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Inspection on 26/06/06 for Queens Court Nursing Home

Also see our care home review for Queens Court Nursing Home for more information

This inspection was carried out on 26th June 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

One resident said "I like it in here. It`s lovely and clean, it`s like a home from home. Nothing is too much trouble for them". A number of relatives considered that end of life care was very good. Residents considered that the home was kept clean and were very happy with the laundry service.

What has improved since the last inspection?

A new chef had been appointed, and steps had were being taken to address the lack of management in the kitchen and the poor quality of food being served. Residents were being consulted about a new menu. One resident said, "I`m impressed with the new chef".

What the care home could do better:

It was of concern that residents told the inspector about problems with some staff attitudes and poor care practices, that amounted to descriptions of institutional abuse. The issues were discussed with the manager and director of nursing at the time of inspection, and an immediate plan of action was made to address the problems identified. A number of residents and relatives considered that the home was short of staff, as there was often a considerable delay in staff responding to residents` needs. A few residents and relatives reported that some staff were reluctant to assist residents by using the hoist due to time constraints. Although action was being taken to address issues surrounding catering and activities, at the time of inspection a few residents still considered that the standard of food was poor and activities could be improved. The home had a commitment to training and good recruitment practices but some training needs were identified and documentation needed to be improved. Some relatives considered that odour control in parts of the home could to be improved at times.

CARE HOMES FOR OLDER PEOPLE Queens Court Nursing Home 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS Lead Inspector Francesca Halliday Key Unannounced Inspection 26th – 14th August 2006 09:45 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 Queens Court Nursing Home DS0000015397.V300467.R02.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. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queens Court Nursing Home Address 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 559 0620 0208 559 0315 queenscourt@hotmail.com Ranc Care Homes Limited Mrs Rosemary Mathias Care Home 89 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (21), Physical disability of places over 65 years of age (27), Terminally ill over 65 years of age (1) Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 21 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 27 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 41 persons) One person, over the age of 65 years, who requires palliative care The total number of service users accommodated in the home must not exceed 89 persons 24th January 2006 Date of last inspection Brief Description of the Service: Queens Court is a purpose built two-storey care home for up to 89 residents. The home has a garden to the rear and a patio area to the front. It is near to the local shops and underground railway system. It has a bus stop nearby, and is within easy reach of the M25 and M11. The home provides personal care to people over 65 on the ground floor. The nursing units on the first floor are predominately for people over the age of 65, but people with physical disabilities above the age of 40 can also be accommodated. The home has a range of information for prospective residents and their representatives. At the time of inspection in June 2006 the fees were £434 - £625 for residential placements and £569 - £1200 for nursing placements. Additional charges are made for private chiropody, toiletries, newspapers and hairdressing. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visits took place on 26th and 28th June 2006. The inspection process included: discussions with 7 residents, 4 relatives and 5 members of staff including the manager and the director of nursing for the company. 3 relatives were spoken with following the inspection. Parts of the premises and a sample of records were inspected. Further information was requested following the inspection, which was received on 14th August 2006 and this concluded the inspection process. What the service does well: What has improved since the last inspection? What they could do better: It was of concern that residents told the inspector about problems with some staff attitudes and poor care practices, that amounted to descriptions of institutional abuse. The issues were discussed with the manager and director of nursing at the time of inspection, and an immediate plan of action was made to address the problems identified. A number of residents and relatives considered that the home was short of staff, as there was often a considerable delay in staff responding to residents’ needs. A few residents and relatives reported that some staff were reluctant to assist residents by using the hoist due to time constraints. Although action was being taken to address issues surrounding catering and activities, at the time of inspection a few residents still considered that the standard of food was poor and activities could be improved. The home had a commitment to training and good recruitment practices but some training needs were identified and documentation needed to be improved. Some relatives considered that odour control in parts of the home could to be improved at times. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 6 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. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, (6 not applicable) The overall quality outcome for this group of standards is good. The home has a good pre-admission assessment system in place, which ensures that the home can meet the needs of new residents. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents said that they were happy with the assessment process prior to admission. Some residents and their representatives had taken up the offer to visit the home, before making a decision to accept a place. The manager or her deputy generally carried out the preadmission assessment. There was evidence that the management team considered both the current needs of residents in the home, and the ability of staff to provide specialised care before accepting a new admission. There was also evidence that residents were reassessed if their condition changed significantly whilst in the home. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Care plans are generally of a good standard but they are not sufficiently resident focused, and residents are not involved in their development and review. Relatives consider that end of life support and care is good. However, the overall quality outcome for this group of standards is poor, as medicines management needs to be substantially improved, poor care practices are promoting incontinence and residents’ privacy and dignity are not always upheld. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The care plans sampled were generally of a good standard, but a few did not fully reflect current needs, as identified from discussions with residents and staff. A few evaluations of care and care needs were seen but this was an area that needed to be developed. Some excellent and detailed clinical care plans were seen. However, throughout the home care plans were not generally resident focused; they did not provide sufficient evidence that the resident (and/or representative if appropriate) had been involved in developing the care Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 10 plans and evaluating the care and care needs. None of the residents spoken with were aware of their care plans. There was evidence that staff were generally monitoring residents’ nutritional needs and taking action when needed. However, some residents needed to be weighed more frequently on the residential unit. One resident had not been weighed on admission, or since admission two months previously. A relative said that the person they visited was frequently not being given food in a form that they could eat so they were losing weight. A range of risk assessments was in place, but some of the assessments seen had not been recently reviewed and did not fully reflect the current risk. The daily progress records were of variable quality; some were detailed and informative others had statement such as “care as planned” without specifying the actual care given, the residents’ physical and mental health or how they had spent their day. There was evidence from a number of sources that staff were not promoting continence. Residents who were continent, when they were admitted to the home, were being given pads and discouraged from requesting assistance to go to the toilet particularly when this involved the use of a hoist. A resident said that they were told that they were only “supposed to go to the toilet every four hours” and that they should use a pad even though they were continent. One resident said that they were afraid to drink sufficient fluids or ask to go to the toilet to have their bowels open, and that this was resulting in them becoming constipated. Some of the continence assessments seen had conflicting information in them. The manager said that all residents would be reassessed following the inspection. Residents generally reported that they were happy with the way that staff handled the hoist to assist them in and out of bed. Staff confirmed that they had access to a good range of pressure reliving mattresses to meet different needs. Staff said that they had excellent support from the home’s GP, who did a round at the home each week as well as attending when requested. Residents reported that they could see the GP “promptly” if they had any health concerns. There was evidence that residents had access to a chiropodist and could have dental and optical checkups when needed. A number of residents with mobility problems had input from the home’s part time physiotherapist. However, one resident with mobility problems did not consider that the physiotherapist had sufficient hours to give them the rehabilitation that they needed. There was evidence that residents had very good access to local specialists, such as dieticians, speech and language therapists and clinical nurse specialists. The manager said that an independent occupational therapist was available to carry out assessments when needed. On the residential floor the balance of one controlled drug (CD) was not correct, some CDs needed to be returned to the pharmacy, and one CD was Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 11 recorded as having been given to relatives when it was in the cupboard. Jewellery belonging to a resident was being stored in the CD cupboard. The clinical room temperature was not being taken at the hottest time of the day and was not being recorded daily. No action was being taken when temperatures exceeded 25c. One resident, on the residential floor, considered that some staff spent too much time chatting when they did the medicine rounds so that medicines were not given on time. On the nursing floor staff were not always recording the reasons that medicines were omitted. In some instances it was difficult to ascertain whether medicines had been given, as both an omission code and a signature were recorded. In the weeks prior to the inspection a number of medicines were not available on the nursing floor. Staff said that there had been problems with supply whilst the service was being changed over from one pharmacist to another. However, one resident did not have a number of medicines for a period of over a week. The recording of blood glucose levels, insulin administered and warfarin administered was at times confusing, as nurses did not always use the same recording systems. The balance of CDs on the nursing floor was accurate apart from the fact that one CD was recorded as having been returned to the pharmacy when it was still in the CD cupboard. A relative said that on occasions staff did not assist dependent residents to take their tablets, but left them on the side where they could not reach them. On both floors the drugs fridge temperatures were being recorded regularly at between 12-13c and 12-14c. No action had been taken even though these temperatures were above the safe storage temperature (2-8c) for medicines requiring refrigeration. It was not possible to carry out an accurate audit of medicines in the home or be sure that residents had received all their prescribed medicines, as the start date of a new supply of medicines was not identified on the Medicine Administration Records (MAR). Some medicines had been dispensed with a label on the outer carton but not on the container itself, which could cause problems if the outer carton was mislaid or if two residents were on the same medication. There was no date of opening on some medicines that had a limited shelf life on opening. Staff did not have an up to date British National Formulary for reference. A number of letters were seen from relatives complementing the home on the “support and kindness” and the “respect they gave”. A female resident said that she had been asked whether she would be happy for her care to be provided by a male carer. Residents spoken with said that staff treated their room as their private space. However, one relative said that they had observed staff frequently entering residents’ rooms without knocking beforehand. A resident described “a pained expression” that came over the face of a few staff, if they requested assistance to go to the toilet. One resident said that they were very concerned about body odour, as some staff were reluctant to change their pad promptly. A resident also said that staff Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 12 tended to remain in the toilet with them “so I can’t go”. These practices did not uphold residents’ privacy and dignity. A number of nurses were in the process of receiving palliative care training as the home was hoping to increase the number of palliative care beds. The home had introduced the “Gold Standard Framework” for End-of-Life Care in one of the nursing units and was hoping to introduce it to the rest of the home. The manager considered that the introduction had improved the care for a number of residents with progressive illnesses as well as for those requiring care at the very end of their life. The manager said that the home had good support from the Parkinson’s Disease Society, and the Huntingtons Disease Association. There was evidence that additional support was given to residents and staff following the death of a number of residents. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The overall quality outcome for this group of standards is adequate. Activities and the quality of food need to be improved, but the management team are aware of the shortfalls and are taking action to address them. More dependent residents are not always helped to exercise sufficient choice and independence in their lives. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A number of staff provided activities on a part time basis in addition to their main role. However, the amount of time provided for activities and the quality of activities was extremely variable. The manager considered that the average number of hours for activities was 30 hours each week. This was insufficient for the size of home and number of residents. Residents were aware of an exercise class and bingo sessions. One resident said that they had appreciated having lunch outside in the garden when the weather had been particularly fine. A few residents attended the local churches with the help of church volunteers. A communion service was held in the home once a month. The manager said that the home had some links with local clubs and societies, but was aware that this was an area that could be developed. Residents’ and Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 14 relatives’ meetings were held approximately twice each year. The manager said that the home was considering purchasing a bus for the home, so that they could take residents in wheelchairs out more easily. One resident said that they could not go to the local church as often as they wished. Residents said that they could choose the activities they wished to attend, but some felt that the range and frequency of activities needed to be improved. Staff had not received any training in the range of activities and stimulation appropriate for older people. The director of nursing and manager were aware that the provision of activities needed to be organised and developed, and were taking steps to address this. Some residents considered that they could get up and go to bed at a time that suited them. Other residents who were more reliant on staff assistance, considered that staff did not offer them a genuine choice and said that they usually had to rely on staff convenience. The continence issues described under the section for health and personal care demonstrated that some staff did not promote choices and independence. Residents were aware that a new chef had been just been appointed and that changes were being made in the kitchen, but considered that the quality of food was still extremely poor at the time of inspection. Some residents said that the new chef had visited them to find out what they were dissatisfied with, and what they would like on the new menu. Residents were not always aware that they could have alternatives if they did not like what was on the menu. One resident said that staff would not get them a snack or a drink in the night even when they asked. A relative said that a frail resident was frequently given their drink in a cup rather than the beaker so they were unable to drink. The kitchen floor was due to be replaced and the kitchen refurbished soon after the inspection. Residents and relatives knew about the work being done, and arrangements had been made to provide a mobile kitchen while the work was carried out. The chef was in the process of reviewing the quality of the produce currently provided, and the storage required for increased supplies of fresh vegetables and fruit. The chef said that he would like to move away from reliance on frozen food and use of packet soups. There was insufficient space in the fridges at the time of inspection and eggs were being stored in the storeroom. A fly screen was needed for one of the kitchen doors, and a larger blender if fresh soups were to be made. Improved cleaning schedules and temperature checks were being put in place. Food was not appropriately labelled in the fridges and freezers. The chef said that date labels had been ordered. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The overall quality outcome for this group of standards is adequate. Some residents do not feel able to make complaints about staff. Verbal complaints and concerns are not generally documented. Residents are not always protected from institutional abuse. However, management action was being taken to address the issues raised immediately following the inspection. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home had a complaints procedure and there was evidence that written complaints had been appropriately investigated and resolved. A resident and a relative said that when they had made complaints the management had addressed the problems to their satisfaction. However, another relative considered that their complaints and concerns were not always acted upon. A number of residents on different units were reluctant to discuss complaints or concerns they had about individual members of staff. There was evidence that verbal complaints and concerns were not generally documented. The home had policies for the prevention of abuse and majority of staff had received training in the protection of vulnerable adults (POVA). However, the practices and attitudes of some staff, described in the section under health and personal care constituted institutional abuse. The manager was advised to obtain the Essex POVA guideline for all staff and provide staff with further training on institutional abuse. Actions were being taken immediately following the inspection to address the issues raised. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The overall quality outcome for this group of standards is adequate. A programme of redecoration was underway. Residents generally considered that the home was kept clean, but a few relatives considered that odour control could at times be improved. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home was in fairly good decorative condition, but a number of the communal rooms and corridors were in need of redecoration. The manager said that there was a programme to redecorate the communal areas, and that some new chairs had been ordered. One relative considered that the badly creaking floorboards in some parts of the home disturbed residents, and should be fixed. Some carpets were stained and in need of additional cleaning. In some cases consideration should be given to replacing some of the Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 17 particularly damaged carpets. The upstairs corridor and three of the lounges had been redecorated since the last inspection. Residents considered that the home was generally kept very clean, and were happy with the laundry service. One resident described the laundry staff as “very helpful” and the laundry service as “fantastic”. The majority of relatives spoken with considered that poor odour control could be a problem at times. One relative said that staff did not clean the mattresses after the bed had been wet. The manager and director of nursing confirmed that it was the policy for mattresses to be cleaned. The home was generally very clean on the day of these unannounced inspections, and no unpleasant odours were noted in the selection of rooms seen. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The overall quality outcome for this group of standards is adequate. However, staffing levels need to be reviewed in light of the high dependencies in the home. The home generally had sound recruitment procedures. Staff confirmed that the home had an emphasis on training, but documentary evidence of this was not fully available. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A number of residents and relatives considered that the home was often short of staff, particularly at weekends. This perception was in part received from staff themselves. One resident was told on a number of occasions that staff had problems with transport at weekends, and was also told on one occasion that a member of staff could not assist them with care as they were the only person on duty. A relative and a resident considered that staff were on occasions reluctant to provide care that involved the use of hoist, because of time constraints. Some residents considered that staff responded fairly promptly to the call bells, whilst others considered that they sometimes had to wait a very long time for staff to assist them. They considered that this was particularly a problem when they needed to go to the toilet. The manager said that she would investigate whether the nurse call system could be fitted with a printout so that call response times could be monitored. However, a relative said that staff sometimes turned the call bells off without responding to Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 19 residents’ needs. The manager and director of nursing said that staff numbers were kept under review, in relation to bed occupancy and the level of dependencies in the home. However, the inspection highlighted the fact that staff were not consistently meeting residents’ needs in relation to the promotion of continence and assistance to the toilet. Residents spoken with considered that the majority of staff were very good, and some were described as excellent. Examples were given of staff who had gone out of their way to be helpful and supportive to residents. However, a number of residents, on different units, were extremely reluctant to talk about the minority of staff that they found unhelpful. One relative said that some staff gave the impression “that helping residents is too much work”. The recruitment process was generally sound. However an interview record was not made, so that there was no evidence that issues raised by the application had been explored. The manager said that all staff received a two day induction when they first started at the home, and were supernumerary for 2-5 days depending on their experience and needs. She said that the home was introducing an induction for care assistants that complied with Skills for Care standards. The home did not meet the standard for 50 of care staff having completed the National Vocational Training (NVQ) at level 2 or above. However, 3 staff were in the process of completing NVQ level 2 and 4 staff were due to commence the training. The manager said that a number of care assistants who had completed the training had left to do their nurse training. The home had been accredited to provide placements for some student nurses during their training. Staff said that they were being provided with training updates to enable them to meet residents’ specialist needs such as tracheostomy care, the giving of subcutaneous fluids and PEG feeding. However, there was not always documentary evidence of this. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The overall quality outcome for this group of standards is adequate. Residents and staff consider that the manager is supportive. Quality assurance systems are being developed. Some staff need updates or training in safe working practices. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The manager is an experienced registered nurse. A number of residents praised the manager and said that she was “very good”. Staff spoken with said that they had good management support. The home surveyed residents and relatives on a regular basis. However, the last survey seen only had a 27 response rate. A quality assurance system Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 21 with audits was being put in place to monitor the care and services in the home. The manager said that a quality assurance report would be forwarded to the Commission when the audits had been completed. The home held some monies for individual residents. Two residents’ monies were checked, one balance was correct but the other had a small discrepancy. Receipts were available for most purchases on behalf of residents, but a few multiple purchases for a number of residents did not always identify each resident and provide proof of purchase for the individual’s records. The majority of transactions had a double signature but a few did not. The manager and administrator carried out regular audits. A number of residents had a risk assessment stating that they had requested that their bedroom doors (fire doors) be wedged open. The director of nursing said that a fire safety officer had condoned this practice, as the corridors in the home had regular fire doors between small groups of bedrooms. Accidents noted in the care records were appropriately recorded on accident records, and there was evidence of monthly audits of the accidents. There were good systems in place for servicing and maintenance of equipment. There were systems in place for training staff in safe working practices, but a number of staff still needed updates or training in moving and handling, health and safety, food hygiene and infection control. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes 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. The requirements were discussed with the manager at the time of inspection. No. Standard 1 OP7 Regulation 15(1)(2) Requirement Timescale for action 14/08/06 2 OP8 14(2) 18(1)(c) The registered person must ensure that: 1. Care plans are resident focused and are developed and updated in consultation with the resident, and relatives if appropriate. 2. Care and care needs are evaluated monthly, and care plans are updated to reflect current needs. 3. Daily records reflect the care given, the residents’ mental and physical health and how they have spent their day, and provide evidence of monitoring of needs identified in the care plans. 14/08/06 The registered person must ensure that: 1. Risk assessments are regularly reviewed and updated when residents’ condition changes. 2. Residents’ nutritional needs and food intake are monitored when they are losing weight. 3. All residents have continence assessments. 4. All staff have promotion of continence training. DS0000015397.V300467.R02.S.doc Version 5.2 Page 24 Queens Court Nursing Home 3 OP9 13(2) 4 5 OP10 OP12 OP13 OP30 12(4)(a) 16(2)(m) (n) The registered person must ensure 14/08/06 that: 1. Accurate Controlled Drugs (CD) records are kept. 2. Residents’ valuables are not kept in the CD cupboard. 3. Clinical room temperatures are taken daily (at the hottest part of the day) and action is taken if the temperatures exceed 25c. 4. Staff clearly document the reasons why medicines have been omitted. 5. Residents receive their prescribed medicines, and that interruptions to supplies are kept to a minimum. 6. Staff record the administration of insulin, blood glucose levels and the administration of warfarin in a consistent manner. 7. Dependent residents are given assistance to take their medicines when needed. 8. Action is taken when the drugs fridge temperatures are recorded outside the range of 2-8c. 9. A record is made on the Medicine Administration Record when a new supply of medication is started, to enable an audit trail to be made. 10. A prescription label is attached to the medicine container, as well as or instead of to the outer carton. 11. All medicines with a limited shelf life are dated on opening. 12. Staff have access to an up to date copy of the British National Formulary for reference. The registered person must ensure 26/07/06 that staff uphold residents’ privacy and dignity at all times. 01/09/06 The registered person must ensure that: 1. Staff receive training in the range of activities and stimulation appropriate for older people. 2. There are sufficient staff hours identified for activities for the number of residents in the home and for DS0000015397.V300467.R02.S.doc Version 5.2 Page 25 Queens Court Nursing Home 6 7 OP14 OP15 12(2) 16(2)(i) 16(4) 8 OP16 22 9 10 OP18 OP26 13(6) 23(2)(d) residents to have activities every day. 3. Community links are developed. Requirement in previous report timescale of 14/05/06 not met. The registered person must ensure that staff promote choices and independence in the home. The registered person must ensure that: 1. The standard of food is regularly monitored until improvements are made to the satisfaction of residents. Requirement in previous report timescales of 24/01/06 not met. 2. Residents are offered drinks and snacks throughout the day and at night when they are awake. 3. Residents are made aware that they can have alternatives if they don’t like what is on the menu. 4. Individual staff on each shift are made responsible for ensuring that dependent residents are assisted with regular drinks, or are provided with an appropriate drinking container. 5. The kitchen has adequate fridge space for fresh produce and eggs. 6. A fly screen is installed in the outside kitchen door. 7. Food in the fridge and freezers is date labelled. The registered person must ensure that: 1. An open culture is promoted in the home, whereby complaints are addressed positively as part of the quality assurance process. 2. Verbal concerns and complaints are documented along with the action taken to address the issues raised. Requirement in previous reports – timescales of 01/06/05 and 30/04/06 not met. The registered person must ensure that all staff receive additional training on institutional abuse. The registered person must ensure that the carpet cleaning schedule is DS0000015397.V300467.R02.S.doc Version 5.2 26/07/06 14/08/06 26/07/06 01/09/06 14/08/06 Page 26 Queens Court Nursing Home 11 OP27 12 OP29 13 14 OP30 OP33 15 OP35 16 OP38 sufficiently frequent to control any unpleasant odours. 18(1)(a)(c) The registered person must: 1. Review staffing levels in order to ensure that numbers of staff are appropriate for the level of dependencies in the home. 2. Ensure that staff receive training in customer care. 19(1) The registered person must provide documentary evidence that all issues raised by staff applications have been explored. 18(1)(c) The registered person must provide documentary evidence of all clinical training. 24(2) The registered person must send a quality assurance report to the Commission when the audits have been completed. 17(2) The registered person must ensure that a system is set up whereby the purchases on behalf of an individual resident can always be identified. This particularly refers to multiple purchases on behalf of a number of residents. 13(5) The registered person must ensure 13(4) that staff receive updates or training in moving and handling, health and 16(2)(j) 13(3) safety, food hygiene and infection control. 01/09/06 26/07/06 01/09/06 01/11/06 26/07/06 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP15 Good Practice Recommendations The registered person should consider increasing the physiotherapy hours, so that more residents can be provided with active rehabilitation. The registered person should consider purchasing a larger DS0000015397.V300467.R02.S.doc Version 5.2 Page 27 Queens Court Nursing Home 3 4 5 OP19 OP28 OP35 blender so that fresh soup can be made. The registered person should ensure that the creaking floorboards are repaired when the damaged carpets are replaced. The registered person should ensure that a minimum of 50 of care staff achieve NVQ level two in care. The registered person should ensure that two signatures are obtained for all monetary transactions on behalf of residents. Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Queens Court Nursing Home DS0000015397.V300467.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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