Inspection on 15/02/07 for Quinton House Nursing Home

This inspection was carried out on 15th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

Other inspections for this house

Quinton House Nursing Home 18/03/09

Quinton House Nursing Home 26/03/08

Quinton House Nursing Home 01/12/05

Quinton House Nursing Home 12/07/05

Quinton House Nursing Home 02/03/05

Quinton House Nursing Home 18/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY Lead Inspector Yvette Delaney Unannounced Inspection 15th February 2007 11:30 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 Quinton House Nursing Home DS0000004407.V323754.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. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quinton House Nursing Home Address Lower Quinton Stratford On Avon Warwickshire CV37 8RY 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) 01789 720247 01789 720245 angelabirioo@quinton.house.wanadoo.co.uk Quinton House Limited Ms Kathleen Januszka Care Home 37 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (37) of places Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Ms Kathleen Januszka to undertake management training equivalent to NVQ level 4 by April 2005. Residents with dementia will not be accommodated in the annex. Date of last inspection 1st December 2005 Brief Description of the Service: Quinton House is situated in the village of Lower Quinton a short drive away from Stratford on Avon. The current provider Quinton House Ltd has owned the home since 1995. The home is registered to provide nursing care to 35 elderly residents, with three of these places registered for care of those with dementia. Accommodation is provided in two areas of the home. The main House, which accommodates up to 29 residents and a smaller annex, which is adjacent to the main building and accommodates up to 8 residents. The main house has accommodation on three floors with access via a passenger lift or stairs. Accommodation is provided on the ground floor of the annex. The majority of the accommodation for residents in the main house is provided in shared bedrooms. Gardens to the front and side of the main building are well maintained with access possible for all of the homes residents including those who may require a wheelchair. The owner of the home has advised that the current fees for residents ranges between £435 and £595 per week. Residents pay additional charges for the services of the hairdresser, Dentist, Optician and Chiropodist. Further charges are also made for other items or services provided by the home. These include the transport and staff escort time to attend out patient visits if an ambulance is not booked, name tapes and fixings for clothing, sundry items and newspapers, which includes the weekly delivery charge. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place on Wednesday 15th February 2007 between 11.30 am and 7.00 pm. The registered manager and the deputy manager were present at the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Four questionnaires were received from residents and eleven from relatives. Comments from these are included where appropriate within this report. The registered responsible individual (owner) of the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to resident care, staff training, recruitment, health, and safety were examined. Five relatives were seen and spoken with during this visit. Six staff, which includes the manager, deputy manager and the cook, were spoken with on a one to one basis on topics, which include care practices in the home, training attended, meals and their experience of working in the home. Further information to identify the outcomes for residents’ was also gained through observation of residents and staff and discussion with relatives. What the service does well: Quinton House is a home with a homely friendly atmosphere. It is well maintained and looks comfortable. The furniture, lighting and general fittings are of a good standard and in keeping with the age and look of the home. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 6 Relatives said that the ‘homeliness’ and ‘Friendliness’ of the home impressed them. All residents spoken with said that they were happy with the their choice of home. Residents made positive comments about the standards of care they received, the qualities of the staff, facilities and meals provided in the home. Comments received from residents, relatives both through conversation and in the questionnaires returned to the Commission include: “There is always a happy and caring atmosphere when we walk in and granny is always beautifully looked after. The children are also made very welcome.” “…My mother is well looked after. I always get positive feedback from her, even when we are alone and nobody else can hear. The home is ‘perfect’ for my mum and it is so comforting to know she is content, safe and well cared for…” “My grandmother has been loved and cared for better than I could wish for. I am so grateful to the staff here for their kindness and patience.” The care plans were informative and provided comprehensive details of residents’ health and personal care needs. A choice is available for all meals offered daily. All residents spoken with felt that the food provided offers a good variety. The cook enjoys cooking a wide range of home cooked food based on resident’s preferences. What has improved since the last inspection? What they could do better: Nursing staff must be able to evidence that they are making a professional judgement to seek medical aid in the event of any unexplained/unexpected deterioration in a resident’s condition. The registered provider and manager must ensure that the skill mix of nurses and care staff is appropriate to meet the individual care needs of all the residents accommodated in the home and ensure that care is delivered safely at all times. Records related to the management of residents personal monies must be improved. Quinton House Nursing Home DS0000004407.V323754.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. Quinton House Nursing Home DS0000004407.V323754.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 Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People receive a full assessment of their needs, which means that their diverse needs are identified and planned for before they move to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken with were able to confirm that someone from the home had assessed them before they were offered a place in the home. Visiting family members spoken with also said that the manager had visited their relatives at home and carried out an assessment of their needs. Assessments read in care files show that residents are assessed before they are admitted to the home. Records showed that a standard assessment format is used by the home to record the initial care needs and someone from the home had carried out the assessment. The assessment form is used to record the abilities and needs of the resident and the information used to devise the care plan. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome group is adequate. Resident’s health, personal and social care needs are set out in individual care plans, which should result in the delivery of appropriate care. Medication administration practices puts residents at risk of harm. Residents are generally treated with respect at all times. These judgements have been made using available evidence including a visit to the home. EVIDENCE: The care plans for three residents were examined. The care plans were informative and provided comprehensive details of residents’ health and personal care needs. Individual care needs were identified and the action to be taken by staff was detailed to support staff in meeting these needs. Information available also considered how much residents were able to do for themselves therefore promoting their independence. Evidence shows that residents and their family have been involved in planning their care. The nurse on duty was heard to ask the family of a resident for information that would support the care planning process. Life histories have Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 11 been written giving an insight to the individuals past, these help to inform the care, provided and ensure that care is appropriate for the individual needs and preferences of residents. Risk assessments had been carried out and written for each area of care examples of these includes nutrition, falls, mobility and the prevention and treatment of pressure area damage. Where risks are identified, care plans had been developed to provide staff with direction on how to manage the risk. Daily entries are recorded by nurses after each shift, which describes how residents spend their day, and note any changes in their general health and well being. Residents care plans are reviewed monthly by nursing staff. Information provided in care files show that residents and family members are involved in identifying and planning their care. Concerns were discussed about information contained in care assessment records. Family members are asked to make decisions as to whether their relative should be hospitalised or resuscitated in the event of illness or unexpected death. Discussions with the manager identified that this is not good practice and that nursing staff should be making a professional judgement to seek medical aid in the event of any unexplained/unexpected deterioration in a resident’s condition. On the day of the inspection, a resident returned from hospital following a short stay as an inpatient. Conversations with residents and relatives confirmed that there was no problem in gaining access to a doctor or attending hospital appointments. Residents have access to a local GP who visits the home weekly and staff are able to contact the GP between visits. A dentist, chiropodist and optician have also made visits to the home. The management of medicines in the home was not fully examined. However, some unsafe practices were observed. Observation of the nurse carrying out the evening drug round showed that some medicines once dispensed were given to care staff to give to the residents. A conversation with the registered owner of the home following the inspection confirmed that the carer is actually a registered nurse who was working as a carer on the day of inspection. However, the nurse carrying out the drug round signed to say the resident had taken the medicine, she could not be sure of this, as she did not observe the resident taking the medicine. On one occasion, the medicines for one resident remained on her side table not taken. There was one nurse on duty on the evening of the inspection, supported by five care staff. The nurse did not have Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 12 dedicated time to conduct the medicine round, without getting involved in other areas, which required her clinical expertise. These practices increase the risk of errors and extend the time it takes to complete the medicine round. All residents spoken to were positive about the care they receive in the home. Throughout the inspection, staff were observed to be caring and supportive towards residents. The people living at the home were well groomed and dressed. Residents’ personal care needs are met in their own bedroom or in one of the communal bathrooms and doors were closed demonstrating that staff respect resident’s privacy and dignity. Written information in residents care plans however does give mixed views. The care plan for one of the resident’s case tracked identified that the resident should have their catheter bag strapped to their leg under their clothing so that it could not be visible. This practice demonstrates ways of promoting dignity however in another care plan it says, “wears a nappy pad” which does not promote dignity, as the reference to ‘nappy’ is not age appropriate. Compliment card received from family members of residents who once lived in the home expressed gratitude towards staff for the care their dying relative received. Comments read include: “It was a great comfort, particularly to my mother to know that he was in such caring hands.” “Mother looked wonderful when they fetched her from the home, that meant a lot.” Quinton House Nursing Home DS0000004407.V323754.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome group is good. Resident’s are able to exercise choice and control over their day-to-day life in the home. Meals and mealtimes are an enjoyable, social occasion for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities were not seen to take place on the day of inspection. Exercise sessions ‘Motivation to Music’ are held and led by a person external to the organisation. Other activities documented on a weekly activity programme and included in the Pre-inspection questionnaire (PIQ) includes outings to the theatre, potting plants, knitting and baking.’ The detail of individual resident’s hobbies and interests are included in care files and the activities offered are based on their likes and dislikes. Residents spoken with said that it was their choice whether they take part in any of the social activities and how they spend their day. Comments made by residents and relatives in the questionnaires sent out by the Commission indicate that activities to provide suitable stimulation and encourage social interaction takes place, a number of responses indicate that no activities take Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 14 place. One comment read says, “Usually activities are arranged but not interested in activities, like my own company.” Residents were seen to have good contact with their family and a number of visitors were freely coming and going on the day of inspection. Visitors all signed a visitor’s book, which was at the entrance of the home. Signing the visitor’s book promotes the safety of residents living in the home and provides information for staff on who is present in the home in the event of an emergency. Three residents spoken with, which includes residents followed through the case tracking process said that their family and friends are able to visit regularly and on occasions, residents do go out with their family. Two visitors spoken with said they always feel welcomed by all the staff whenever they visit. Comments received in a relatives questionnaire says: “I visit my mother on…I am always made welcome.” The kitchen is large was seen to be clean, organised and well managed. Records of fridge, freezer and high risk cooked food temperatures are maintained. A cleaning schedule was in place and used to make sure all areas of the kitchen were regularly cleaned and hygienic. Food storage areas were well stocked with a wide range of fresh, tinned and frozen foods. The home has been given a silver award by the local environmental department for good practices related to food hygiene. A choice is available for all meals offered daily. All residents spoken with felt that the food provided offers a good variety and that alternatives to the choices on the main menu would be offered if requested. There is good variety of fresh fruit and vegetables each day. During the inspection, the cook was seen to have a good relationship with the residents and was aware of individual likes and dislikes and the needs of those residents who are on a special diet. The cook enjoys cooking a wide range of home cooked food based on resident’s preferences. One resident commented, “The variety of meals are excellent.” The nutrition care plan for a resident identified their personal preference for “A cooked breakfast, a cold beer with meals and that they liked a beaker of water and juice at night as likes a few sips.” A conversation with the resident demonstrates that these are provided. The likes and dislikes for a resident who is a diabetic was also identified in their care plan. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 15 Residents were relaxed during teatime and enjoyed chatting to each other in the dining room. Staff were available to provide assistance as required and assisted residents in a discreet and sensitive manner. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome group is good. Residents feel safe and listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure was seen and read. The document is sufficiently detailed to provide residents, staff and visitors to the home with guidance on what action they should take if they are unhappy about anything in the home. The Commission for Social Care Inspection has not received any complaints related to Quinton House since the last inspection visit of 1 December 2005. The manager for the home advised that they have not received any complaints. A record of compliments and complaints is maintained in the home. A number of the compliment cards and letters were read and all spoke highly of the service their relative had or is receiving in the home. Several residents and two visiting family members commented that the staff were approachable and always listened. One resident said, “There is always a member of staff to approach with any personal problem knowing that it will be kept in confidence.” Staff said that residents usually expressed any concerns that they have with whoever was in charge of the home and they usually know if a resident was unhappy through their attitude or if they went quiet. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 17 Staff training records were seen to demonstrate that all staff had received training in the protection of vulnerable people. Staff have been trained in the recognition and reporting of abuse by the manager and deputy manager. Staff have signed to confirm they have read and understood the policies and procedures relating to vulnerable adults. Discussions with staff show that they are aware of how to respond to an allegation of abuse in the care home. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 26 Quality in this outcome group is good. Ongoing improvements to the environment ensure safety, maintenance, comfort and cleanliness of the home, which should increase the experience of quality of life for residents. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Quinton House is a large domestic building that has had some modifications to meet the needs of elderly residents. There is an annexe to the main house, which has been built to provide accommodation for up to 8 residents’ on the ground floor and the first floor provides accommodation for staff working in the home. Access to the first floor of the annexe is separate to that of the home, to ensure that visitors to staff living on the premises do not have to enter the resident’s home. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 19 Roofing has been erected over the passageway, which links main house to the annexe. This means that residents will be safer when returning from the main home to their bedroom in the annexe and the roof offers protection from the weather, especially in the colder months. Residents and relatives spoken with saw the home an attractive, comfortable and homely environment. The home was clean and there were no unpleasant odours on the day of inspection. The home looked in a good state of repair and work was being carried out on completing the refurbishment of the annexe. The window openers in residents’ bedrooms did not have restrictors fitted, which could be unsafe for residents due to the uncontrolled width to which the window could be opened. There are very extensive grounds around the home, which residents have ease of access to, especially in warmer weather. There was evidence of specialist equipment being used and examination of records and observation showed that these were well maintained. During a tour of the home, several of the bedrooms were seen including those of the residents followed through the case tracking process. Residents spoken with were happy with the accommodation provided and bedrooms viewed showed that residents had personalised their rooms with small items such as furniture and photographs. The home has a high percentage of shared bedrooms, which are not all best suitable to be shared. The shared bedrooms viewed had screening provided to promote privacy. The home has systems in place for the management of dirty laundry and the clothes of everyone living in the home looked clean, clothing was ironed and well looked after. A resident commented, “There are no problems with the laundry. Bed linen is changed regularly and is always clean.” One of the comments received in questionnaires returned from relatives says, “The residents always look clean and tidy.” Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome group is adequate. Staffing levels in the home do not ensure that the needs of residents will be met at all times. Improved recruitment procedures support the protection of residents from the risk of harm. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Four staff files were accessed in the absence of the owner who is responsible for recruitment. Information was not available to demonstrate the interview process and confirm that interviews had taken place. Records demonstrated that for all four staff the outcome of ‘POVA first’ checks had been obtained before they started working in the home. The outcome of Criminal Records Bureau (CRB) checks was received for two of the staff before employment the remaining two arrived one month after starting work in the home. The home provides sufficient numbers in respect of care staff but the skill mix and ratio of nurses to care staff has the potential to affect the standards of care and safety of residents. Observation of resident’s show that the high dependency needs of residents require increased nursing input. The number of nurses on duty during the course of the inspection does not allow the time for Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 21 this care to be delivered safely. One resident said, “When they are not available it’s usually because they are extra busy.” Training is provided both in-house by the registered manager and the deputy and through an external organisation. There are five care staff that have attained a National Vocational Qualification (NVQ) level 2 in care and three staff have attained level 3, which incorporates a supervisory element. Records show that staff have received training in dementia care, infection control and care of people who have been diagnosed with Parkinson’s. Three care staff spoken with confirmed that they had received training related to meeting the needs of residents in the home. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome group is adequate. Most management arrangements are meeting the needs of the service. The management of residents’ personal monies does not ensure residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager/matron has completed a NVQ level 4 in management and the certificate was seen to confirm this. The manager and her deputy were present at the inspection and both were knowledgeable about the residents living in the home. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 23 Staff were aware of their responsibilities and the lines of accountability within the home. Regular staff meetings are held and minutes of one of the meetings were read and show evidence of staff involvement in the running of the home. There was no evidence that a structured approach to quality assurance had been implemented. The registered manager does not routinely carry out audit of systems and practices carried out in the home. Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely. Residents’ money is held separately in individual envelopes. Records are held of financial transactions, but individual receipts are not always held in respect of money spent on behalf of the resident and record keeping systems were not robust. Individual records detailing financial transactions must be maintained in accordance with the Data Protection Act 1998. The manager confirmed that the majority of residents at the home receive support from outside of the home to manage their finances, either from their relatives or other advocates. Evidence was seen to confirm that staff receive regular training to meet mandatory training requirements. Training attended includes moving and handling, fire safety, first aid and food hygiene. The deputy manager takes the lead on training and records show that supervision for staff is formalised in the home. Staff are supervised at least six times per year this includes an annual appraisal. Staff files showed that the outcomes of supervision sessions are not consistently recorded. Topics discussed and action or activity that staff would be undertaking before their next supervision to demonstrate any progress made were not identified. Supervision of staff will monitor that safe and appropriate care is provided for residents. The pre-inspection questionnaire completed by the manager indicates that all relevant health and safety checks are carried out by the home. All certificates, maintenance records and servicing records were available during the inspection for the maintenance and service of major systems. The fire log was checked. These records indicate that fire alarms and lights are tested and that fire drills are carried out at the home. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 24 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 2 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 25 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. No. 1 Standard OP8 Regulation 13(1) Requirement The registered person must ensure that arrangements are in place for service users to receive where necessary, treatment, advice and other services from health care professionals at all times. This must include: Seeking medical advice for any service user where there is deterioration in their health and well being. The registered person must ensure that there are sufficient nurses on duty at all times to safely undertake the administration of medicines to all service users. The registered manager must ensure that the care home is conducted in a manner which respects the privacy and dignity of residents: • Respect for service users dignity must be followed through when documenting any information related to individual residents. The registered person must DS0000004407.V323754.R01.S.doc Timescale for action 30/04/07 2 OP9 13(2) 30/04/07 3 OP10 12(4)(a) 31/05/07 4 OP27 18 30/04/07 Page 26 Quinton House Nursing Home Version 5.2 5 OP33 24 6 OP35 Sch. 9(a) 7 OP36 18(2) 8 OP38 23 9 OP38 17 ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of service users. This is to include: • A review of the skill mix of staff on duty at any one time to ensure that there are sufficient nurses on duty at all times to safely meet the needs of residents. The registered person must establish and maintain a suitable system for reviewing and improving the quality of care, provided in the home and shall supply the CSCI a report in respect of any review. The registered person must maintain appropriate records of the purpose for which residents’ money was used and retain receipts for items or services purchased on behalf of the resident. The registered person must ensure that following supervision clear and informative records are maintained and available for inspection. The registered person must ensure that suitable opening restrictors are fitted to windows and routine checks made to ensure that they are working and effective. The registered person must ensure that policies and procedures, induction and training promote and maintain safe working practices in the home. This must include the safe administration of medicines. 30/06/07 31/05/07 30/06/07 31/03/07 31/05/07 Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 27 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 OP23 Good Practice Recommendations The registered provider should review the number of shared bedrooms in the homes. Quinton House Nursing Home DS0000004407.V323754.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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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