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Inspection on 31/10/05 for Ross Wyld Nursing Home

Also see our care home review for Ross Wyld Nursing Home for more information

This inspection was carried out on 31st October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

The inspector was satisfied that service users are provided with adequate communal and private space in the home. Staffing levels are sufficient to meet service users needs. Service users are given the opportunity of visiting the home before making a decision as to move in or not. Service users spoken to gave some positive feedback about the home, for instance over the quality of food and approachability of the manager.

What has improved since the last inspection?

There have been some improvements to the home since the previous inspection, and the overall number of requirements set as fallen slightly. Parts of the home have been decorated, although much still remains to be done in this area. Staff employment records are now more comprehensive, and those checked by the inspector appeared to be in line with Schedule 2 of the Care Homes Regulations 2001.

What the care home could do better:

As stated, there is much room for improvement at the home. Areas of particular concern include the administration of medications, care planning, risk assessments and pre admission assessments. Many staff currently do not receive any formal supervision, and at times service users are left unsupported by staff.Several staff have not received any training in adult protection issues, and the homes adult protection policy is not in line with current legislation.

CARE HOMES FOR OLDER PEOPLE Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ Lead Inspector Rob Cole Unannounced Inspection 31st October 2005 10:00 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 Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ross Wyld Nursing Home Address Ross Wyld 458 Forest Road Walthamstow London E17 4PZ 0208 521 8773 0208 520 0690 ross.wld@fsch.co.uk 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) Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Lutchemee Hele Care Home 54 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (25), of places Physical disability (7) Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2005 Brief Description of the Service: Ross Wyld is a care home registered to provide care for a maximum of 54 service users. This includes 25 places for those requiring nursing care, 22 places for older people with dementia and 7 places for younger adults with physical disabilities. The registered provider is Tamaris Ltd, part of the Four Seasons Health Care Group. The home is a large purpose built, three storey detached house with 48 single bedrooms and three double bedrooms located across all three floors. All floors are accessible via a lift. The home is situated on Forest Road, in the London Borough of Waltham Forest. The home is close to shops, transport networks and other local amenities. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 31/10/05 and was unannounced. The inspector had the opportunity of speaking with service users, staff from the home and the homes manager was present throughout the inspection. Overall, the inspector believes that much work still needs to be done at Ross Wyld to ensure that the home is operating in line with all National Minimum Standards and Regulations. Although there has been some limited improvement since the previous inspection, there remain several areas of concern, for instance around medication and the environment. What the service does well: What has improved since the last inspection? What they could do better: As stated, there is much room for improvement at the home. Areas of particular concern include the administration of medications, care planning, risk assessments and pre admission assessments. Many staff currently do not receive any formal supervision, and at times service users are left unsupported by staff. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 6 Several staff have not received any training in adult protection issues, and the homes adult protection policy is not in line with current legislation. 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. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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 Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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): 1,2,3,4 and 5 Although the inspector was satisfied that service users are provided with sufficient information about the home, the home itself must ensure that it is in a position to meet service users needs. Comprehensive pre admission assessments must be carried out, and the home must only admit service users from within its categories of registration. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place. Both documents are written in plain English and all service users are provided with their own copy of the Guide. The Statement of Purpose includes details of the management and staff team, the philosophy of care and the aims and objectives of the home. The Guide includes details of the services provided and a copy of the homes complaints procedure. However, neither document is dated, nor is there any indication of when they are due to be reviewed, or indeed were last subject to review, and this must be addressed. All service users have been issued with a contract/statement of terms and conditions. Contracts contain information on fees payable, conditions of occupancy and the rights and responsibilities of both parties, and are in line with National Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 9 Minimum Standards (NMS). Contracts have been signed by the service user or their representative were appropriate. The inspector was informed by the homes deputy manager that a senior member of staff will carry out a pre admission assessment of prospective service users. However, the inspector noted that for a recent admission to the home there was no evidence that any such assessment had been carried out. Further, the assessments of several other service users were seen to be very basic, for example they did not contain any information relating to the service users cultural, social or leisure needs. It is required that comprehensive pre admission assessments are carried out for all prospective service users, to determine what their needs are, and if the home is able to meet those needs. The assessment for one service user admitted to the home since the previous inspection indicated that they had been diagnosed as suffering from depression, yet the home is not registered to provide support to service users with mental health needs. It is a repeat requirement that the home only admits service users from within its categories of registration. The home has an admissions procedure, and this states that service users would be able to visit the home before making a decision as to move in or not. Service users spoken to confirmed that they were given this opportunity. The home does not provide intermediate care. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 It is the view of the inspector that at present the home is not meeting the health needs of service users. Care planning and risk assessing is of a poor standard, as is the recording of medications. All of this puts service users at potential risk and must be addressed. EVIDENCE: Care plans are in place for some service users. However, as at the last inspection, these tend to focus almost exclusively on service users medical, mobility and nursing needs, and some of those seen by the inspector made no mention of service users social, cultural or leisure needs. For one service user there was no evidence of any care plan been in place at all. This must be addressed. Similarly, for one service user there was no evidence that a risk assessment had been carried out on their behalf. Other risk assessments seen were far from comprehensive, for example, one service user had been identified in April of this year that they were at risk from falling. The only control around this was that staff were to observe them. Since the date of the assessment, accident/incident records indicated that this service user has had nine separate falls, yet the assessment has not been reviewed or developed in any way. Further more, on the day of inspection, the inspector observed this Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 11 service user to be left unsupported by staff on three separate occasions. It is required that comprehensive risk assessments are in place for all service users, covering all areas of potential risk to themselves and others, and identifying strategies to manage and reduce these risks, and that these assessments are subject to regular review. All service users are registered with a GP, service users are able to retain the GP they had prior to admission where practical. Records are maintained of medical appointments. However, these are not comprehensive, they merely state the date of the appointment and who the appointment was with. It is required that clear and comprehensive records are maintained of all medical appointments, including details of the appointment and any follow up action necessary. Records indicated that service users have recently had access to a variety of health professionals including district nurses, chiropodists and physiotherapists. However, as at the last inspection service users still do not have access to regular dental and eye care, for instance records indicated that one service user had not had access to dental and eye care in the past two years. This must be addressed. The home has a comprehensive medication policy. Medications are stored in each unit in designated and locked rooms. Only nursing staff administer medications on the nursing unit, and only staff who have received training administer medication in the dementia unit. Records are maintained of medications entering the home, and there was evidence that medications are disposed of appropriately. The inspector checked several Medication Administration Record (MAR) charts at random, and found that they were generally maintained to a poor standard. There were instances of unexplained gaps on MAR charts, of medications been entered on MAR charts that the service user was no longer taking, and inappropriate recording. For example on several charts the symbol O was used, the key on the charts stated that this stood for “Other, please define”, yet there were many instances were the O had not been defined, and it was impossible to determine what it actually stood for in these instances. Further, there were no guidelines in place around the administration of medications prescribed on a PRN basis, for instance one service user had been prescribed ZOPICLONE on a PRN basis, yet there were no guidelines in place around the administration of this medication. All of this must be addressed as a matter of priority. MAR charts did not contain a recent photograph of service users, and this is recommended. There was evidence that the dignity and privacy of service users is respected. Staff were observed to knock and wait before entering bedrooms, and were seen to interact with service users in a friendly and respectful manner. The laundry system helps ensure that service users only wear their own clothes, and all were appropriately dressed on the day of inspection. The home has a policy in place on death and dying. The manager informed the inspector that service users are able to remain in the home with a terminal Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 12 illness, as long as the home can meet their medical needs. The home has sought the wishes of service users in the event of their death, and these have been recorded. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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): None The standards in this section were not tested on this occasion, but will be tested as part of the next inspection. EVIDENCE: The standards in this section were not tested on this occasion, but will be tested as part of the next inspection. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 14 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): 16,17 and 18 The inspector was satisfied that the home has appropriate procedures in place for making, recording and investigating complaints. However, more must be done in regard to adult protection, in particular the homes policy must be in line with current legislation, and all staff must undertake training in this area. EVIDENCE: The home has a complaints procedure, this was prominently displayed within the home and made appropriate reference to the CSCI. The home also has a complaints log. Since the last inspection there was evidence that the home now appropriately records and investigates any complaints received. The home has a copy of the Local Authorities adult protection procedures and also its own policy on adult protection. However, this is not in line with current legislation. For example it suggests that the homes manager or regional manager has responsibility for carrying out any investigations into suspected adult protection issues, yet the decision as to who would carry out such an investigation rests with the Local Authority. The manager informed the inspector that not all staff working in the home have received training in adult protection issues. Both of these issues must be addressed, and both are repeat requirements. The inspector was satisfied that service users legal rights are protected, for instance all service users are entered on the electoral register, and service users informed the inspector that they are able to vote in elections. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 15 Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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): 19,20,21,23,24 and 25 It is the view of the inspector that although some redecoration work has been carried out, there is still much that needs addressing. Service users are provided with adequate communal and private space. EVIDENCE: The home is situated in the Walthamstow area of the London Borough of Waltham Forest, and is close to shops, transport networks and other local amenities. The inspector believes that a considerable amount of work needs to be done to the building in order for it to meet National Minimum Standards. Whilst it was positively noted that some redecorating work has been carried out, there is still much to do. Throughout the home there are instances of peeling and faded wallpaper and cracked paint. Communal areas consist of sitting rooms, dining rooms and two designated smoking rooms, and are sufficient in numbers to meet service users needs. Likewise the inspector was satisfied that the home has sufficient numbers of bathing and toilet facilities to meet service users needs. However, the lock on Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 17 the first floor shower room did not have an emergency override devoice fitted, and this must be addressed. Bedrooms were also found to be in a generally poor state. Many contained broken items of furniture, and were often sparsely decorated and bleak in appearance. Furniture in bedrooms was often found to be in a poor state, and one bedroom had a strong offensive odour. Further, many bedrooms did not have any locks fitted. It is a repeat requirement that all bedrooms have working locks fitted, and that service users are offered keys to their bedrooms subject to satisfactory risk assessments. Bedrooms met NMS on size requirements, and had adequate natural light and ventilation. There was no evidence of any assessment of the premises by a suitably qualified person having taken place and no evidence of aids and adaptations being provided, despite this being identified in previous inspection reports. It is a requirement that such an assessment is undertaken and that the registered person provides any necessary aids, adaptations and equipment to meet the needs of service users. This is a repeat requirement. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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 and 30 The inspector was satisfied that staff are employed in sufficient numbers to meet service users needs, and receive training as appropriate. However, the home must ensure that staff are employed in the home so as best to meet the needs of service users, and help ensure their safety. EVIDENCE: The home provides 24-hour support including an emergency on-call procedure. The home had a staffing rota, which accurately reflected the actual staffing situation on the day of inspection, and since the last inspection this now includes details of the hours worked in the home by the manager. In addition to nursing and care staff, the home also employs designated laundry, cleaning, administrative and kitchen staff, along with a full time activities coordinator. Although the inspector was satisfied that the home is staffed in sufficient numbers to meet service users needs, they have concerns over the way staff divide their time whilst on duty. For example, at one stage the inspector noted that in the ground floor lounge and smoking area there were sixteen service users present, but no nursing or care staff. This was brought to the attention of the manager who arranged for staff to support these service users. However, two hours later it was again noted that this same area was left unstaffed, and on this occasion there were fourteen service users present. This was of particular concern as several service users risk assessments indicated that they should be closely observed by staff due to the risk of falling. It is required that service users are provided with appropriate levels of support from care and nursing staff. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 19 The home has policies in place on equal opportunities and recruitment and selection. At the last inspection a requirement was set that the home only recruits staff in line with its policies and procedures. The recruitment policy states that all interviews will be carried out by at least two people, yet the manager informed the inspector that they routinely carried out staff recruitment interviews on their own. As there have been no further staff recruitment to the home since the last inspection this requirement is repeated in this report. The inspector checked several staff employment files at random, and all appeared to be in line with Schedule 2 of the Care Homes Regulations 2001 since the last inspection. All staff undertake a structured induction programme on commencing work at the home. This includes health and safety issues, service user issues and policies and procedures. Records are kept of staff training, and these indicated that staff have recently received training in manual handling, first aid and infection control. Of the fifty six care related staff employed at the home the manager in formed the inspector that nineteen have either a nursing or relevant NVQ care qualification, and that it was the intention of the organisation that all staff will be given the opportunity of completing a care qualification. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 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): 31,32,33,35,36,37 and 38 Although the manager is suitably qualified and experienced, it is the view of the inspector that more attention needs to be paid to several key areas within the home, for instance quality assurance and staff supervisions. EVIDENCE: The manager is a registered nurse, with thirteen years experience of working in residential care, including four years in a managerial capacity. Staff and service users informed the inspector that they found the manager to be approachable and accessible, and staff were observed to interact with the manager in a relaxed manner during the course of the inspection. Since the last inspection the home now holds regular staff meetings, and all staff are able to bring items to the agenda. There was evidence that monthly unannounced Regulation 26 visits take place, and copies of previous inspection reports were available to view in the home. The home has produced a Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 21 questionnaire to be issued to service users to gain their feedback on the running of the home, however, there was no evidence that this is regularly given to service users, and the home was unable to produce a completed sample of these questionnaires for inspection. Further, requirements set by the CSCI often go unmet within agreed timescales for action. It is required that the home implements quality assurance systems to ensure that the home successfully meets all its aims and objectives and provides high quality care to service users. Records within the home were stored securely, and staff and service users can access their records as appropriate. The home holds money on behalf of service users in a locked safe. Records and receipts are kept of financial transactions involving service users monies, but these are far from comprehensive. The inspector checked several financial records at random, and found many instances were money had been spent, yet there was no receipt in place and no indication on what the money had been spent on, further, service users had often not been asked to sign for any monies received. It is required that effective systems are put in place to monitor and check the spending of monies that the home holds on behalf of service users to ensure that it is been spent appropriately. At a previous inspection it was noted that the home held money for several service users in a single pooled bank account, and that service users did not receive the interest generated from this account. At this inspection the home was able to demonstrate that it has taken steps to ensure that one service user will receive income generated from their savings, but nothing has been done to ensure that the other service users receive the interest their savings generate. This must be addressed. Some staff receive regular supervision, and the quality of supervisions has improved since the last inspection. Supervision agendas are set jointly by both parties, and include performance, training needs and service user issues. Staff receive a copy of their supervision notes. However, for some staff there was no evidence that they have received any formal supervision since the previous inspection, and it is a repeat requirement that all staff receive regular formal supervision at least six times a year. The home has various health and safety policies in place, including on fire safety and COSHH, staff undertake training in appropriate health and safety subjects, such as manual handling and first aid. Fire fighting equipment was situated throughout the home, and last serviced in September 2005. Fire exits were clearly signed. However, on the day of inspection the inspector noted that a fire exit on the ground floor was obstructed by a wardrobe, and a fire exit on the first floor was obstructed by a mattress, both of these obstructions would make it exceedingly difficult for someone using a wheelchair to access these exits. These obstructions were pointed out to staff in the home, who removed them. It is required that all fire exits are kept free of obstruction. The home had in date certificates for gas safety, electrical installation and PAT testing. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 22 Routine checks are carried out on water temperatures, fire alarms and emergency lighting and COSHH products were stored securely. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 2 2 X 3 2 3 X STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 1 2 3 2 Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 24 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 OP22 Regulation 23 Requirement Timescale for action 28/02/06 2. OP7 14 3. OP10 12 The registered person must demonstrate that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist with specialist knowledge of the client group catered for; and provide evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. (Timescale 31/8/05 not met) The registered person must 28/02/06 ensure that all care plans demonstrate how each of the assessed needs of the service users are met. (Timescale 31/8/05 not met) The registered person must 28/02/06 ensure that all service users bedrooms are fitted with suitable locks, and service users provided with a key unless a completed risk assessment indicates otherwise. This must be recorded in the individual plan of care detailing the reasons why. DS0000025960.V261318.R01.S.doc Version 5.0 Ross Wyld Nursing Home Page 25 4. OP18 18 5. OP19 23 6. OP24OP8 13 7. OP19 23 8. OP9 13 9. OP9 13 10. OP18 13 11. OP29 18 12. OP4 14 (Timescale 31/8/05 not met) The registered person must ensure that all staff working in the home receive training in adult protection issues and the protection of vulnerable adults. (Timescale 31/8/05 not met) The registered person must ensure that all parts of the care home are kept in a good state of repair and reasonably decorated. (Timescale 31/8/05 not met) The registered person must ensure that all service users have access to relevant health professionals as appropriate, and that records are kept of appointments, and any follow up action required. (Timescale 31/8/05 not met) The registered person must ensure that all incidents of peeling wallpaper are redecorated. (Timescale 31/8/05 not met) The registered person must ensure that only medications in current use are entered on MAR charts. (Timescale 31/8/05 not met) The registered person must ensure there are clear guidelines in place for the administration of all medications prescribed on a PRN basis. (Timescale 31/8/05 not met) The registered person must ensure that the homes adult protection procedures are in line with current legislation. (Timescale 31/8/05 not met) The registered person must ensure that all staff recruited to the home are done so in line with the homes recruitment and selection policy. (Timescale 31/8/05 not met) The registered person must DS0000025960.V261318.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Page 26 Ross Wyld Nursing Home Version 5.0 13. OP8 13 14. OP9 13 15. OP24 16 16. OP35 20 17. OP3 14 18. OP36 18 19. OP21 12 ensure that the home does not admit any service users from outside its category of registration. (Timescale 31/8/05 not met) The registered person must ensure that comprehensive risk assessments are in place for all service users, covering all areas of potential risk to themselves and others. (Timescale 31/8/05 not met) The registered person must ensure that all medications administered are accounted for, and that there are no unexplained gaps left on MAR charts. (Timescale 31/8/05 not met) The registered person must ensure that all bedrooms contain adequate furniture, and that this furniture is in a good state of repair. (Timescale 31/8/05 not met) The registered person must ensure that service users receive all interest paid out on monies held in accounts by the home on their behalf. (Timescale 31/8/05 not met) The registered person must ensure that comprehensive pre admission assessments are conducted and that all information is fully considered prior to the admission of a service user. (Timescale 31/8/05 not met) The Registered person must ensure that all staff receive formal supervision at least six times a year and that a written record is maintained which details the nature of the discussion and topics discussed. (Timescale 31/8/05 not met) The registered person must DS0000025960.V261318.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Page 27 Ross Wyld Nursing Home Version 5.0 20. OP1 6 21. OP9 13 22. 23. OP24 OP27 16 and 23 18 24. OP33 24 25. OP35 16 26. OP38 13 and 23 ensure that all bathrooms and toilets have suitable locks fitted with an override device for staff to use in an emergency. (timescale 31/8/05 not met) The registered person must ensure that the homes Statement of Purpose and Service User Guide are both dated and subject to regular review. The registered person must ensure that all symbols used on MAR charts are used in line with the key code for symbols on the MAR charts. The registered person must ensure that all bedrooms are free from offensive odours. The registered person must ensure that all ervice users are provided with appropriate and adeqate levels of care from nursing and care staff at all times. The registered person must ensure that the home implements appropriate systems of quality assurance to monitor the quality of care in the home and ensure that the homes aims and objectives are met. The registered person must ensure that appropriate checks are in place to ensure that service users monies are spent appropriatly, and to reduce the risk of financial abuse. The registered person must ensure that fire exits are kept free from obstruction at all times. 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 28 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 OP9 Good Practice Recommendations It is recommended that a recent photograph of service users is placed on their MAR charts. Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Ross Wyld Nursing Home DS0000025960.V261318.R01.S.doc Version 5.0 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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