Inspection on 17/11/08 for Raj Nursing Home

This inspection was carried out on 17th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Raj Nursing Home 28/01/08

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Raj Nursing Home 31,33 & 35 Osterley Park Road Southall Middlesex UB2 4BN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rekha Bhardwa     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Raj Nursing Home 31,33 & 35 Osterley Park Road Southall Middlesex UB2 4BN 02085741795 02088139292 raj@afterhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Dominic`s Ltd Name of registered manager (if applicable) Veronica Singh Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The Registered Person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home Raj Nursing Home is a conversion of three houses into one home and is situated in a residential area of Southall. There are some shops near to the home and the home can be accessed by bus. The home specifically caters for Asian and ethnic minority residents with dementia, mental health or physical disability healthcare needs. The home has sixteen single and four double bedrooms. Five of the single bedrooms also have an ensuite facility. There is a spacious day room and a prayer room situated at the end of the garden. The home is near to the local Temple and Gurdwara. The food provision is specific to the residents cultural, religious and dietary needs. The staff Care Homes for Older People Page 4 of 24 care home 24 Over 65 0 24 Brief description of the care home employed at the home collectively speaks several languages and dialects to cater for the communication needs of the residents at the home. The fees range from five hundred pounds per week to seven hundred pounds per week. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 10 hours was spent on the inspection process, and was carried out by 1 Inspector. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, administration records and maintenance & servicing records were viewed. 14 residents, 6 staff and 3 visitors were spoken with as part of the inspection process. The Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, representatives/visitors and staff have also been used to inform this report. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 24 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed prior to admission, thus the home ensures they are able to meet each residents needs. Evidence: The home uses a pre-admission assessment document that provides a good picture of the resident and their needs, to include specialist needs. This is completed for all prospective residents in order to ascertain if the home is able to fully meet their needs. Completed assessments were viewed and were detailed and clear. The home does not provide intermediate care. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the service user plans were being well completed to provide staff with the information to meet each residents needs. Medications are being well managed at the home, thus safeguarding the residents. Staff care for residents in a caring, gentle and professional manner, thus respecting their privacy and dignity. Information regarding the residents wishes in the event of health deterioration and end of life care are ascertained, thus ensuring that the residents individual wishes can be respected. Evidence: We viewed two service user plans. Overall these were well completed and provided a good picture of each resident and their needs. There was evidence of monthly review and whenever the needs of the resident had changed. The care plan information was personalised and included medical care needs and clearly identified how each need is to be met. There was evidence of residents representatives being involved in the formulation and review of the service user plans. Risk assessments for falls had been completed as had risk management plans for other Care Homes for Older People Page 11 of 24 Evidence: risks identified. Wound care documentation was viewed. Individual care plans and wound progress records were available for the wound. Photographs had been taken of the wound. Pain assessments had been carried out. Evidence of input by the tissue viability nurse had been clearly recorded. Changes to wound products and frequency of dressing changes had also been clearly recorded. Pressure sore risk assessments had been completed and for those residents who required turning charts these were in place. Nutritional assessments and continence assessments had been completed in the service user plans viewed. Moving & handling assessments were available and moving & handling equipment in use for each individual had been identified. For residents who required bedrails a risk assessment for their appropriateness was available with signed consent from the residents representative. Residents weights are undertaken monthly or sooner if required. There was evidence of input from the dietician and the speech and language therapist in relation to residents nutrition. There was evidence of input from healthcare professionals. Medication management was viewed. Lists of staff signatures and initials were available. Appropriate lancing devices for professional use for blood glucose monitoring were in use. Administration records were complete and where a medication had been omitted for some reason, coding with an explanation for the omission had been used. Receipts and disposal records were clear and up to date. The fridge temperatures were being taken and recorded. Liquid medications and eye drops had their date of opening recorded. Controlled drugs were being appropriately stored and recorded. Balances checked at the inspection were correct. For residents being fed via a percutaneous endoscopic gastronomy tube(PEG)clear fluid charts with the start and end times of the feed being clearly recorded. We recommended that the batch number of the feed also be recorded. There was evidence of regular auditing of medication. Staff were seen caring for residents in a gentle and professional manner and we observed good interaction between the staff and the residents. There are staff on duty who speak Hindi, Punjabi and Gujarati. These are the main languages spoken by the residents. All staff also speak English. Residents were dressed to reflect individuality and cultural preferences. These had also been clearly recorded in the care plan. The home had worked hard with the residents and their representatives in relation to their end of life and health deterioration wishes. These had been clearly recorded in the care plan along with the residents specific cultural and religious needs. The Registered Manager informed us that further work is required in this area and that staff would also be undertaking training in this area. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity provision in the home has improved, with some activities being provided to meet the residents needs. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents right to independent representation is respected. The food provision is good and residents are offered a choice, to meet their individual preferences. Shortfalls in relation to record keeping should be easy to address. Evidence: Since the last inspection the home has employed a part-time activities co-ordinator. At the time of the inspection she had been in post for a month and was in the process of obtaining information on the residents and abilities. A activities programme is in place and group and 1:1 activities take place. Some comments were received via the CSCI comment cards in relation to activity provision and these were fed back to the Manager in general terms. The Manager is aware that this area of care provision needs to be developed and is considering creating a full-time post to meet the needs of the residents. Care plans in relation to activities were in place. There is a prayer room at the the end of the garden which can be accessed by residents. Care Homes for Older People Page 13 of 24 Evidence: The home has an open visiting policy and visiting is encouraged. Two visitors spoken with confirmed that they are made welcome at the home and kept informed of any changes to their relatives condition. Residents can choose to receive visitors in their own bedrooms or in one of the communal rooms, as they so wish. Information in relation to advocacy services was available. We were informed that this would be displayed in the main entrance upon completion of the decoration of the entrance. We viewed the kitchen. Overall this was clean and well organised. Deep cleaning of the kitchen is undertaken monthly. Residents are offered a choice of vegetarian and nonvegetarian food. Records of meals taken are kept. The cook caters for residents cultural and religious preferences. Drinks and snacks are offered throughout the day. Records in relation to fridge temperatures and food temperatures were not up to date and this was discussed with the Manager. See requirement under standard 38. Risk assessments for the kitchen were in place. All staff working in the kitchen have received Food Hygiene training. Fresh and dry foods were stored appropriately. Residents spoken with during the inspection confirmed that they enjoyed the meals provided. Staff were observed assisting residents with their meals and were seen doing so in a gentle and discreet manner. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by residents and their representatives. There is a system in place for the safeguarding of residents from abuse, understood by staff, thus protecting residents. Evidence: The home has a clear complaints procedure and all complaints and concerns are recorded. There had been one complaint since the last inspection and the documentation viewed confirmed that this had been investigated and responded to. The home has in place policies and procedures in place for safeguarding adults and also follows the Ealing Safeguarding Adults procedures. Staff spoken with confirmed that they had received training in safeguarding adults and whistle blowing. Since the last inspection no incidents have been reported to the Ealing Safeguarding Adults team. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has recently been redecorated and refurbished, thus providing a clean, homely and safe environment for residents to live in. Procedures are in place for infection control, thus minimising the risk of infection. Evidence: We carried out a tour of the home. Since the last inspection the home has been redecorated and refurbished. Several of the double bedrooms have been created into single and where possible en suite bedrooms. This has enhanced the quality of accommodation that is offered to residents. New furniture has been ordered for the bedrooms and communal areas and will be delivered once all redecoration has been completed. Flooring has been replaced throughout the home. New curtains and linen has been ordered. New skylights have been installed in the first floor corridors to create a bright atmosphere. Plans are in place to landscape the gardens in the summer. The laundry room was clean and tidy. Protective clothing to include gloves and aprons were available. Residents clothing was appropriately labeled. Policies and procedures were in place for infection control. The AQAA confirmed that the majority of staff have received training in infection control. Overall the home was clean and fresh throughout. The Manager confirmed that prior to the new furniture being installed all Care Homes for Older People Page 16 of 24 Evidence: bedrooms would be thoroughly cleaned. Residents toiletries were safely stored. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staffed to ensure that the needs of the residents are met. Systems for vetting and recruitment practices are in place and protect residents. There is a training programme, to provide staff with the skills to meet the needs of residents. Evidence: The staffing levels were appropriate to meet the needs of the residents. Staff spoken with said that they have enough staff to care for the residents effectively. At the time of the inspection there were 19 residents living at the home. Overall the home was clean and fresh throughout and ancillary staff are employed in appropriate numbers to meet the overall needs of the residents and the home. The AQAA identified that over 50 of the care staff are trained to NVQ level 2 or above. Several staff who are qualified Nurses in their country of origin are undertaking NVQ level 4 training. We viewed 2 sets of staff employment records. These contained the information required under Schedule 2 of the Care Homes Regulations 2001. The home has an induction programme that includes the Skills for Care common induction standards. Staff spoken with said that they had received thorough induction Care Homes for Older People Page 18 of 24 Evidence: training and that they had worked alongside more experienced staff. There was evidence of training in topics relevant to the diagnoses of the residents, to include dementia and health and safety training. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has the qualifications and experience to manage the home, and does so in a professional and approachable manner. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Systems are in place for the management of residents monies. Overall systems for the management of health and safety throughout the home are good, thus safeguarding residents, staff and visitors. Shortfalls identified should be easy to address. Evidence: The Manager is a first level registered nurse with 4 years experience of being the Deputy Manager at the home. She became the Registered Manager of the home in July 2008. She has undertaken periodic training relevant to her role and the needs of the residents. The Manager has completed the Registered Managers Award NVQ level 4 and is also a moving and handling instructor. Staff spoken with said that the Manager is supportive, approachable and works alongside the staff to ensure good care Care Homes for Older People Page 20 of 24 Evidence: practice. She is able to communicate with the residents and their representatives in their preferred language. The Manager said that she has an ‘open door’ policy for staff, residents and visitors and that any issues are listened to. There are clear lines of accountability within the home. We were informed that the Manager is in the process of recruiting a Deputy Manager. Since the last inspection the home has developed and implemented a quality assurance system. Regular audits are carried out to include medication, infection control, health and safety and service user plan audits. Satisfaction questionnaires to residents, representatives were undertaken in August 2008. There was evidence of regular staff meetings and minutes of each meeting are taken. We were informed by the Manager that at the present time relatives were happy to meet with her to express any concerns rather then attending a relatives meeting. Regulation 26 unannounced visits on behalf of the Responsible Individual take place and copies of the reports were available to view. The home does not hold money for any of the residents. The servicing and maintenance records were sampled. Those viewed were up to date. The home is in the process of recruiting a maintenance person. Any maintenance issues are addressed at present through contractors. We viewed the training matrix and this confirmed that all staff had received training in health and safety at the required intervals. Some of the kitchen records to include fridge and food temperatures had not been completed consistently and this was discussed with the Manager. Generic risk assessments for equipment and safe working practices were in place and also included risk assessments to include the refurbishment work being undertaken. There was evidence of regular fire drills taking place for day and night staff. The fire risk assessment had been updated to include the new rooms. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Further work must be undertaken in the development of activity provision. To ensure that residents have a full range of activities that they can participate in. 13/02/2009 2 38 13 Kitchen records to include fridge and food temperatures must be kept up to date. In order to ensure that the residents safety is maintained. 13/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Staff should record the batch number of each feed on the fluid balance chart. Care Homes for Older People Page 23 of 24 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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