Inspection on 06/07/06 for Rowanweald Nursing Home

This inspection was carried out on 6th July 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.

Other inspections for this house

Rowanweald Nursing Home 11/08/09

Rowanweald Nursing Home 09/10/07

Rowanweald Nursing Home 09/09/05

Rowanweald Nursing Home 20/04/05

Rowanweald Nursing Home 22/06/04

Rowanweald Nursing Home 19/05/04

Rowanweald Nursing Home 13/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Rowanweald Nursing Home 1 Weald Lane Harrow Weald Middx HA3 5EG Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 6th July 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 Rowanweald Nursing Home DS0000022941.V303042.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. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowanweald Nursing Home Address 1 Weald Lane Harrow Weald Middx HA3 5EG 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) 020 8424 8811 020 8424 8585 Sanctuary Housing Association (trading as Sanctuary Care) Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum staffing notice applies Date of last inspection 9th September 2005 Brief Description of the Service: Rowanweald Care Home is a part of Sanctuary Care, a subsidiary of Sanctuary Housing Association. The home was first registered in 1998 for 45 elderly frail residents requiring nursing. It is located in Harrow Weald. The back of the home faces the High Street and entrance to the home is through Weald Lane, a small road off High Street. The home is easily accessible by public transport and by car. It is close to some shops and local amenities. More extensive shopping can be found in Harrow Weald. There is a large car park in the front of the home for more than ten cars. There are maintained garden areas in the front, the side and the back of the home. The building is three-storey high and was purpose built to be a care home. Rowanweald as registered with the Commission for Social care Inspection consists of forty-five single rooms with en-suite facilities (toilet and wash basin). There are three units of fifteen residents each. Pelena and Rheola units are found on the ground floor and the Arden unit is found on the second floor. The first floor of the building, which has two units of fifteen beds each, is leased to Harrow PCT. The home has all the necessary support facilities such as laundry, kitchen and maintenance. It is run by Sandy Vigor, the manager and Denise Cooper the deputy manager with support from the Head Office of Sanctuary Care, including Denise Cooper, the regional manager. The range of fees that the home charges is: • • Private residents: (Low) £675, (Medium) £695 , (High) £745 depending on nursing needs assessment. Social Services: (Low) £595, (Medium) £615 , (High) £665 - depending on nursing needs assessment At the time of the inspection there were 39 residents in the home. Rowanweald Nursing Home DS0000022941.V303042.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 a Thursday 6th July from 09:50 to 16:50 and on Friday 7th July from 10:00 to 13:45. During the course of the inspection, the inspector was able to tour some of the premises, observe care practices where possible, look at a sample of care, personnel and health and safety records in the home, talk to some residents, visitors and members of staff. He was also able to talk to Denise Cooper the regional manager, Sandy Vigor, the home manager and Denise Tolland, the deputy manager. He would like to thank all the residents and visitors who have spoken to him. He is also grateful to manager and all her staff for their support and assistance during the inspection. What the service does well: The service users’ guide has been updated with all the relevant information and is provided to prospective residents and their relatives. The home has a dedicated group of staff (including management, nursing and support staff) who are willing to improve the service that the home provides. Residents who are admitted to the home can be confident that their needs will be met. Staff are aware of the healthcare needs of residents although on some occasions it was noted that this was not put in writing. Residents are offered the opportunity to make decisions and choices about aspects of their life such as about their meals, time to get up and about how they want to spend the day. The management of medicines at the time of the inspection was in the main good with a few issues identified. The provision of activities in the home is of a very good standard. Residents were pleased with the social and leisure activities in the home. The home has a full time manager and deputy manager. Nurses and carers feel supported in their daily work and involved in running the home. The management of the personal monies of residents is good. Health and safety issues are managed appropriately in the home. All the maintenance certificates were up to date and there was evidence of regular Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 6 checks being made for example on the fire detection system, emergency lights system and water temperatures. What has improved since the last inspection? What they could do better: The needs assessments of all residents must be more comprehensive and must be reviewed as and when the needs of the residents change. There must be care plans for residents’ needs which have been identified and the care plans must be comprehensive and address all the actions that need to be taken to meet the needs of the residents. Records must be comprehensively kept to demonstrate that the healthcare needs of residents are being met. Residents who are epileptic must have care plans in place to address these needs and there must be record with regard to blood tests being carried out for the monitoring of serum levels of anticonvulsant medicines. Care plans must also be in place for any new needs/problems that have been identified. The registered person must review the lancing devices in use in the home for the blood sugar testing for diabetic residents. Control solutions must be available to calibrate the glucometers. Records about the wishes and instructions of residents and/or their representatives with regard to end of life care and death must be recorded where possible to ensure that when the time comes staff are aware of what need to be done. A record must be made if attempts to receive this information have failed. The practice about getting residents up and dressed in the morning must be reviewed to ensure that that this does not take priority over the need for residents to have breakfast at a reasonable time and according to their choices. All food cooked in the home must be recorded to enable any person looking at the records determine whether the diet is satisfactory in relation to Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 7 nutrition and otherwise, and of any special diets prepared for individual service users. While there was some evidence of redecoration in the home, some areas of the home were starting to look old and dated. There was a programme of redecoration and refurbishment which has been drawn up by the manager which seemed to address key areas in the home. It was not clear if the programme also addressed the communal areas. The home should ensure strict compliance with this programme of refurbishment and redecoration as without this the home may fail to continue providing a high quality environment for residents. Some areas were noted where the standard of cleanliness could improve. This included the carpet in some areas and areas under the beds. A number of residents had a particular infection. Antimicrobial solutions and/or alcoholic handrub must be available in the bedrooms of residents who have a particular infection according to a risk assessment. Residents and their visitors must be involved in the prevention of cross-infection where possible. The recruitment procedures for staff must be tightened to ensure that all staff have appropriate references prior to employment. Whilst staff have regular training, the home must now ensure that 50 of its care staff are trained to NVQ level 2 as soon as possible. A few issues were noted where the safety of residents could be compromised. These were: • The restrainers on two windows in the lounge of the Arden Unit were easily disabled • A few items of food were noted not to have a date of opening and the names of the owners • The doors to the sluices were left ajar 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 DS0000022941.V303042.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ guide and the statement of purpose are kept updated and are offered to enquirers and prospective residents and their relatives prior to the residents moving into the home. The needs of the prospective residents are assessed to ensure that the home will be able to meet their needs. Once admitted to the home the assessments of needs in a few cases were not fully completed and as a result there is a possibility that in these few cases the needs of residents might not always be met. The home is able to meet the needs of the residents who are admitted to the home. EVIDENCE: Copies of the service users’ guide were seen in the bedrooms of residents. These have been recently up dated and have taken into consideration the changes with regard to the management of the home. A resident said that he would refer to it if he requires more information. The statement of purpose has Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 10 also been similarly updated and made available to residents and other stakeholders. The inspector looked at the care records of six residents. He noted that preadmission assessments were on file and that these were on the whole appropriately completed. The pre-admission assessments of prospective residents are carried out by the manager or by her deputy. The manager stated that all residents have a pre-admission assessment prior to them being offered a place in the home. The needs assessments of the funding authorities were also available on the files of a number of residents. Once residents were admitted to the home there was a more thorough assessment of their needs for care plan purposes. It was noted that there has been a lot of input from the deputy manager as the clinical lead in the home and from the organisation to improve these as well as the care plans. Most of the assessments were completed to a good standard, and appropriately identified the needs of the residents. A few of them unfortunately lacked basic information in a few areas. For example the likes dislikes of residents with regard to food, the time for residents to get up and to go to bed were not always identified and some sections of the assessment were left unfilled. One resident did not have his needs’ assessment reviewed after his needs changed following a hospital admission and another resident’s assessment was not also updated when his mobility improved and he was no longer using an aid for mobilising. One resident had the front page of the assessment format completed and the other pages were not completed. There are two carers and one trained nurse on each unit during the day with an additional carer who is a ‘floater’ and goes to the unit where she is most required. Conversation with nursing staff and care staff showed that they were familiar with the needs of the residents who are admitted to the home. The home had a few residents from ethnic minorities. The staff team was representative of the ethnic minorities to a certain degree and therefore staff were mostly aware of the needs of these residents. Although the meals in the home catered mostly for the majority British origin residents, there were a few meals which would cater for the needs of residents from ethnic minorities. The relatives of these residents were encouraged to bring meals which staff would then give to the residents as appropriate. One resident confirmed that she at times gets meals according to her ethnic background and that her relatives also bring food for her. It is therefore possible to conclude that the home is able to meet the needs of the residents who are admitted to the home. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 11 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): 7-11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The content of care plans has improved but a few areas were noted where more improvement could be achieved. Without this there is a danger that all the needs of residents would not be addressed. Records were not comprehensive enough to demonstrate that the healthcare needs of residents were being consistently met at all times. Medicines management in the home was in the main good with very few issues identified which could put residents at risk. Records with regard to managing the end of life care and the death of residents were not always comprehensive enough, to suggest that these needs would be met when the time comes. EVIDENCE: As stated previously six care plans were inspected. The standard of care plans has also improved. These were more detailed and there was evidence that these were reviewed at least monthly. The standard of care plans varied from units to units. Some were very good and some not so good. A few areas were identified where improvement was required. For example care plans needed to be more specific and more detailed in some cases. In one case the care plan Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 12 for a resident with diabetes did not clarify the signs and symptoms of hypoglycaemia and hyperglycaemia and the action to take if these conditions should occur. It mentioned that a particular medication should be given but that medication was not in stock. Another resident with a history of fits did not have a care plan addressing this. A resident who was losing weight did not have a care plan addressing the weight lost although there was evidence that the resident was seen by the GP. A resident who had an infection and who was on antibiotics had a care plan addressing this need but the plan did not contain actions with regard to monitoring the vital signs of the resident. The care plans for the mobility of residents although addressing how residents should be moved from bed to chair, did not always address how residents were to be turned or moved in the bed. A range of risk assessments was in use and there was evidence that these have been agreed with the residents or the next of kin. In cases where residents have been identified at risk, care plans with appropriate action plans were in place addressing these risks. The home uses a form to record that residents or that their relatives have agreed to their care plans and that they are being involved in this process. These were completed in most care plans. The home has also sent letters to relatives and next of kin of residents for the review of care plans. A new format has been introduced to record the review of care plans. One visitor confirmed that she has seen the care plan of the resident she visits. One resident mentioned that he had not been involved in the care planning process but the care plan showed that his next of kin had been consulted about the care plan. It was not immediately clear why the resident himself was not involved at least to some extent in the care planning process. The home has indeed achieved progress in this area and the efforts that staff have made for this to happen are commended. Residents presented as appropriately dressed, groomed and shaved. All residents received personal care in their bedrooms or in the bathrooms and the inspector observed that residents were addressed appropriately by members of staff. Residents were registered with a GP. Records showed that residents were regularly seen by the GP, tissue viability nurse, nurses from the local PCT and other healthcare professionals to address their needs. The waterlow score was used to assess residents with pressure sores. Three residents had pressure sores and all were in the process of healing. All residents who had pressure sore or who have been identified at risk were on pressure relief equipment. Photographs and wound mapping were in use to monitor pressure sores. Care plans addressed the dressing to use and the Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 13 frequency to change the dressing. They did not always clarify the type of pressure relieving equipment in use and the arrangement for seating and for turning the resident in bed. The wound progress notes were also not being completed for all residents. The manager was aware that there was no format for the record of wound progress and she showed the inspector a format that she has devised to record wound progress when wound dressings are being renewed. Residents were assessed for incontinence when admitted to the home by the PCT continence nurse, but the home did not have an incontinence assessment format to be used by staff. Although care plans were in place in this area of care, the care plans did not always identify the frequency to change the pads of residents or the frequency to toilet residents and the type of incontinence products in use for the individual resident. Medicines management in the home was on the whole good. Each unit had a clinical room which was air-conditioned. Temperatures of the medicines’ fridge were recorded and were appropriate. There was a system of in-house audits to monitor the management of medicines. Most medicines charts were signed appropriately and the amounts of medicines received in the home or disposed of were recorded. The knowledge of nurses with regard to the medicines that they administer was on the whole adequate. It was noted that the location for the administration of some creams and other topical medicines were not always described which meant that a new nurse might not know where to apply these medicines. Staff were using a lancing device for the testing of blood sugar which was one that is used for self-testing and not one for professional use. The glucometers were for professional use but there were no control solutions for checking the calibration of these. The medicines and care records of two residents who were on anti-convulsant medicines were checked with regard to blood tests being carried out to monitor the serum levels of the anti-convulsant medicines. It was not clear when residents were having the blood tests to monitor these levels. There were section in care records addressing the end of life care of residents and the wishes of residents/representatives with regard to funeral arrangements. These sections were completed to varying degree, some were very well completed and some not so well. It was therefore not always clear what residents/representatives’ wishes and instructions were with regard to end of life care and management of death in consideration of the cultural and ethnic backgrounds of the residents. The Commission is informed of all deaths in the home as per regulations 37 of the Care Homes Regulations 2001. Monitoring of information provided suggests that the deaths of residents are appropriately managed by the home. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 14 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service A range of social and leisure activities is arranged for residents, where the relatives/friends of residents also have the opportunity to take part in. Meals are provided to suit the needs of the residents, but the time for the serving of breakfast, the provision of fresh fruits, and adaptations to promote the independence of residents must be reviewed. EVIDENCE: The home has a full time activities coordinator. A programme of organised activities was in place on the units. Feedback from residents and visitors about the activities provided by the home and the input of the activities coordinator was positive. Residents looked forward to being involved in activities and to take part. Care records contained a section ‘Getting to know me’ which described the life story and the background of the resident. Care plans addressing the social and recreational needs of residents were then put in place. Outings for residents consisted of taking a few residents outside the home in the local community in wheelchairs. The activities coordinator mentioned the lack of interest of residents with regard to taking part in outings. Residents are encouraged to sit outside in the enclosed garden but apparently few residents Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 15 are interested in doing that also. A garden party was being arranged for the 15th July. The inspector was informed that representatives from the local churches visit regularly to see residents. The Church of England representative and the Roman Catholic representative both visit every two weeks. The home has an open visiting policy and a number of visitors were observed in the home. They were able to meet the residents in the communal areas or in the bedrooms of the residents. The home does not have any volunteers. Relatives of residents and residents themselves are involved in running their personal affairs. The home does not collect the benefits of any residents. A number of bedrooms were seen where residents and/or their relatives had brought in some of the personal effects of the residents. This made the room homely and personalised. The inspector was informed that while previously hotel services in the home were contracted out, including the catering and housekeeping, these have now been brought in house and the home has appointed its own staff for catering. The manager stated that as a result the home has better control about the service. A new four weekly menu has been produced by the chef for a trial period, which would then be reviewed as required. The lunch on the day of the inspection consisted of sausages and mash potatoes, green beans and sweet corn. The second choice consisted of a vegetarian dish and rice. Desert consisted of spotted dick and custard or ice cream. There was a choice of a hot meal for supper or sandwiches. As a result the inspector noted that meals provided by the home were suitable varied to meet the needs of the residents. Conversation with staff and residents and observations by the inspector seems to show that there were not a lot of fruits being offered to residents. Fruits were offered as part of the desert if requested by the resident but not generally offered at other times. There was no supply of fresh fruits on the units from which residents could help themselves during the course of the day. Meals times were observed on all three units. It was noted that trained nurses took a leading role with regard to serving meals and supervising the residents having their meals. This is good practice. The inspector noted that a few residents would have benefited from aids such as plate guards. It is recommended that residents are assessed for aids such as plate guards to promote the independence and dignity of residents while they feed themselves. On the first day of the inspection, residents were observed having their breakfast at about 10:00 on the Arden unit. One resident even started having her breakfast at 10:15. Lunch would then be served at about 13:00 and Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 16 supper at about 17:00. This meant that if residents do not have a snack at night they would go for about 14 hours at least before the next meal is served in the morning. The late service of breakfast seems to be linked to the fact that staff tried to get all the residents up, washed and dressed prior to breakfast. As a result the registered person must review the arrangements in place in the home with regard to the serving of breakfast and with regard to getting residents up, washed and dressed before breakfast is served. The kitchen was clean and tidy and most records as required were kept except for a record of all food cooked in the home. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 17 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 home takes complaints and allegations and suspicions of abuse seriously and deal with these appropriately. EVIDENCE: The complaint procedure was provided to all residents in the service users’ guide. A copy was also available in the foyer of the home. The Commission has not received any complaint about the service since the last inspection in September 2005. Since April 2006 two complaints were received by the home from relatives of residents. These were acknowledged, investigated and appropriate and detailed responses were sent to the complainants by the home. It was however not immediately clear from the responses if the complaints were substantiated or not substantiated. There was also no tracking form with regard to clearly recording all the information about each complaint. There have not been any allegations or suspicions of abuse since the last inspection. The manager and staff spoken to by the inspector were familiar with the procedure to follow if there was an allegation of abuse. Staff were also familiar with the whistle blowing policy of the home and some stated that they have had training on abuse and on Protection of Vulnerable Adults. There were notices of more training planned on this subject. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home’s location, the standard of redecoration and level of cleanliness were appropriate for the home to meet its stated aims and objectives, although there was room for improvement. EVIDENCE: The home is close to main roads and as such is easily accessible by public transport and by car. It is found close to shopping facilities and public amenities. The front of the home is reached by a small road off Weald Rd. Cars and vans are parked on this road which then leads to a large car park. There are maintained gardens to the front, back and side of the home. The exterior of the building was in good order. The interior of the home was fair and there was evidence of some redecoration in the home. The carpet in the corridors on the ground floor and the second floor has been changed and the ceiling on the second floor has been redecorated following a recent water leak. The standard of redecoration of the Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 19 communal areas and of the fixtures and fittings were also fair but these were starting to look old and past their useful life. A number of bedrooms were noted with holes in the plaster and which have started to look in need of redecoration. The manager stated that she has started a rolling programme for the redecoration of bedrooms and that the corridors on the ground floor will be redecorated in September. The kitchenette area on the Arden unit was also noted to be in a poor condition. A door to one of the cupboards was missing and there was a dip in the flooring near the sink, suggesting that the floor was not very secure. The floor has been identified for repair in the redecoration plan of the home. The arrangements in place in the home to deal with issues regarding fire prevention were good. Bedrooms doors of residents were kept closed, except for the doors to the sluices which were kept ajar by the lock on each door being activated while the door was opened hence preventing the doors from fully closing. There were regular fire checks and fire drills in the home. The inspector noted stains on the carpet in a number of areas including the corridors, lounge and bedrooms of residents. There were also a few bedrooms where there was an unpleasant odour. These may well be linked to the frequency of the shampooing of carpets and would suggest that carpets should be cleaned/shampooed as soon as a spillage/incident has occurred. The ventilation in the sluices was also noted to be non-existent. This was a problem which management was aware of and which was being addressed. While most of the bedrooms were clean with little dust on the furniture, pictures and items of decoration, there was some dust on the frames of the beds. As a result of the above it is required that the programme/schedule for cleaning and the shampooing of carpet is reviewed in the home. An electronic thermometer is used on each floor to check the temperature of the different food items before these are served. The normal guidance is for an alcoholic wipe to be used to clean the probe between each check. There was however no alcoholic wipes on that unit. There were a number of residents with a certain infection in the home. There was no antimicrobial solution for hand washing in the room or alcoholic hand rub for hand decontamination. Good infection control guidance suggests that hands should be immediately decontaminated before and after any activity that could result in hands becoming contaminated. (NICE, June 2003, Guideline on Infection Control. http:/www.nice.org.uk/page.aspx?o=CG002NICEguideline ) . There were antimicrobial solutions but these were available mostly in the sluice and alcoholic hand rub was available at the nursing stations. There was also no evidence that the residents and their visitors were being involved in the active prevention of cross infection. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home has sufficient numbers of staff to meet the needs of residents, although it does not yet have 50 of care staff trained to NVQ level 2 in care. Procedures for the recruitment of staff with regard to the receipt of references have on a few occasions not been very thorough. EVIDENCE: There were one trained nurse and two carers for each of the units. There is also a carer who is a ‘floater’ and who is allocated to each of the units according to the needs of the residents of the residents. The mornings are particularly busy as staff attempt to get all residents dressed and changed before breakfast. This could explain why breakfast was being served at around 10:00. One resident mentioned that staff take a long time to attend to him when he rings the bell. The rush in the morning seems to be linked to some extent to the practice that all residents have to be washed and changed before breakfast. As a result the registered person must review the care practices in place in the home as well as the staffing levels with regard to the needs of the residents to ensure that the needs of the residents are always being appropriately met. Figures provided by the manager showed that the home has 23 of care staff trained to NVQ level 2 in care. There was evidence that more staff in the home were enrolled on the course. As a result the home does not meet this minimum standard yet. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 21 The personnel records of three members of staff were inspected. It was noted that whilst most of the records as required by Schedule 2 of the Care homes Regulations 2001 were available for inspection some of the references and the process of receiving these were not as comprehensive as they should have been. One member of staff had references which were not dated and signed and the two other member of staff did not have a reference from the last employer. Interview forms were in place, but these were not always dated and signed. Staff confirmed that they have had training in food and hygiene, manual handling, fire training and protection of vulnerable adults. Training has been booked for manual handling and first aid. The inspector was informed that the home was looking at providing training for staff in dementia care as it was identified as a key area for training by management. A training programme and the training grid were available for inspection. The training grid showed that most staff were up to date with regard to statutory training. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager runs the home in an open and transparent manner. The home has a quality assurance system in place and carries out customer satisfaction surveys. The management of the personal monies of resident is good. Health and safety aspects were in the main appropriately addressed with a few issues identified where safety of residents could be compromised. EVIDENCE: The home has a full time manager. She has worked in other care homes and was familiar with running a care home. She has a nursing qualification and has completed a number of other courses in nursing. She does not yet have a qualification in management and has not yet been registered by the Commission. She stated that she would be enrolling on one of the registered Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 23 manager courses and would be sending her application to be the registered manager. The manager has a deputy who is also familiar with issues with regard to running a care home and who has the responsibility for clinical issues in the home. The home’s management team is supported by a regional manager and by the overall management structure that exists within Sanctuary Care. Staff, residents and visitors who spoke to the inspector were pleased with the management in the home. Some members of staff said that they were being appropriately supported by the management. A relatives’ meetings was organised in the evening of the first day of the inspection. The manager stated that this was the second meeting that she has arranged since she has started this job. There was evidence that the manager has arranged other meetings with staff to enable them to participate in the running of the home. The home has a quality assurance policy. There was evidence that audits were taking place in the home addressing key areas including, the environment, health and safety, catering and care. Some of these were carried out by Sanctuary Care Head Office staff. Sanctuary Housing is accredited to Investors In People (IIP), but it was not clear how the home fits within the framework of IIP. The inspector was also provided with a report following a satisfaction survey of stakeholders which was carried out in February. An action plan was drawn up to address issues where improvement was required. The home does not manage the social benefits of residents, but does keep a certain amount of personal money for some residents. Small amounts of money were kept individually for each resident in the home’s safe but larger amounts were kept in a special account. Appropriate records and receipts were kept about the expenditures and when money was received on behalf of the residents. There was evidence that the personal money of residents was regularly audited by head office staff, the regional manager and the manager. The inspector concluded that there were good systems in place in the home to manage the personal monies of residents. The home had up to date electrical wiring, portable appliances test, gas safety and chlorination (for the prevention of Legionella) certificates. There was evidence that equipment in the home was being maintained and tested as appropriate. A fire risk assessment was available for inspection and records were available about fire drills and regular checks on the fire system, fire fighting equipment and emergency light system. Contingency plans were also available for inspection, addressing a number of health and safety scenarios. Health and safety risk assessments were also available for inspection. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 24 The restrainers on two windows in the lounge of the Arden unit were found not to be very secure. They could easily be disabled and could therefore be a risk to residents. The restrainers should be effective and should not be easily disabled for the safety of the residents. The inspector noted that the doors to the sluices on all three units were left slightly ajar. The locks have been actioned while the doors were opened and the catches on the locks were preventing the doors from fully closing. The reason for this was not clear but this could be a health and safety hazard. A few items of food in the fridge in the kitchenette of the Arden unit were noted with no date of opening and no names. All food items stored in the fridges of the kitchenettes must be labelled and must be dated when opened. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 25 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 3 x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 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 3 3 x x x x 3 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 X X 2 Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14(1,2) Requirement All service users must have a comprehensive assessment of their needs. (Repeated requirement-timescale 30/06/05 not met). The assessment of needs must be kept under constant review and must be updated as and when the needs of residents change. 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 (Repeated requirementtimescale 30/06/05 not met).. Care plans/risk assessments for the manual handling of residents must address all manual handling manoeuvres including turning residents and moving residents up and down in the bed. Residents must have care plans for problems which have been identified such as for residents who have fits and for those who DS0000022941.V303042.R01.S.doc Timescale for action 30/09/06 2 OP7 15(1,2) 30/09/06 3 OP7 13(5) 30/09/06 4 OP8 12(1) 30/09/06 Rowanweald Nursing Home Version 5.2 Page 27 5 OP8 17(1)(a), sch 3,3(n) 6 OP8 12(1) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP11 15(1,2) are loosing weight. The registered person must ensure that the pressure relief equipment in use is clarified in the care plan of the resident and that the arrangement in place for the seating of residents is also addressed. There must also be regular records of wound progress. The registered person must ensure that all residents have a regular assessment of their continence/incontinence needs and that care plans addressed not only the promotion of continence but the management of incontinence including the frequency to change the incontinence aid and the type of incontinence aid in use for the resident. The location for the administration of creams and other topical medicines must be clarified on the medicines’ sheet. Staff must use lancing devices specifically for use by professionals for the testing of blood sugar as per the Medical Device Alert MDA/2005/063. Control solutions must be available for the calibration of glucometers (Repeated requirement-timescale 30/06/05 not met). The registered person must ensure that residents who are on anti-convulsants medicines have blood tests at a determined interval to check the serum levels of these medicines as required. Care records must provide information about the aspirations, about the way service users see the future, and about their wishes and DS0000022941.V303042.R01.S.doc 30/09/06 30/09/06 31/08/06 31/08/06 31/08/06 30/09/06 Rowanweald Nursing Home Version 5.2 Page 28 11 OP15 12(1) 12 OP15 16(2)(i) 13 OP15 13(4) 14 OP26 23(2)(d), 16(2)(k) 15 OP26 13(3,4) instructions with regard to death taking into consideration their ethnic, religious and cultural background. (Repeated requirement-timescale 30/5/6 not fully met). The registered person must review the arrangements in place for the serving of breakfast particularly with regard to whether all the residents should be up and dressed before breakfast is served. The registered person must review the provision of fresh fruits in the home, and the use of aids such as plate guards to promote the independence and dignity of residents with regard to feeding themselves. Records about all the meals cooked in the home must be available for inspection (Repeated requirementtimescale 30/06/05 not met). The registered person must ensure that all areas of the home, including bedrooms are kept to a high standard of cleanliness. Bedrooms must also be free of foul odours (Repeated requirementtimescale not fully met ). The arrangements in place for the shampooing of carpets must be reviewed. Bed frames must be free of dust There must be antimicrobial solution and/or alcoholic hand rub in the bedrooms of residents for the decontamination of hands in order to prevent cross infection and according to a risk assessment. Residents and their visitors must be encouraged to take part in the active prevention of cross DS0000022941.V303042.R01.S.doc 31/08/06 31/08/06 31/08/06 31/08/06 31/08/06 Rowanweald Nursing Home Version 5.2 Page 29 16 OP26 13(3) 17 OP28 18(1)(c) 18 OP29 19(1) 19 OP38 13(4) 20 OP38 13(4) 21 OP38 13(3,4) contamination. Alcoholic wipes must be available for the cleaning of thermometer probes used to check the temperature of food items being served to residents. The registered person must ensure that 50 of care staff are trained to NVQ level 2 as soon as possible. The registered person must ensure that all new members of staff have all the information as detailed in schedule 2 of the Care Homes Regulations 2001, particularly with regard to having comprehensive references. Action must be taken to address the health and safety of residents with regard to leaving the doors to the sluices open according to a risk assessment. The registered person must ensure that the restrainers on windows are not easily disabled to ensure the safety of residents at all times as per a risk assessment. All food items stored in the fridges of the kitchenettes must be labelled and must be dated when opened. 31/08/06 31/12/06 30/09/06 31/08/06 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations That residents are involved in the first instance in the formulation of care plans and that their next of kin is involved when there is limited participation from the resident. DS0000022941.V303042.R01.S.doc Version 5.2 Page 30 Rowanweald Nursing Home 2 OP16 3 OP19 It is recommended that the home introduce a system to record comprehensive information about complaints such as a ‘tracking form’. Information about whether complaints were upheld or not upheld could also be included. It is recommended that the redecoration of the communal areas in the home is addressed in the redecoration and the refurbishment plan for the home. Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow 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. Extracts may not be used or reproduced without the express permission of CSCI Rowanweald Nursing Home DS0000022941.V303042.R01.S.doc Version 5.2 Page 32 - 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. 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