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Inspection on 04/09/06 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 4th September 2006.

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

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

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

What the care home does well

The home has adequate staffing levels, and appropriate complaints procedures are in place. There is a designated activities room and coordinator, and service users informed the inspector that they are happy with the food provided.

What has improved since the last inspection?

As stated, there have been some limited improvements to the home since the previous inspection. The inspector was pleased to note that the quality of risk assessments has improved considerably, and that the homes procedure on adult protection is now in line with current legislation.

What the care home could do better:

There are many issues that must be addressed. Health and safety management, medications, care planning, employment checks and pre admission assessments are all areas that should be treated as priorities.

CARE HOMES FOR OLDER PEOPLE Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ Lead Inspector Rob Cole Unannounced Inspection 4th September 2006 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.V312006.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. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 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 (South East) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) Mrs 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.V312006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To allow the home to provide continuous care for two named service users and to permit admission of one named service user with mental health needs. 30th August 2006 Date of last inspection 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.V312006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 4/9/06 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. The inspection also included an examination of records and documents, and a tour of the premises. Overall, the inspector believes that much work still needs to be done at the home before Ross Wyld is fully in line with the National Minimum Standards and the Care Homes Regulations 2001. There have been some improvements since the last inspection, but the inspector was disappointed to note that the overall number of requirements has gone up. What the service does well: What has improved since the last inspection? What they could do better: 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.V312006.R01.S.doc Version 5.2 Page 6 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.V312006.R01.S.doc Version 5.2 Page 7 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the inspector was satisfied that service users are able to visit the home before moving in, the home must ensure that it is able to meet all service users assessed needs prior to admission. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place. Both documents are written in plain English. The Statement includes details of the organisational structure, the aims and objectives of the home and of the services provided. However, as at the last inspection, the Statement is still not dated, nor is there any indication that it has been subject to review. Further, the Service User Guide has not been dated or reviewed, and now contains inaccurate information, for example about whom to make complaints to within the organisation. It is required that both documents are dated and subject to regular review. 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 Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 8 are in line with National Minimum Standards (NMS). Contracts have been signed by the service user or their representative were appropriate. The home has a pro forma which it uses to assist in carrying out pre admission assessments for service users prior to them moving into the home. The inspector checked pre admission assessments for service users who have moved in to the home since the last inspection. Some of these were found to be extremely basic. The only information provided on one form was that the service user prefers vegetarian food and does not like pork. For another, there was even less information, merely giving contact details of their next of kin, GP and social worker. It is required that comprehensive pre admission assessments are carried out for all prospective service users, covering all areas of potential need, to determine how the home can meet those needs. The home has an admissions procedure. There was evidence through talking to service users that they were given the opportunity of visiting the home before making a decision as to move in or not. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The inspector has concerns that service users are been put at potential risk by bad practice in regard to the recording and administration of medication, and this must be addressed. Further, care planning needs to be improved. EVIDENCE: Care plans are in place for all service users. However, these tend to concentrate on needs associated with mobility, nursing and medical care, and do not include needs associated with culture or social and leisure needs. Some plans were seen to be very basic, for instance one care plan merely included information about managing the service users epilepsy. For the most part plans are subject to regular monthly review, but not all, for example one care plan examined by the inspector had not been reviewed since January of this year. It is required that clear and comprehensive care plans are in place for all service users, and that these are subject to regular review, at least monthly. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 10 Risk assessments were in place for all service users. The inspector was pleased to note that these have improved since the last inspection, and are now sufficiently clear and detailed. Assessments included risks associated with mobility, wandering and the environment. All service users are registered with a GP. The home keeps records of medical appointments; these indicated that service users see health professionals as appropriate, including dentists, opticians and physiotherapists. However, these records only included the date of the appointment, and who it was with. They did not give any information on the reason for the appointment, or of any follow up action necessary. It is required that comprehensive records are maintained of any medical appointments. The home has a comprehensive medication procedure, and medications are administered by nursing staff and staff who have received training on the administration of medications. Medications are stored in locked cabinets. Records are maintained of medications entering the home and of those that are returned to the pharmacist. One service user is on controlled drugs, these are stored and recorded as appropriate. However, the inspector found several areas of concern with regard to medication: • • There were several instances of unexplained gaps on Mediation Administration Record (MAR) charts. There were no guidelines in place around the administration of medications prescribed on a PRN basis, for example one service user has been prescribed LORAZAPAM, yet there were no guidelines on when this was to be given. On several occasions the letter X was entered on MAR charts, yet on the key code there was no X, so it was impossible to tell what this actually stood for. One service user had been prescribed BENDROFLUMETHIAZAIDE ORAL SUSPENSION, yet the MAR charts indicated that it was not given between the 20th and the 30th of June inclusive as the pharmacist did not have it in stock. There was no evidence that the home made any attempts to obtain this medication from another pharmacist, or that they contacted the GP to seek advice about this matter. • • All of these issues must be addressed, and the homes manager must introduce a system of checking the administration and recording of medications throughout all areas of the home, to ensure that medications are administered appropriately, and that any instances of bad practice are dealt with in a swift manner. Continued failure of the home to comply with NMS and the Care Homes Regulations 2001 in regard to medication may lead the CSCI to take enforcement action against the home. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that service users have control over their daily lives. EVIDENCE: Service users informed the inspector that they have control over their daily lives, for example when to get up and go to bed, what to wear etc. The home has a designated activities room and activities coordinator. The weekly activities programme was advertised by poster in the home, and included quizzes and bingo. Service users informed the inspector that they have the opportunity of visiting local shops and parks, and that they have recently been on a day trip to Alexander Palace which they enjoyed. A further trip was planned for Canvey Island in the near future. The home has a visitors policy in place, service users informed the inspector that they were able to receive visitors at any reasonable hour, and were able to see them in private if they so wished. The home maintains records of menus, these indicated that service users are offered a varied, balanced and nutritious diet. Service users spoken to informed the inspector that they were happy with both the quantity and quality Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 12 of food provided. Service users were seen to be offered drinks and snacks throughout the day. The kitchen was clean and tidy, and food was stored appropriately. However, the home has not tested and recorded the fridge and freezer temperatures for the past six weeks. The homes cook informed the inspector that this was because they had run out of the forms for recording the temperature. It is required that the home checks and records the temperatures of all fridges and freezers used for food storage on a daily basis. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 13 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector believes that the home has appropriate procedures in place around complaints and protection, but that all staff must undertake training in adult protection issues. EVIDENCE: The home has a complaints log, and this indicated that complaints have been investigated and recorded appropriately. There was also a complaints procedure, which included contact details of the CSCI. An abbreviated version of the procedure was on display within the home. The home has a copy of the Local Authorities adult protection procedure, and also its own policy on adult protection. This has been amended since the previous inspection, and is now in line with current legislation. However, the inspector was informed that not all staff have as yet received training in adult protection issues, and it is a repeat requirement that they do so. The inspector was satisfied that service users legal rights are protected. For example, the manager informed the inspector that all service users are on the electoral register, and service users confirmed that they were able to vote in elections. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 14 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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite some improvement to the homes physical environment, there remains much that needs to be done. Bathrooms and toilets were found to be dirty, and bedrooms were very sparsely decorated. 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. At the time of inspection redecorating work was in progress around some of the communal areas around the home. This was positively noted, as requirements have been set over several inspections that the home was in need of redecorating. These requirements are repeated in this report, as there are still some areas in need of attention. A random inspection of the home was carried out on the 30/8/06, and three requirements were made at that inspection connected with the decorating and building work in progress, these were as follows: Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 15 1. The registered manager to ensure that service users are appropriately supervised – particularly if occupying areas of the home considered temporarily hazardous. 2. The registered manager to ensure that service users are not unnecessarily exposed to hazards posed by contractors. 3. The registered manager to ensure that adequate (by means of safety and size) common space is made available for service users at any time when usual facilities are unavailable. The inspector was pleased to note that all these requirements were found to have been met at least partially. Requirements 2 and 3 were found to be met in full. While with regard to Requirement 1, service users were found to be appropriately supervised in areas of the home considered temporarily hazardous. However, the inspector did not believe that service users were appropriately supervised at all times, please see the staffing section of this report for details. Communal areas consist of sitting rooms, dining rooms and two designated smoking rooms, and are sufficient in numbers to meet service users needs. The homes garden was generally well maintained, although there were several items of discarded furniture in the garden that must be removed. Bathrooms and toilets were situated around the home. Some of these were found to be dirty, while others did not all include a working lock with an emergency override device fitted. 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 several bedrooms had a strong offensive odour. Bedrooms 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. One service user spoken to informed the inspector that they would like a key to their bedroom. It is required that all bedrooms are fitted with working locks, and that all service users are offered keys to their bedrooms, subject to the completion of a risk assessment, which is to be held on the service users file. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It is the inspectors judgement that at times service users are not provided with appropriate staff support in order to meet all their needs. Further, service users are been put at risk by poor recruitment practices and lack of health and safety training. EVIDENCE: The home provides 24-hour support including an emergency on-call system. There was a staffing rota on display within the home. However, this did not accurately reflect the staffing situation on the day of inspection, for example the rota indicated that the homes manager was not working on the day of inspection, when in fact they were. Further, the rota did not indicate who was in charge of the home at any given time. This must be addressed. Although the inspector was satisfied that the home is staffed in sufficient numbers to meet service users, they have concerns over how staff are deployed in the home, and the level of supervision provided to service users. At one point, the inspector and the homes manager toured the ground floor. Sixteen service users were seen to be in the ground floor lounge, with only one member of staff supporting them. This despite the fact that several had risk assessments indicating that they were at risk of falling, and needed to be monitored closely. In the ground floor dining area there were eleven service users, again supported by only one member of staff. This staff member was Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 17 seen to be merely sitting with the service users, and not attempting any interaction with them whatsoever. The home has policies in place on recruitment and selection and equal opportunities. The inspector checked several staff employment records at random. One was found not to contain employment references, and there were several without a full written records of staff employments history. Further, the home could not evidence that CRB checks had been carried out for all staff. For some staff the home had a copy of the CRB disclosure number, but it is required that CRB checks are retained for inspection, to evidence that they have actually been carried out, and that the home is recruiting staff appropriately. One CRB seen was dated from March 2006, but this did not include a POVA check. It is required that enhanced CRB checks are carried out for all staff, and that these are retained for the purpose of inspection by persons so authorised to do so. Staff undertake structured induction programme on commencing work in the home, this includes the environment and polices and procedures. Records are kept of staff training, recent training has included falls prevention, palliative care, wound dressing and dementia. However, as at the last inspection not all staff have undertaken all necessary statutory health and safety training, and this must be addressed. The inspector was informed that over 50 of the care staff have a relevant nursing or care qualification. Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 18 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): 31,32,35,36,37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The inspector believes that in many ways the management of the home is in need of improvement, for example around supervising staff and health and safety management. EVIDENCE: The homes manager is a registered general nurse, with several years experience of working in a registered care setting. Staff and service informed the inspector that they found the manager to be approachable and accessible. The inspector had concerns over the level of supervision provided to staff. Supervision is provided by various members of the staff team, not all of whom have received training in the supervision of staff, and this is required. Further, for several staff, supervision is very infrequent, for example for two staff there was evidence that they have had just one formal supervision in the past year, Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 19 while the home could not evidence that the deputy manager had received any formal supervision at all in the past year. It is required that all staff receive regular formal supervision at least six times a year. The manager informed the inspector that they were aware that there was a problem with service users monies, in that several service users finances were held on their behalf by the organisation in a pooled account, and that service users did not receive any interest generated by their monies. The manager informed the inspector that the home was trying to address this issue, and this is a repeat requirement. The home holds money on behalf of service users in a locked safe. Since the last inspection all transactions involving service users monies are appropriately recorded. The standard of record keeping in the home was generally poor. Many records were not kept up to date as appropriate, for example care plans, medication records and fridge/freezer temperatures. Records were however stored securely, and staff and service users can access their records as appropriate. Fire extinguishers were situated around the home, however, these were last serviced in August 2005, and it is required that they are serviced at least once every twelve months. Fire alarms were last serviced by an engineer on the 27/1/06, but the home has not tested them since the 3/5/06, and it is required that the home tests and records fire alarms at least weekly. There was evidence of in date Portable Appliance Testing, but the home had not had a gas safety check within the past year, or an electrical installation safety check within the past five years, and both of these issues must be addressed. The home had in date employer’s liability insurance cover in place Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 20 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 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 2 3 2 3 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 2 1 2 1 Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 21 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 30/11/06 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 31/08/06 not met) The registered person must 30/11/06 ensure that all care plans demonstrate how each of the assessed needs of the service users are met, and that care plans are subject to regular review, at least monthly. (Timescale 31/08/06 not met) The registered person must 30/11/06 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 DS0000025960.V312006.R01.S.doc Version 5.2 Ross Wyld Nursing Home Page 22 4. OP18 18 5. OP19 23 6. OP19 23 7. OP9 13 8. OP9 13 9. OP24 16 10. OP35 20 11. OP36 18 in the individual plan of care detailing the reasons why. (Timescale 31/08/06 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 31/08/06 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 31/08/06 not met) The registered person must ensure that all incidents of peeling wallpaper are redecorated. (Timescale 31/08/06 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 31/08/06 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 31/08/06 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 31/08/06 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 31/08/06 not met) The Registered person must ensure that all staff receive formal supervision at least six times a year and that a written DS0000025960.V312006.R01.S.doc 30/11/06 30/11/06 30/11/06 30/09/06 30/09/06 30/11/06 30/11/06 30/11/06 Ross Wyld Nursing Home Version 5.2 Page 23 12. OP21 12 13. OP1 6 14. OP27 18 15. OP9 13 16. OP20 23 17. OP29 19 18. OP30 13 and 18 19. OP3 14 record is maintained which details the nature of the discussion and topics discussed. (Timescale 31/08/06 not met) The registered person must ensure that all bathrooms and toilets have suitable locks fitted with an override device for staff to use in an emergency. (Timescale 31/08/06 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. (Timescale 31/08/06 not met) The registered person must ensure that all service users are provided with appropriate and adequate levels of care from nursing and care staff at all times. (Timescale 31/08/06 not met) The registered person must ensure that all prescribed medications are administered appropriately. (Timescale 31/08/06 not met) The registered person must ensure that all items of discarded furniture are removed from the homes grounds. (Timescale 31/08/06 not met) The registered person must ensure that the home has a full written record of staff’s employment history, including an explanation of any gaps in employment. (Timescale 31/08/06 not met) The registered person must ensure that staff undertake all required statutory health and safety training as appropriate. (Timescale 31/08/06 not met) The registered person must ensure that comprehensive pre DS0000025960.V312006.R01.S.doc 30/11/06 30/11/06 30/09/06 30/09/06 30/11/06 30/11/06 30/11/06 30/09/06 Page 24 Ross Wyld Nursing Home Version 5.2 20. OP4 14 21. OP8 13 22. OP9 13 23. OP9 13 24. OP15 13 25. 26. OP21 OP27 23 17 27. OP29 19 28. OP36 18 admission assessments are carried out on all prospective service users before they move in to the home, covering all areas of potential need. The registered person must be able to demonstrate the homes capacity to meet the assessed needs of service users at all times. The registered person must ensure that comprehensive records are maintained of all medical appointments, including details of any follow up action necessary. The registered person must ensure that any symbols entered on MAR charts are in line with symbols on the MAR chart symbols key code. The registered person must ensure that the home has adequate supplies in place of all prescribed medications. The registered person must ensure that the home checks and records the temperatures of all fridges and freezers used for food storage at least daily. The registered person must ensure that all bathrooms and toilets are kept clean. The registered person must ensure that the homes staffing rota accurately reflects the actual staffing situation, and that it clearly indicates who is in charge of the home at any given time. The registered person must ensure that the home carries out CRB checks for all staff employed at the home. The registered person must ensure that all staff who have responsibility for supervising other staff, undertake DS0000025960.V312006.R01.S.doc 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/11/06 30/11/06 Ross Wyld Nursing Home Version 5.2 Page 25 29. OP37 17 30. OP38 13 and 23 31. OP38 13 and 23 32. OP38 13 and 23 33. OP38 13 and 23 appropriate training in supervision skills. The registered person must ensure that the home maintains all records accurately and up to date in line with the National Minimum Standards and the Care Homes Regulations 2001. The registered person must ensure that the homes fire extinguishers are serviced by an appropriately qualified person at least once every twelve months. The registered person must ensure that fire alarms are tested and recorded at least once a week. The registered person must ensure that the home has an appropriate gas safety check carried out at least once every twelve months. The registered person must ensure that the home has an appropriate electrical installation safety check carried out at least once every five years. 30/11/06 31/10/06 30/09/06 31/10/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ross Wyld Nursing Home DS0000025960.V312006.R01.S.doc Version 5.2 Page 26 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.V312006.R01.S.doc Version 5.2 Page 27 - 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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