Inspection on 09/10/07 for Rowanweald Nursing Home

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 06/07/06

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 9th October 2007 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.V346308.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.V346308.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) Sandra Elizabeth Vigor Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum staffing notice applies Date of last inspection 6th July 2006 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 Tolland the deputy manager with support from the Head Office of Sanctuary Care, including Denise Cooper, the regional manager. The home charges fees ranging from £705-£775 depending on the needs of the residents and accept residents who are publicly as well privately funded. At the time of the inspection there were 40 residents in the home. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on Tuesday 9th October from about 10:15 to about 17:45. This was the first inspection for the period 20072008, which assessed the home against key standards. As part of the inspection an Annual Quality Assurance Assessment was completed by the manager. I also toured some of the premises, looked at a sample of records, spoke to residents, the manager and some of her staff. Part of the methodology also included assessing the home for evidence of compliance with past requirements and recommendations. The last inspection in the home was a random inspection, which took place on the 2nd March 2007. That inspection looked at the safety of residents and compliance with past requirements. The report may be accessed in the home or upon request from the commission. I would like to thank all residents who spoke to me and the manager and all her staff for a kind welcome and support during the inspection. I am also grateful to the manager for her efforts in producing all the documents that were requested as part of the inspection. What the service does well: The home has a stable staff team, which is well supported by management, to make sure that they are able to care for residents in the home. As a result there is continuity of care and an expectation of continuous improvement and good standards of care. Prospective residents’ needs are appropriately assessed before they are offered a place in the home. Residents/representatives are offered appropriate information and the opportunity to visit the home and to ask questions to decide if the home is suitable for them. Residents appeared well cared for and feedback from all residents and visitors spoken to were satisfied with the standard of care that they receive. The standard of care in place with regards to the management of pressure ulcers is generally of a good standard. In the past residents usually benefited from appropriately arranged social and recreational activities, but the activities coordinator has left and the home has recruited a new activities coordinator who was due to start work in the home. It is hoped that the standard of the provision of social and recreational activities in the home will be maintained. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 6 Residents have the opportunity to take part in making decisions regarding the meals that are prepared in the home by meeting with the chef in residents’ meetings and discussing the menus. They receive a variety of nutritious meals according to their needs. The meals are served in congenial settings and staff assist residents in a discreet manner. The grounds in front of the home are maintained and the exterior of the building is also maintained to a good standard. The inside of the home is decorated and maintained to provide a suitable environment for residents. Bedrooms of residents are homely and personalised. On the whole there are no odours in the home. The staffing levels that are provided by the home are appropriate to make sure that the needs of residents are met. The standard of training provided to staff is also suitable to make sure that they are competent to care for the residents. What has improved since the last inspection? The care records have been improved to make sure that these address all the needs of residents in a comprehensive manner. They are drawn up and reviewed with residents or their representatives. The needs of residents are assessed comprehensively and care plans are drawn up to address the identified needs. The care plans are clear about the action to take to meet the needs of the residents. Medicines management in the home was of a good standard. Medicines were appropriately recorded when received in the home and when administered to residents. Weekly audits are carried out to make sure that an appropriate standard is maintained with regards to the administration of medicines. Residents’ care plans now comprehensively address the needs of residents with regards to end of life care and include information about the wishes and instructions of residents with regards to death and funeral. As a result there is greater guarantee that the needs of residents with regards to this aspect of care would be met. The standard of laundering of residents’ clothes has improved and residents’ clothes are kept in the wardrobes and drawers tidily. There has been further improvement with regards to making the environment more homely and personalised to meet residents’ needs. Most of the staff in the home have received training on infection control. The manager has been registered and is in the process of completing the registered manager’s award. She is closely supported by the deputy manager and together they have been able to improve general standards in the home. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 7 The home takes quality issues seriously. There is a quality control system in the home, which includes a schedule of audits and a satisfaction survey of stakeholders in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rowanweald Nursing Home DS0000022941.V346308.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.V346308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and/or their representatives can expect that the needs of the residents would be met if they are accepted into the home and if they then decide to move in. EVIDENCE: The service users’ guide has been updated and now contains information about the range of fees charged by the home. A copy of the service users’ guide is available in the bedrooms of residents and is also available in the reception area of the home together with additional information about the service and the organisation. Residents and/or their representatives have the opportunity to visit the home, to meet staff and other residents and to ask questions about the service before deciding if Rowanweald is suitable for them. A sample inspection of residents’ files showed that residents, who are admitted to the home, receive a contract/statement of terms and conditions even if they Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 10 are publicly funded, to make them aware of their rights and responsibilities. This is good practice. Inspection of the care records of residents who have been recently admitted showed that comprehensive pre-admission assessments of the residents’ needs were conducted by the manager or her deputy to make sure that the home would be able to meet the needs of the residents. The manager and staff demonstrated that the home is able to meet the needs of all the residents who are accommodated in it. This conclusion was reached by looking at the overall wellbeing of residents, their care records, training records of members of staff and other issues such as the management of health and safety. Members of staff were on the whole aware of the needs of residents in relation to the cultural, religious and ethnic aspects of the care of the residents. These issues were also addressed in the care records of residents. The manager stated in the AQAA that staff receive information about equality and diversity issues as part of their induction training. Rowanweald Nursing Home DS0000022941.V346308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are of a good standard to make sure that the needs of residents would be met. The healthcare needs of residents are mostly met, but care plans did not always contain a repositioning regime of residents to manage and prevent pressure ulcers. The management of medicines is of a good standard to promote the safety of residents. End of life care needs of residents are addressed appropriately to make sure that these needs would be met. EVIDENCE: I looked at the care records of six residents and met all of them to find out whether their needs were being met. The assessment of needs of residents were on the whole completed to a good standard and addressed all the needs of residents including the cultural, religious and ethnic needs. These were clearly recorded and kept under review. One issue, which was slightly lacking was information about the likes and Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 12 dislikes of residents. Whilst most residents have their likes identified, their dislikes were not always identified. Care plans were in place to address all the needs of residents, including short term care needs such as when residents had acute illnesses. The care plans were on the whole clear and described the action to take to meet the needs of residents. Risk assessments were also in place as required. All care plans and risk assessments were agreed and reviewed with residents/representatives. This is commendable. Manual handling risk assessments were on whole clear about the equipment to use when carrying out various manual handling manoeuvres. One manual handling risk assessment said to use a cradle hoist. It is recommended that the make of the hoist be used as the home has many types of cradle hoists. Care records showed that residents were seen by healthcare professionals when required. They had all the usual annual health checks as required, except for a dental check as there seems to be a shortage of dentists who are willing to visit care homes to see residents who are funded by the NHS. There were three residents with pressure ulcers in the home, one of them was admitted with multiple pressure ulcers. Inspection of the care records showed that all the pressure ulcers were healing and that the residents were referred to the tissue viability nurse as required. One of the residents had a pressure ulcer on the buttock, which changed from a grade 2 to a grade 3 some time ago. The tissue viability nurse recommended that the time that the resident sit out be restricted when it was noted that the pressure ulcer had deteriorated. Inspection of the care records showed that a repositioning regime was not in place for this resident at the time when the pressure sore was a grade 2 to address the seating and turning regime required to promote healing and to prevent deterioration of the ulcer. There were care plans, photographs, body charts and wound progress notes addressing the pressure ulcers for each resident. A resident with multiple pressure ulcers had one care plan and progress notes addressing all the ulcers. As the management of each ulcer and progress may be different it is recommended that there be separate care plans and progress notes for each sore, which would then make all information about one ulcer more easily accessible and would also make monitoring of the progress of each ulcer easier. The continence assessment and the associated care plans were clear about the frequency of toileting and the management of the incontinence of residents. It was noted that there were no odours in the home. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 13 The home kept some equipment to use in emergency and with the provision of 1st aid to residents and other people if required. It was noted that the suction machine was not left in a state when it would be ready to use in an emergency. There were no suction catheters to use with the suction machine if that was required. The staff nurse on duty stated that the home planned to address this by putting in place a resuscitation trolley/tray with all the emergency equipment to be found in a care home with nursing, ready to be used when required. The end of life care needs of residents and their wishes and instructions that they might have with regards to the management of death, resuscitation and funeral arrangements, were addressed in a comprehensive manner in the care records of residents. There was also evidence that staff have had some training in managing the end of life care needs of residents. Medicines’ management in the home was of a good standard. All medicines were signed for when administered or a code was used when not administered. Instructions about the administration of medicines including creams and lotions were on the whole written down to make sure that staff knew how to administer the medicines. The amounts of most medicines were recorded when received into the home except for a few, which were addressed at the time of the inspection. Medicines such as antibiotics and other liquids had a date of opening recorded to monitor the expiry dates of the medicines. Rowanweald Nursing Home DS0000022941.V346308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs with regards to their lifestyles are assessed and action is taken according to a plan of care to meet these needs. Residents are able to benefit from a variety of nutritious meals according to their individual needs and choices. EVIDENCE: Care records address the social and recreational needs of residents. There is a section on the assessment of the social needs of residents and a ‘Getting to know you’ form, which are on the whole completed to a good standard. The ‘getting to know you’ form contains personal information about the resident and helps to know the ‘person’. Care plans addressing the social and recreational needs of residents are in place to address the identified needs of residents. The home employs a full time activities coordinator, but the position has just been filled after the previous activities coordinator left. The activities coordinator has not started yet as she was waiting for the employment checks to be carried out. The manager stated that one care staff covers some of the activities hours. Residents were however clearly missing the input that the Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 15 previous activities coordinator had in the home. The manager however demonstrated her commitment to provide appropriate activities in the home. She has made contact with the National Association of Provider of Activities (NAPA) to learn more about the provision of activities. She stated that she would arrange training for the new person who is going to take up the post of activities coordinator. Visitors were observed in the home and they were made to feel welcome when they visited residents. Staff and management seemed to have a good rapport with visitors to the home. There was evidence of trips that have been arranged for residents. The manager stated that outings are arranged once monthly and that a mini bus is used to take residents out. She stated that she was making arrangements for residents to attend a lunchtime Recital in the local church, if there were residents who would be interested in this. Residents are able to practice their religion according to their individual faith. Representatives from the local churches visit residents on a regular basis to support them with their spiritual needs. I visited the home at about 10:15 and by that time all residents have had their breakfast. Some residents were in the lounge while others were in their rooms. I was able to observe lunch being served on the Arden and the Pelena units. Lunch on the day consisted of Carrot and coriander soup, beef stroganoff, rice, potatoes, beans and vegetable pasta bake for the second choice. There was sweet Eton mess for desert. Residents’ choices were recorded and copies of the choices’ sheet were available on the floors. Residents were encouraged to make choices about their meals where this was possible, and in other cases staff relied on the likes and dislikes of residents which would have been recorded. Residents were able to benefit from fresh fruits, which were available on each of the units. Trained nurses were involved in dishing out the meals and serving residents. By being involved in meal times they can accurately monitor the intake of residents during meals times. The manager recorded in the AQAA that the TV is switched off during lunchtimes and that there is low background music to create an ambience conducive to mealtimes for residents. Staff were observed supporting residents one at a time and in an appropriate manner. Residents and their relatives have the opportunity to discuss the menus in meetings where the chef also attends. The chef is then able to make changes to the menu as per suggestions of residents/relatives if necessary. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home takes complaints seriously and learns from these to prevent similar events from happening again. Allegations and suspicions of abuse are addressed according to the safeguarding adults procedure of the local Borough to make sure that residents are safe. EVIDENCE: It was recorded in the AQAA that the home has received 10 complaints during the past year. Out of this 9 were substantiated. The last inspection was in March and since then there have been 3 complaints. The complaints were about the standard of care provided by care staff. All of the complaints were appropriately investigated and action plans were put in place to address areas where there might have been lacking. A tracking form was in place to monitor progress with regards to each complaint. The home has an up to date procedure to deal with abuse and safeguarding adults. There has been one referral, which the home made to the safeguarding adult team, but which was eventually dealt with by the home itself. Staff, who were spoken to, are familiar with the action to take when they are informed about or come across allegations and possibilities that abuse may have been committed. This is covered as part of the induction and is also addressed in the training programme of the home. The manager stated in the AQAA that she has made available a concerns folder for each unit which Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 17 contains the complaints procedure and action plans to follow in cases of allegations or possibilities that abuse may have been committed. Rowanweald Nursing Home DS0000022941.V346308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a warm and homely atmosphere and a well-maintained environment for residents to enjoy. EVIDENCE: The grounds and areas in front of the home were maintained. The parking area was clean and tidy. The lawn was trimmed and the shrubs were pruned. The manager said that the home employs a gardener to maintain the grounds of the home. The exterior of the building also appeared in good condition. The first sight of the home and the grounds therefore provided a positive view about the home. There was a small enclosed garden, which was also maintained to a good standard. This garden consisted of patio areas with sitting facilities and a variety of flowers and shrubs in the flowerbeds and the borders. I was informed that residents and their relatives like to use these areas particularly when the weather is nice. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 19 The reception area of the home was bright, airy, well maintained and decorated to a good standard. Recent areas that have been recently redecorated included the lounges and the kitchenettes. Plans for the future included replacement of the carpet on the Arden unit. Furniture in the communal areas was of an appropriate standard. The bedrooms of residents were also maintained and decorated to a good standard. There were good attempts at personalising the bedrooms of residents. Apart from the home having purchased new bed covers, residents/representatives were encouraged to bring photos, pictures and personal items of decoration for their bedrooms. The manager has identified the need to change the curtains in the bedrooms of residents, as the next step to improve the condition of the bedrooms. This is commendable. There were no odours in the home and the home was on the whole clean, although some areas were noted that would benefit from dusting. The manager said that she had already spoken to the cleaning supervisor about that. The AQAA showed that 60 members of staff have had training in infection control. Rowanweald Nursing Home DS0000022941.V346308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides appropriately trained and competent staff in adequate numbers to meet the needs of the residents. The checks prior to employing new members of staff were not always as thorough as they should have been to ensure the safety of residents, particularly with regards to having appropriate employment references. EVIDENCE: There are one trained nurse and two care staff on each unit during the day with an additional care staff that is a ‘floater’ and is allocated to units according to the dependency of residents on each particular unit. At night there are a trained nurse and a carer for the Arden unit and a trained nurse with three carers for the 2 units on the ground floor. The deputy manager has some allocated hours where she is supernumerary. It was noted that the home has a relatively stable group of staff, particularly trained members of staff who are aware of the standards that need to be maintained in the home. Staff said that they felt involved in running the home and that under the guidance of the manager and the deputy manager they are able to make ongoing improvement of the home. The personnel files of 6 members of staff were inspected. While most of the records were in place including appropriate CRB checks, there was a lacking with regards to ensuring that appropriate references were in place. Four of the Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 21 applicants did not have professional references from their last place of work/employer and had references from people including colleagues and friends. Some had testimonial references addressed ‘to whom it may concern’. A few of the applicants have worked in care services or have had some form of work experience in care services. There were no references from those sources to verify what the applicants say in their application form. I was informed that new members of staff complete the common induction standards as per Skills for Care as well as the home’s own internal induction. The home has 8 members of staff out of 23 who are qualified to NVQ level 2 or above. There are 6 members of staff in the process of studying for an NVQ level 2 qualification in care. Therefore the home does not yet have 50 of its care staff trained to NVQ level 2 or above. It does however have 9 student nurses and 3 trained nurses from abroad who work in the home as carers. As a result although the home does not have 50 of carers trained to NVQ level 2 or above, a significant number of them are trained or in the process of training either in social care or in nursing care. The home has a training programme, which included statutory training as well as training in clinical areas such as dementia awareness, heart failure, nutrition and hydration and continence training. The organisation has introduced a training pack to deliver mandatory training. The manager and the deputy manager have completed a ‘train the trainers’ course to be able to deliver this training. A training grid, which was provided by the home, showed that most members of staff in the home were up to date with regards to statutory training. Rowanweald Nursing Home DS0000022941.V346308.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is fit and able to run the service in a manner, which promotes the wellbeing of residents. The home has a quality system, which is appropriate to measure the quality of the service that is provided. The management of resident’s personal money is on the whole appropriate to make sure that residents do not suffer financial abuse. The home manages health and safety issues appropriately to make sure that all people who use the service are safe. EVIDENCE: The manager has now been registered. She is a trained nurse and is in the process of completing the registered managers’ award. She is closely supported by her deputy and line management to make sure that the aims and Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 23 objectives of the service are met. She stated that the deputy manager and her run the home in an open manner and have an open door policy. It was noted that staff and visitors did go into the office to see the manager when that was required and that she also visited the floors when needed. Residents, visitors to the home and members of staff were pleased with the way that the home is managed. Members of staff also mentioned the support and guidance that they receive from the management team while undertaking their day to day job. Minutes of residents’ meetings and of relatives’ meetings were available for inspection. It was positive that the home offered so many opportunities for people to contribute their ideas to the management and improvement of the home. The home has a quality assurance procedure. A procedure for internal quality audits was seen as part of this inspection. It mentions that each procedure in the home should be audited at least annually to check how it is being applied and complied with. It was noted that there was a schedule of audits, which was planned such that different areas were audited throughout the year. The schedule included care documentation, activities, laundry, housekeeping, infection control, health and safety and environment audits. The manager stated that it is normally the person in charge of the relevant department who carries out the audit for that area. The manager is overall responsible for collating the outcomes of the audit and the regional manager is responsible for validating the audit. Satisfaction surveys are conducted as part of the quality assurance process. An action plan was produced following the satisfaction survey conducted in 2007, which addressed the findings of the survey where improvement to the service was required. The management of residents’ money is carried out by the administrator of the home with the assistance of the manager and head office staff. Individual records are kept for each resident and there are individual envelopes to keep the money of each resident, which are then kept in the safe. I was informed that residents are only allowed to keep less than £100 and that any amount in excess of that money is then banked in the home residents’ account. A record of any money, which is banked, is made in a form, which is kept at the back of the residents’ personal money folder. It was noted that this sheet is not kept with all of the residents’ accounts. It is recommended that all records about the finances of residents be kept together to make sure that nothing is missed when reconciling the accounts of residents. A record of the breakdown of the residents’ bank account with regards to the names of residents who have money in the account and the amount of money that they have was not available. It is recommended that one be made available. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 24 Residents also kept some valuables in the safe. A valuable would have been recorded on the valuables form in the resident’s care file then stored in the safe. A copy of the Management of residents’ money and financial affairs procedure was seen. This makes an inference to the management of residents’ valuables but is not detailed to say exactly how residents’ valuables are being managed in the home. It says all items should be recoded and signed for, but does not say how many persons are required to witness a transaction, and where should the record be made. There was no evidence that the content of the safe was being audited to make sure that all items that were stored in the safe were accounted for. There are kitchenettes in each communal areas where facilities to make drinks are available and to assist in serving the meals. An Electric water urn was noted in each kitchenette. The door to one of the kitchenettes was broken and therefore it was possible for residents to have access to these areas. It is required that there are risk assessments in place with regards to residents’ access to the kitchenettes and hot water boilers. Records are kept about the maintenance of equipment in the home and of the safety checks that are required. There was evidence of regular water temperature checks, fire detectors and emergency light checks. A gas safety certificates for gas appliances, an electrical portable appliances test certificate and the electrical wiring certificate were also in place. LOLER certificates for the hoists and for the passenger lifts were in place, demonstrating that these items of equipment were being maintained as required. There was evidence that the fire detection and fighting system was being maintained. A fire risk assessment, fire emergency plan and a health and safety risk assessment were also in place. The fire emergency plan looked like it would benefit from a professional view. Rowanweald Nursing Home DS0000022941.V346308.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 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 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 2 X x 3 Rowanweald Nursing Home DS0000022941.V346308.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 OP8 Regulation 17(1)(a), sch 3,3(n) Requirement Timescale for action 31/12/07 2 OP8 12(1) 3 OP28 18(1)(c) 4 OP29 19(1) Care plans for residents who are at risk of developing pressure ulcers or who have pressure ulcers, must address the repositioning regime in place to prevent pressure ulcers from developing and deteriorating if these have already developed. The registered person must 31/12/07 ensure that the suction machine and any other items of equipment which are used in emergencies and during 1st aid, be prepared and ready to use in an emergency as these could be life saving measures. The registered person must 31/08/08 ensure that 50 of care staff are trained to NVQ level 2 as soon as possible (Repeated requirement-timescale 30/12/06 not met). The registered person must 31/12/07 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 DS0000022941.V346308.R01.S.doc Version 5.2 Rowanweald Nursing Home Page 27 (Repeated requirementtimescale 30/09/06 not met). 5 OP35 17(2) A record of the breakdown of the residents’ bank account with regards to the names of residents who have money in the account and the amount of money that they have must be available in the home to reconcile the content of the account. That the health and safety risk assessment include the residents’ access to the kitchenettes and residents’ access to boiling water. That the door to the kitchenette’s area is kept in good working condition. 31/12/07 6 OP38 13(4) 31/12/07 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 2 Refer to Standard OP7 OP8 Good Practice Recommendations It is recommended that the make of the hoists to use for the manual handling of residents be recorded to clarify the hoist to use as the home has many types of hoists. It is recommended that in cases where residents have multiple pressure ulcers that there be a separate care plan and separate wound progress notes for each ulcer to make it easier to monitor the progress of the ulcers. It is recommended that all records, about the finances of residents, including the record of money that residents have in the bank, be kept together to make sure that nothing is missed when reconciling the accounts of residents. That the policy with regards to the management of residents’ valuables be reviewed to describe exactly how residents’ valuables are being managed in the home. That an audit of the content of the safe is carried out at regular DS0000022941.V346308.R01.S.doc Version 5.2 Page 28 3 OP35 4 OP35 Rowanweald Nursing Home 5 OP38 interval to make sure that all of residents’ valuables, which are stored in the safe are accounted for. That the emergency fire plan of the home be reviewed by a competent person such as by a fire officer to make sure that it is suitable for the home. Rowanweald Nursing Home DS0000022941.V346308.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V346308.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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