure that they are skilled in meeting the care and support needs of residents. Sufficient numbers and skill mix of staff are employed to meet the needs of people using the service, but there could be review of night staffing needs. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was inspected. This record confirmed that there are generally four care staff, a registered nurse, the cook and the domestic staff member on duty during the day. On the day of the inspection these numbers and skills of staff were on duty, plus the manager. The night staff were just going off duty when we arrived. The night staff nurse said it had been a busy shift with a number of people being quite poorly and needing a lot of attention. The current night staffing is one nurse and one carer for 23 people. There is also a care staff member on duty until 9pm. In light of the range of dependency needs identified in this inspection the manager needs to review the number of night staff. Concern has been raised in this report about the inconsistency in the frequency of turning people and clearly if residents are unwell then more staff are needed to provide the extra Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 24 support to carry out other tasks such as ensuring that people have assistance with changing their position regularly. An inspector looked at a sample of staff recruitment files for two staff nurses and two carers who had been recently appointed. All checks that are required to ensure people are protected from harm had been carried out. These included protection of vulnerable adult (POVA)first checks. The inspector was concerned that the home had not requested proof of identity from the referees i.e. a company stamp, compliment slip or headed paper to ensure the references were genuine. This was discussed with the manager and he was advised to include this when asking for references. The files were disorganised and information hard to find. Training and supervision records are held else where. It is recommended that staff files be reorganised to ensure that there is an audit trail of checks carried out, proof of qualification, identity and references. A checklist at the front of file could be used to record when checks had been requested and received to ensure staff appointments were completed in a timely manner. Dates of appointment were not in all the files sampled. Induction records were not available for the staff nurses and for only one care staff. There was a record of the key policies that staff had read and signed that they understood them; these included adult protection, complaints, health and safety etc. The manager stated that staff nurses are inducted but no record of this is kept at the moment. He carries out the induction. The manager was advised that staff nurses need to have record of their induction as well as care staff. Given that two new nurses had been appointed and had had no formal induction and no supervision (see Standard 36) this was of concern to the inspectors in terms of staff fully understanding their role and residents needs. Care staff that spoke with the lead inspector confirmed that they had received an induction in regard to the care home and of their roles and responsibilities. AQAA (Annual Quality Assurance Assessment) supplied by the manager informed the Commission that eighty percent of the staff have achieved an NVQ care qualification, or are in the process of completing this training. During this inspection staff confirmed that they received a variety of training to develop their skills and competency. An inspector examined the file containing the training certificates for all staff. This was very disorganised with no clear indication of what training individual staff had undertaken. The manager informed the inspector that staff had all undertaken dementia training over the past year this included the cook. The staff nurses were also due to start palliative care training the week of the inspection. AQAA (Annual Quality Assurance Assessment) informed the inspectors that staff training in the care of people who have Parkinson’s disease, nutrition training has taken place. The manager was advised to reorganise the training file, review what training individuals had undertaken so that a training plan could be written for them and the staff team as a group. A list of mandatory training undertaken is needed to be compiled so that the manager was aware of what was needed Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 25 and a rolling programme set up to ensure certificates were kept up to date in areas such as moving and handling, food safety, fire safety, infection control health and safety and medication. A clear record of all training is required as is a rolling programme of mandatory and professional development training Training records should be in better order. Each staff member should have an individual training plan. Staff spoke of enjoying working in the care home and confirmed that team work amongst staff was positive. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 26 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): Standard 31,33,35, 36, and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager/provider is qualified, competent and experienced to run the care home. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision by the care home. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: The manager is a registered general nurse, and registered mental health nurse and has managed and run the care home for several years. He completes most of the staff ‘in house’ training, and has a management qualification. He informed the inspectors that a senior member of staff is in the process of completing an NVQ level 4 management qualification. The manager spoke of Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 27 undertaking periodic training, and of his plans to appoint a deputy manager. Feedback from a visitor and residents confirmed that the manager was approachable. Systems for monitoring the quality of the service are in place. This includes staff training, monthly medication audits, and accident monitoring, maintenance review. These include reviewing records, care plans and staff training needs. Staff meetings and resident meetings take place. I attended a staff meeting during the inspection. This was well attended and a variety of agenda items were discussed. A requirement in regard to seeking the views of residents, relatives and others (including care managers, the GP and a librarian).about their views of the service was judged to have been met. The recorded feedback from relatives was generally very positive about the care home. The manager spoke of the action to be taken in response to the feedback such as ‘could be better informed’, and ‘trips out would be nice’ to continue to improve the service. He confirmed that improvements to the in the meals was in response to feedback. Records and the manager confirmed that relatives had been invited to a meeting at the care home. The care home manages small sums of resident’s monies. Resident’s financial affairs are generally managed by family members, and care managers. An inspector examined a sample of residents and records monies held in the home and managed by the manager. These were noted to be correct. She was informed that the majority of resident’s relatives managed their money. A few gave the home “pocket money “to cover small purchases such as hairdressing, toiletries etc. The manager stated that he buys toiletries in bulk for the residents. This was discussed in some detail with him. We were concerned that a home as small as Primrose House would need to buy in bulk for just a few residents. Residents need to have toiletries etc purchased on an individual basis to ensure that residents have their choices and preferences listened to and met, and individually purchased not sharing costs of bulk buys. It was recommended that key workers be given the task of purchasing personal items such as toiletries and other items for their clients to make it more ‘person centred’ and then people would have a real choice of these items. The management of resident’s monies by the care home needs to be reviewed. Records need to be in place and accessible of all transactions including those when relatives/significant others are invoiced. This was discussed with the manager/provider. Care staff, and records confirmed that they received 1-1 staff supervision. A plan of forthcoming staff supervisions was available for inspection. The care home has a supervision policy and staff sign a supervision contract. The manager said that the staff nurses were responsible for supervising the care staff. He also stated that he was looking to appoint a nurse as a deputy to carry out a number of the management tasks. This is strongly recommended to ensure that staff nurses are professionally supervised and managed and care staff are fully supported to carry out their roles. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 28 Staff nurses supervision was discussed. Again the manager stated that he carries out on going supervision of the staff nurses, but does not carry out formal supervision. The manager stated that he was in the process of completing staff appraisals. The inspector discussed with him the value of having written records of supervision so that an appraisal of the past year’s achievements could be fully documented. Required checks of the electrical and gas systems are carried out. All certificates and service records for appliances and equipment used in the home were noted to be in order and up to date. Services for the hoists were due the day after the inspection. The lift is serviced six times a year. A fire risk assessment had been carried in August 2007. The manager informed an inspector that he carries out the fire safety training with staff. There was a detailed record of all fire safety and other checks carried out in the home on either a weekly or monthly basis. The inspector was shown a record of fire drills attended by staff. The manager stated that these are carried out every six months. He was advised to increase this to four times a year and one of which should be at night to ensure night staff participate in a drill. As stated in the previous section training records were disorganised and an inspector was unable to see whether staff had received the mandatory health and safety training, but staff who spoke with the lead inspector confirmed that they had received ‘lots of training’ including health and safety training. AQAA (Annual Quality Assurance Assessment) information informed the inspectors that most staff have completed two three month training courses in Health and Safety in the Work Place and Infection Control. Accidents and incidents are recorded. Fridge and freezer temperatures are documented. The employer’s liability insurance certificate was displayed and up to date. Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 29 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 3 Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 12(1) 14(1) • Requirement Timescale for action 01/12/07 • 2 OP7 12(1) 15(1) • • The manager and senior staff must ensure that all care plans are completed within the stated timescales. This timescale need to be reviewed to ensure that there is an initial immediate care plan (following admission) which includes recorded action to be taken by staff to meet the resident’s significant and basic needs such as pressure area care, nutritional assessment, medication needs, moving and handling assessment, risk of falls. The care plan needs to 01/12/07 state clearly the frequency of when residents need their position changed, and staff must adhere to this to ensure people’s tissue viability is maintained. Fluid monitoring record charts need to be closely monitored by senior staff Version 5.2 Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Page 31 3 OP9 13(2) 4 OP12 16(m) 5 OP19 23(2) 6 OP27 18(1)(a) 7 OP30 18(1)(a) to ensure that residents are receiving an appropriate amount of fluid to prevent dehydration. Staff need to ensure that a resident who has been assessed as having difficulty in swallowing has all her medication reviewed and the medication that can be provided in liquid form should be accessed. There needs to be further action taken by the registered person to ensure that all residents including those with multiple needs (such as dementia care needs) have a choice of varied and preferred activities to enhance the quality of their life. The kitchen in need of total refurbishment. A risk assessment needs to be carried out to ensure that residents and staff are protected during the refurbishment. This must be sent to the Commission prior to any work being carried out In light of the range of dependency needs identified in this inspection the manager needs to review the number and skills of night staff needed to ensure that all the needs of the residents are being met by staff, and increase the staffing levels if needed. • The registered staff nurses need to have a comprehensive recorded induction. • A clear record of all training is required as is a rolling programme of mandatory and professional development training to ensure that there is recorded evidence that staff receive training DS0000022936.V351689.R01.S.doc 01/12/07 01/01/08 01/04/08 01/12/07 01/01/08 Primrose House Nursing Home Version 5.2 Page 32 8 OP35 14(1) 13(6) 9 OP36 18(2) appropriate for the roles and responsibilities. • Residents need to have 01/01/08 toiletries etc purchased on an individual basis to ensure that residents have their choices and preferences listened to and met, and individually purchased not sharing costs of bulk buys. • The management of resident’s monies by the care home needs to be reviewed. Records need to be in place and accessible of all transactions including those when relatives/significant others are invoiced. There needs to be evidence that 01/12/07 the registered nurses receive regular 1-1 supervision, which is recorded. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The format of the service user guide/statement of purpose documentation should be further developed to improve its accessibility to people using the service, particularly those that have difficulty reading or whose understanding of English is limited. • It is strongly recommended that the home develop a more comprehensive pre admission document, which could incorporate all information provided by health professionals, family and significant others. • It is recommended that staff record who gave the information i.e. family, friends and significant others. • The manager should continue to further develop care DS0000022936.V351689.R01.S.doc Version 5.2 Page 33 2 OP2 3 OP7 Primrose House Nursing Home 4 5 OP8 OP11 6 OP12 7 OP16 8 OP19 9 OP29 plans into a more ‘person centred’ format with residents to ensure that people using the service experience the life that each person wants. • and reorganise the care plan files so that all information is easily accessible. • It is strongly recommended that staff review the individual ‘toileting needs’ of residents and ensure that the guidance documented in the care plan is based on the individual assessed needs of each resident. In order to be more proactive it is advised that pressure relieving equipment is ordered at the point of the preadmission assessment. The manager should ensure that death and dying wishes of people using the service is documented for all residents (with support from their relatives if needed) and that it includes obtaining resident’s views regarding possible future admissions to hospital from the care home. • Staff could be more proactive in supporting people using the service to be more active such as moving, from their seat and being supported (if they wish) in going on walks within and outside of the home. • It is recommended that the activity programme be displayed in a format that is accessible to all residents so that they are `aware of each day’s planned activities. • It is recommended that service users have the opportunity (i.e. it be a resident’s meeting agenda item) to discuss preferred activities. • The format of the complaints procedure could be developed to improve its accessibility to people using the service. • There should be evidence that the registered person supports and encourages residents and others to communicate any ‘concerns’ that they might have. • The registered person should ensure that all relatives and significant others are aware of the complaints procedure. It is recommended that the lounge seating be reorganised to ensure that the residents can have a good view of the garden if they so wish. The net curtains could be rearranged to facilitate this. • In regard to staff recruitment the manager need request the proof of identity from referees i.e. a company stamp, compliment slip or headed paper to ensure staff references were genuine. • It is recommended that staff files be reorganised to ensure that there is an audit trail of checks carried DS0000022936.V351689.R01.S.doc Version 5.2 Page 34 Primrose House Nursing Home 10 11 OP30 OP35 12 OP38 out, proof of qualification, identity and references. A checklist at the front of the staff file could be used to record when checks had been requested and received to ensure staff appointments were completed in a timely manner. Training records should be in better order. Each staff member should have an individual training plan. It is recommended that key workers be given the task of purchasing personal items such as toiletries and other items for their clients to make it more ‘person centred’ and people would then have a real choice of these items. Fire drills could be carried out at least four times a year (including one of which should be held at night) to ensure all staff (including night staff) attends a fire drill at least twice a year. • Primrose House Nursing Home DS0000022936.V351689.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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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