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Inspection on 20/04/05 for Rowanweald Nursing Home

Also see our care home review for Rowanweald Nursing Home for more information

This inspection was carried out on 20th April 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

Provision of activities in the home was good. The home has appointed a new activities coordinator. Service users in general were pleased with the endeavours with regard to activities. Service users knew the members of the management team, who they described as approachable.

What has improved since the last inspection?

The provision of activities has improved. The support that management provides for staff in caring for service users has improved. The atmosphere seemed to be more involving with regard to staff and to service users. The management team has been consolidated and seemed strong. The home now is fully staffed and therefore ensures that there is a continuity of care. The home has reviewed the number of staff hours allocated to the laundry and has increase these to ensure a more comprehensive service with regard to the laundering and ironing of service users clothes.

What the care home could do better:

The needs assessment of service users could be improved to make them more comprehensive. There need to be a comprehensive approach to the issues identified in the report which should be addressed in a holistic manner as theyall contribute to ensure that the needs of the service users are being met. The management must consider systems that would prevent issues raised in the report from happening again, to ensure that lessons have been learnt and to demonstrate their commitment to the improvement of the service. There is ample space to improve the provision of meals in the home. This is an area, which continue to be an area of dissatisfaction for service users in the home. The cleanliness of the home could be improved further. More attention should be given to cleanliness with regular audits being undertaken using a checklist with records being kept. The bedrooms of residents should also be kept tidy. While there has been some redecoration of corridors and of some bedrooms, the inspector noted that a number of bedrooms were of a poor standard of redecoration. Redecoration of the bedrooms of service users must therefore be given more priority. Issues identified during this inspection with regard to medicines must be addressed and there must be a strong audit system to ensure that the issues identified and addressed, do not repeat again. More training could be provided to care staff to raise their knowledge and understanding of wound care and of pressure area care to ensure that service users always receive the appropriate care.

CARE HOMES FOR OLDER PEOPLE Rowanweald Nursing Home 1 Weald Lane Harrow Weald Middlesex HA3 5EG Lead Inspector Ram Sooriah Unannounced 20 April 2005 10:30 hrs 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 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. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rowanweald Nursing Home Address 1 Weald Lane, Harrow Weald, Middlesex, HA3 5EG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8424 8811 020 8424 8585 paulw@sanctuary-housing.co.uk Sanctuary Housing Association (Trading as Sanctuary Care) MR Hakim Issop CRH N Care Home with nursing 45 Category(ies) of OP Older People registration, with number of places Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22nd June 2004 Brief Description of the Service: Rowanweald Care Home is part of Sanctuary Care, a subsidiary of Sanctuary Housing Association. Rowanweald was opened in November 1998 and is found in Harrow Weald. The high street is located on one side of the home and as such the home is easily accessible by public transport and by car. It is also close to local shops and amenities. The home has a large car park in the front and a small garden area with shrubs. There is also an enclosed garden with a patio, sitting areas, a lawn, shrubs and flowers. The home is purpose built and has 75 single rooms with en-suite facility. Accommodation can be found on three floors. The first floor, which has 30 beds, is leased to Harrow PCT. Rowanweald as registered with the CSCI, consists of the ground floor and the second floor and has forty-five beds. It provides accommodation for elderly service users requiring nursing care. There are two units on the ground floor, Pelena and Rheola each with fifteen service users. The Arden unit is found on the second floor and has fifteen beds. There were 44 service users in the home at the time of the inspection. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a Wednesday and started at 1030. It lasted for about seven hours. During the course of the inspection the inspector spoke to service users, visitors to the home, the deputy manager and some members of staff. He toured the building, looked at a number of records and observed care practices. He also checked for compliance with previous requirements. The home now has a registered manager. He was on leave at the time of the inspection, but the inspector was able to have a discussion with the deputy manager. Although the discussion was fruitful, it was however not possible to have answers to all the questions and to sight all the documents such as the training and development plan. Other records requested at the time of the inspection were sent to the inspector. What the service does well: What has improved since the last inspection? What they could do better: The needs assessment of service users could be improved to make them more comprehensive. There need to be a comprehensive approach to the issues identified in the report which should be addressed in a holistic manner as they Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 6 all contribute to ensure that the needs of the service users are being met. The management must consider systems that would prevent issues raised in the report from happening again, to ensure that lessons have been learnt and to demonstrate their commitment to the improvement of the service. There is ample space to improve the provision of meals in the home. This is an area, which continue to be an area of dissatisfaction for service users in the home. The cleanliness of the home could be improved further. More attention should be given to cleanliness with regular audits being undertaken using a checklist with records being kept. The bedrooms of residents should also be kept tidy. While there has been some redecoration of corridors and of some bedrooms, the inspector noted that a number of bedrooms were of a poor standard of redecoration. Redecoration of the bedrooms of service users must therefore be given more priority. Issues identified during this inspection with regard to medicines must be addressed and there must be a strong audit system to ensure that the issues identified and addressed, do not repeat again. More training could be provided to care staff to raise their knowledge and understanding of wound care and of pressure area care to ensure that service users always receive the appropriate care. 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. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 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 standard(s) 3 and 4 The needs of service uses were not always assessed comprehensively. The home did not demonstrate convincingly its capacity to meet the needs of service users The home does not provide intermediate care. EVIDENCE: The inspector looked at the care plans for four service users. One of the service users has recently been admitted to the home. The inspector noted that the latter has had a comprehensive pre-admission assessment by a member of staff from the management team before admission to the home. Once service users are admitted to the home they have an assessment of their needs to enable care planning. The content and comprehensiveness of the needs assessments were variable from unit to unit. On the Arden unit they were quite comprehensive, but not on the Pelena unit. The different sections such as on ‘eating and drinking, communication, personal cleansing’ were not comprehensive and two sections of the assessment were not completed for one of the service users. The inspector identified this issue during the last Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 9 inspection and had imposed a requirement that staff receive training in care planning. The deputy manager stated that training was more in-house. However from the evidence it was clear that more work has to be done to ensure that all service users have a comprehensive assessment of their needs, failure of which could lead to staff being unaware of the needs of service users. Service users in general appeared well cared for. Service users and visitors spoken to by the inspector were pleased with the care that the service users were receiving in the home. The inspector noted that the home has a range of pressure-relief equipment and that service users were seen by a number of healthcare professionals although records were not always available to show whether service users were seen by the dentist and the optician. The understanding of staff about pressure sores was lacking and in one case staff were not clear if the actual wound on the leg of a service user was a pressure sores or a leg ulcer and if another on the sacral area was also a pressure sore or just a type of excoriation of the skin due to incontinence. There was also a lack of understanding about the grading system for pressure sores. In the case of a service user who was vegetarian, the inspector was not clear about the suitability of the meal that was offered to her. The inspector also has concerns about the level of cleanliness and state of decoration of the home. He therefore concluded that in general the home did not convincingly demonstrate its capacity to meet the how the assessed needs of service users were being met. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 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 standard(s) 7-11 Little progress has been made on improving arrangements to ensure that the healthcare needs of service users were being met. These shortfalls have a potential to place service users at risk. EVIDENCE: A number of service users were on antibiotics for chest infections. They did not have care plans in place to address these new problems. The care plan for a service user who was doubly incontinent did not clarify how her needs were being met and the care plan had not been updated with his/her changing needs. There was a section in some care plans where service users/representatives have been involved in risk assessments and in providing consents for example for photographs. There was however not much evidence that the care plan was drawn and reviewed with the service user and /or representative. Of the four care plans inspected one was last reviewed in February and had not been reviewed monthly. It was also noted that when the care plans were reviewed that the changing needs of service users are documented and addressed. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 11 The home had a range of equipment for the pressure area care of service users. One of them was bleeping, as the connecting air tube was broken. Although the bleep was present when the inspector visited, it was him who noted the problem. The records kept about the pressure sores of a service user were not clear to show whether the wounds were actual pressure sores or leg ulcers or caused by other factors. A member of staff was not clear about grading of pressure sores. Photographs about pressure sores or wound mapping were also not available for inspection. A service user with sacral pressure sores was sitting out in a chair and the care plan did not address the time that this person should be sitting out. The National Institute for Clinical Excellence recommends that the time that service users with pressure sores sit out, should not exceed two hours even with appropriate pressure relief (NICE (Oct, 2003). Pressure ulcer prevention. Pg 8, 1.2.2.4. www.nice.org.uk ). The registered person must therefore ensure that all trained nurses have training in wound care and that all care staff have training in pressure area care. There was evidence that service users were seen by healthcare professionals such as the GP, chiropodist, nurse assessor for Registered Nursing Care Contribution and the dietician. Records however for at least two service users did not show whether they were seen annually by the dentist and the optician. The inspector on the day noted that the optician was in the home. A service user with a recent weight loss and changing needs had also not been referred to the dietician although he had in the past been seen by the dietician. The inspector looked at medicines management and administration on all three units. He noted that the home had a homely remedy policy which was signed by the GP but the policy was not available on all the units. Medicines administration records sheets (MARS) were not always signed when the medicines were administered. In some case of non-administration a code was sometimes used, but the code was not always described. In cases where one or two tablets were prescribed, there were not always records to show the actual amount administered. Records of receipts of medicines in the home were not always kept. The home also uses labels on the MARS, however labels are sticky and there have been cases when labels have come off. This is not desirable, as the medicines records have to be kept for a number of years. It is therefore recommended that the home request for pre-printed MARS, or that the GP make an entry and signed the MARS or that two nurses make an entry on the MARS after checking the prescription carefully and both signing their names and ensuring that a copy of the prescription is kept. The inspector noted that the GP had visited service users during the course of the previous day around lunchtime. Some antibiotics were prescribed and these were only started on the day of the inspection in the morning. In cases of medicines, which are paramount for the health of service users (such as antibiotics) the registered person must ensure that these medicines are administered to service users as soon as possible. It is also recommended that Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 12 medicines are administered at the correct interval of time where possible, to ensure that the serum level of the medicine remains within the therapeutic range of the medicine. There were no records that a service user who was on anti-convulsants, have had blood tests to check the serum level of the medicines. The inspector observed that staff related appropriately to service users and that personal care was provided in private. The inspector noted that a healthcare professional visited service users on the day and that service users did not always go their bedrooms to be examined. The home had a pay phone and there were facilities in the bedrooms where service users could have a phone and were charged a rate according to the length of the calls they make. Care plans had sections for information about the death and funeral arrangements for service users. Where this was completed, information was restricted to the name of the funeral directors and type of funeral. There was also a section in the assessment of needs about the ‘Personal feelings for the future’. These were also not always completed and thus an opportunity was missed with regard to providing information about the aspirations and about the way service users see the future, and about their wishes and instructions with regard to death taking into consideration their ethnic, religious and cultural background. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 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 standard(s) 12 and15 The range of activities provides stimulation and interest for people living in the home. Meals were not always provided in sufficient amount and were not appealing enough for service users. EVIDENCE: There was a section in the care plan called ‘getting to know you’ which provided details about the social and recreational needs of service users. This was positive. Care plans were also seen to be in place about social activities. The home has appointed a new activities coordinator since the last inspection. The inspector observed positive interaction between service users and the activities coordinator. While service users were aware of the range of activities that have been arranged in the home as they frequently attended the sessions, there was no programme of activities on the Rheola unit. It is recommended that there is a weekly programme of activities on each unit to provide information to service users and visitors to the home. They all were pleased with activities provided in the home. The inspector was also informed by the activities coordinator and service users that the service users wanted to go for outings in summer and that the activities coordinator was looking at the possibility of arranging the outings. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 14 Service users have the opportunity to watch TV or to listen to music at other times. The inspector noted that the TV aerial on the Arden unit needed to be adjusted to give an appropriate picture on the TV. The home has an intercom system in place to manage the opening of the door outside office hours. During office hours the receptionist and the administrator are responsible for opening the door. The inspector observed a number of visitors to the home, some saw service users in the bedrooms of the service users while others went to the lounge. The inspector noted that menu choices were being completed. In one case however the menu choices did not go to the kitchen and the inspector was therefore not clear how the choices of service users with regard to meals were being respected. He observed that service users were able to bring their personal possession into the home to make their bedrooms homely and familiar. The inspector had the opportunity to observe the lunch being served on the Arden unit. There were sausages, beans and carrots, mash potatoes and sponge and custard for desert (should have been carrot cake). There was Cod for the second choice. While the inspector is very aware that service users do not eat much, he noted that the portions were nevertheless small. Most service users received one sausage with gravy. The registered person must ensure that staff who dish out meals are aware of the appropriate portions to serve to service users and of the presentation of the meals. The home has a four weekly menu cycle, which in general seemed appropriate. It does however require some revision particularly in areas where there is a repeat of meals such as on Saturday and Sunday of week 4 where turkey is on the menu on both days. The inspector received a number of comments about the meals: ‘mashed potatoes is made with water and not milk’; ‘carrots and beans hard’; ‘we do not always get the omelette if we do not want any of the options on the menus’; ‘there is a repetition in meals’. The home also has comments books about the meals on all the floors. The inspector was informed by the deputy manager that the menu has been reviewed recently according to choices of service users/representatives when they were offered the opportunity to contribute to the menu in the relatives meetings. However not a lot of service users/representatives chose that opportunity to contribute to the menus. The inspector noted that the provision of meals is an area, which has not been resolved to the satisfaction of service users in the home and which needs a lot of input to ensure its resolution. The registered person must ensure that service users receive a varied, appealing, wholesome and nutritious diet which is suited to individual assessed and recorded requirements. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 15 The trained nurse was administering the medicines during lunch times. It has been suggested that the meals of service users should not be disturbed by any other activities other than eating and drinking and that the trained nurse supervise and monitor the intake of food and drinks. On the day of the inspection the home had a chef who was covering for the annual leave of the usual chef. Records about fridge and freezer’s temperature and about the meals cooked in the home were not available for inspection. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Some members of staff would not be able to deal with allegations and suspicions of abuse in an appropriate manner and within an inter-agency context for the protection of service users. EVIDENCE: The home has a complaint procedure and in the past has dealt with complaints in an appropriate manner. Since the inspection in June 2004, the home has not received any complaints about the service. A copy of the complaint procedure was available in the foyer of the home. The home has an appropriate abuse procedure which reflects the inter-agency policies and procedures for the protection of vulnerable adults (PoVA). One member of staff spoken to about abuse was not clear about what to do in cases of allegations or suspicions of abuse in relation to PoVA. Care staff must have training on abuse and about the correct procedure to follow in cases of allegations and of suspicions of abuse. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 17 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 standard(s) 19, 23, 24,25 and 26 Although some improvements to the décor have been made, the home was beginning to show the effect of wear and tear. The environment was not always well maintained particularly bedrooms. They could have been better decorated for service users. The bedrooms were not always kept clean and some were not tidy. EVIDENCE: The grounds were being attended to on the day of the inspection and were relatively tidy for the time of the year. The inspector noted that carpets have been changed in the corridors and that both staircases and some bedrooms have been redecorated. The home however did not have a plan for the redecoration and for the replacement of fittings and fixtures, available for inspections. This is important, as the home needs a cycle of continuous input with regard to redecoration and replacement without which, the home’s environment would deteriorate and would cease to be appropriate for service users. There were however records of rooms and areas that have been redecorated since the last inspection. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 18 The above is also evidenced by the fact that a number of bedrooms have not been redecorated since the home opened. Some of the walls in some of the bedrooms were noted to be slightly damaged and some had marks on them. The registered person must ensure that bedrooms that have not yet been redecorated are all redecorated to ensure a high quality environment for service users. Bedrooms of service users contained a bed, wardrobe, chest of drawers, bed locker and a bed table. The inspector was shown new furniture that has been ordered to replace old and damaged furniture. The bedrooms were personalised in most cases and the layout of the rooms was also appropriate. The inspector observed a call bell away from its socket and on the floor. Normally when the bell is removed it will ring and need to be cancelled. All bedrooms must have functioning call bells unless there has been a risk assessment. At least one of the bedrooms contained clothes on the chair and a number of beds did not seem to have been made appropriately. Clothes in the cupboard were also not always put away tidily in the drawers or in the wardrobes. Some items of clothing including woollen items were noted to have been put crumpled in the wardrobe. It looked like some of these items may have been washed inappropriately. The inspector noted that there was dust on skirting boards and on items of furniture in most bedrooms but the frames of the beds were worst. They were all covered with a coat of dust. There were bedpans on the floors of en-suite bathrooms, although the inspector noted that there has been an attempt to tidy the bathrooms by putting shelves in them. There were dead flowers in one of the bedrooms. The big lounge/dining areas were clean and appropriate for the needs of the service users. Fire doors were generally kept closed, but some were wedged open and others did not close properly after the closing mechanism has acted. The bedrooms doors did not have a self-closing mechanism and it is recommended that the home consider having this option on all bedrooms doors. The laundry was kept clean and tidy. Bedrooms of service users were however not that tidy and should have been in a cleaner condition. The inspector noted that there was an unpleasant smell in two of the bedrooms that were visited at random. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The deployment and number of staff particularly in the mornings is not always sufficient to meet the needs of service users. EVIDENCE: The home had a trained nurse on each of the three units. There were also two carers on each unit during the day except for the Rheola unit, which had three carers in the morning. There was one student nurse from the Thames Valley University on placement on one of the units. The numbers were roughly the same as the numbers, which were laid down in the staffing notice that existed with the previous regulatory authority. However staff on the units where there were three members of staff in the morning mentioned that the mornings are difficult and that they are very busy trying to get everyone up and dressed and serving breakfast to all the service users. Some commented that the student nurses are a valuable help to them. As a result the registered person must review staffing on those units where there are three members of staff, particularly in the morning. The inspector was informed that the home has recruited a number of nurses and that most of the posts were occupied. The inspector looked at the personnel records of a member of staff sampled at random. There was evidence, that checks have been carried out including a recent CRB check. The training and development plan was not available during the inspection and the inspector was unable to check the level of training in the home. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The management team understands the needs of the service users and the management style is open and inclusive. EVIDENCE: The registered manager was on annual leave at the time of the inspection and the deputy manager was in charge of the home. The registered manager has been appointed since July 2004 and has managed care homes previously. Service users spoken to were aware of the management team and confirmed that the managers go round the home to meet the service users. The home has been relatively stable with regard to complaints, issues of abuse and concerns since the management team has been appointed. There were supervision notes to show that supervision has taken place. The inspector was informed that the management tries to hold supervision with all care staff every two months. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 21 The home did not have an appropriate lancing device to obtain a drop of blood for blood sugar monitoring. There were two pen devices with the bottom bits missing and there was sharing of glucometers some of which were for individual uses. The glucometers have also not been recalibrated recently and there were no standard solutions for the calibration of the meters. For more advice see Medical Device Alert dated 9th September 2004 (www.mhra.gov.uk ). The registered person must ensure that the home has the appropriate lancing device and equipment for glucose monitoring. The inspector noted that the connecting air tube of a pump for one air pressure cushion was broken and was therefore alarming. Staff did not seem to have noted the alarm until the inspector went to have a look at the pump. The registered person must draw staff’s attention to the general issues with regard to equipment in use in the home (such as pressure relief equipment) for the welfare of service users and must report any malfunctioning equipment to ensure that swift action can be taken to remedy the situation. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x 3 2 2 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x 3 x 2 Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14(1,2) Requirement All service users must have a comprehensive assessment of their needs. (Repeated requirement). The registered person must ensure that issues identified in this report are addressed to demonstrate the capacity of the home to meet the assessed needs of the service users. The service users plan must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service users are met. The registered person must ensure that service users and/or their representatives are involved in drawing and in reviewing care plans and risk assessments . (Repeated requirement). Care plans must be reviewed at least monthly or more often if the needs of service users change. The registered person must ensure that all trained nurses have training in wound care and Timescale for action 30/6/5 2. OP4 14 31/8/5 3. OP7 15(1,2) 30/6/5 4. OP7 15(1,2) 31/7/5 5. OP7 14(2) 30/6/5 6. OP8 18(1)(c) 31/7/5 Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 24 7. OP8 17(1)(a), schedule 3,3(n) 13(1)(b) 8. OP8 9. OP9 13(2) that all care staff have training in pressure area care. The registered person must 30/6/5 ensure that appropriate records are kept about pressure sores including photographs or wound mapping. The registered person must 31/7/5 ensure that service users are seen by the optician and the dentist at least once annually with records being kept. Service users must also be referred to the appropriate healthcare specialist as and when their needs change. (Repeated requirement). Medicines administration records 30/6/5 sheets (MARS) must be signed when the medicines are administered. In cases where a code is used, then the code must be described. (Repeated requirement). In cases where one or two tablets are prescribed, records must show the actual amount administered. (Repeated requirement). The registered person must review staffing on those units where there are three members of staff, particularly in the morning. In cases of medicines, which are paramount for the health of service users (such as antibiotics) the registered person must ensure that these medicines are administered to service users as soon as possible. The registered person must ensure that service users who are on anti-convulsants medicines have blood tests to check the serum levels of these 30/6/5 10. OP9 13(2) 11. OP27 18(1) 30/6/5 12. OP9 13(2) 30/6/5 13. OP9 13(2) 30/6/5 Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 25 medicines. 14. OP11 15 Care records must provide information about the aspirations, about the way service users see the future, and about their wishes and instructions with regard to death taking into consideration their ethnic, religious and cultural background. (Repeated requirement). The registered person must ensure that service users receive a varied, appealing, wholesome and nutritious diet which is suited to individual assessed and recorded requirements. He should also review the menu particularly when the same ingredient repeats itself after a short interval of time. (Repeated requirement). Records about fridges and freezers temperature and about the meals cooked in the home must be available for inspection. Care staff must have training on abuse and about the correct procedure to follow in cases of allegations and of suspected abuse. The home must have a plan for the redecoration of the home and for the replacement of fixtures and fittings. A copy must be sent to the Commission. (Repeated requirement). The registered person must ensure that all the bedrooms are decorated appropriately to provide a high quality environment for the accommodation of service users. The registered person must ensure that the clothes of service users are put in the drawers and wardrobes in a tidy manner. 30/6/5 15. OP15 16(2)(i) 30/6/5 16. OP15 13(4) 30/6/5 17. OP18 13(5) 31/7/5 18. OP19 23(2)(b) 30/6/5 19. OP24 23(2)(d) 31/8/5 20. OP24 16(2)(e) 30/6/5 Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 26 21. OP25 23(4) 22. OP26 23(2)(d), 16(2)(k) 23. OP38 13(4) 24. OP38 13(4) All fire doors must be kept shut and must not be wedged open. The registered person must ensure that all fire doors with a self-closing mechanism close properly. He must also consider fitting self-closing mechanism to all the bedrooms doors. The registered person must ensure that all areas of the home, including bedrooms are kept to a high standard of cleanliness. Bedpans must not be stored on the floor in the ensuites.Bedrooms must also be free of foul odours. The registered person must ensure that the home has the appropriate lancing devices and equipments for glucose monitoring. Staff’s attention must be drawn to the general issues with regard to equipment in use in the home (such as pressure relief equipment) for the welfare of service users and must report any malfunctioning equipment to ensure that swift action can be taken to remedy the situation. 30/6/5 30/6/5 30/6/5 30/6/5 25. 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 Instead of using sticky labels from the chemist which can come off, it is recommended that the home request for pre-printed MARS, or that the GP make an entry and signed the MARS or that two nurses make an entry on the MARS after checking the prescription carefully and both signing their names and ensuring that a copy of the prescription is kept. G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 27 Rowanweald Nursing Home 2. OP9 3. 4. OP10 OP12 5. 6. OP15 OP24 It is recommended that medicines are administered at the correct interval of time where possible, to ensure that the serum level of the medicine remains within the therapeutic range of the medicine It is recommended that service users are seen in their bedrooms by visiting healthcare professionals. It is recommended that there is a weekly programme of activities on each unit to provide information to service users and visitors to the home. The TV aerial on the Arden unit should be adjusted to give appropriate pictures on the TV. The trained nurse should not administer medicines during meal times and should supervise and monitor the intake of food and drinks, unless it is absolutely necessary. The registered person should ensure that bedrooms are kept tidy during the course of the day when service users are not in the rooms, including ensuring that beds are made up appropriately. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V222916 200405 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH 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. 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