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Inspection on 20/05/05 for Sanford House Nursing Home

Also see our care home review for Sanford House Nursing Home for more information

This inspection was carried out on 20th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

All accommodation is on the ground floor so that residents are not at risk from stairs. There is a safe courtyard within the home providing a pleasant area to sit. The maintenance person was planting up tubs for this area to improve its appearance still further. The staff team are committed to the welfare of residents.

What has improved since the last inspection?

The statement of purpose has been updated to include the sizes of rooms on offer so that residents can make informed decisions about whether they wish to move to the home. The assessments completed before people move into the home have improved and contain more detail. Other assessments are reviewed more regularly. (See below.) The inspector did not fully tour the premises and so did not fully assess that all the requirements of the last inspection had been met. However, the manager confirmed verbally that all those to do with the building had been attended to.

What the care home could do better:

The manager has improved the assessments for people newly moved into the home and now gaps in the assessments for other people should now be filled so that a full picture of everyone`s needs is available. Although improved, the review and update of assessments and care plans needs further work so that changed needs are picked up quickly and changes in care needs can be set out clearly and delivered promptly. The plans need to show how and when residents or their relatives are involved in developing them.Records need to be dated accurately and signed, so that everyone can be confident they are up to date, and who has completed them. Residents` social and recreational needs are not properly set out showing how these are to be met. Some people`s records show that a social activity has taken place if the person has been "spoken to". This does not reflect that residents` needs are met and is important in overall welfare, particularly psychologically. Care is needed to ensure that residents` overall health and risk (for example from getting pressure sores) is not damaged by large weight gains. Staff must have enough time during their working shifts, to attend to the needs set out in care plans to help and encourage people to move around, and to spend in social or recreational activities with people. Where the doctor has said that tests are needed (for example urine or blood tests), records need to show that samples have been taken and results followed up, so that residents can receive any treatment they might need without delay. Similarly, treatment provided by nurses (for example application of dressings) needs to be recorded properly so that the success of the treatment (or the need to change it) can be monitored. The investigation of complaints, and whether they are proved or not needs to be improved. Staffing levels must be reviewed in the light of residents` need for assistance, so that it can be shown these are enough to meet the needs of people living at the home. Whenever staffing levels fall below the minimum set out in the home`s historical "staffing notice", the Commission must be told, as this affects the welfare of residents. An audit of the skills and abilities of nursing staff should be carried out so that the manager can be confident when people are admitted, that their needs can be fully met. Staff must undergo the full range of checks set out in regulations, and contained in Department of Health guidance for people who run care homes, to ensure that vulnerable people living at the home are protected, and records kept.

CARE HOMES FOR OLDER PEOPLE Sanford House Nursing Home Danesfort Drive Swanton Road East Dereham NR19 2HH Lead Inspector Judith Huggins Unannounced 20 May 2005 09:25 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Sanford House Nursing Home Address Danesfort Drive Swanton Road East Dereham Norfolk NR19 2HH 01362 690790 01362 690890 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sanford House Limited Awaiting registration - Mrs Susan Lancaster Care Home 43 Category(ies) of Dementia - over 65 years of age (42), registration, with number Old age, not falling within any other category of places (42), Physical disability (1) Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home will only receive patients who are not liable to be detained under the Mental Health Act 1983. 2. The Home may accommodate one (1) male person with a physical disability, named in the Commissions records, who is under 65 years of age. 3. The Home may accommodate up to forty-two (42) elderly people over the age of 65 years, of either sex, who may or may not have dementia. 4. Maximum number not to exceed forty-three (43). Date of last inspection 19 October 2004 Brief Description of the Service: This home provides care with nursing to a maximum of 43 elderly people. It is located on a private driveway close to the centre of the market town of East Dereham. The building is divided into two units with the Carrick unit caring for older people and one person with physical disabilities, and the Shannon unit caring for older people with dementia. There is a secure courtyard garden at the centre of the home, with access from some bedrooms. There are small shrubs and flower borders, and some small lawn areas. Garden seats and tables are provided. It was purpose built in 1998 and all accommodation is located on the ground floor. Wheelchair access and the car park are located at the front of the home. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted 53/4 hours. During the course of the inspection, four staff, two residents and two relatives were spoken to. A selection of staff records was examined, as were care plans and care notes for four residents. What the service does well: What has improved since the last inspection? What they could do better: The manager has improved the assessments for people newly moved into the home and now gaps in the assessments for other people should now be filled so that a full picture of everyone’s needs is available. Although improved, the review and update of assessments and care plans needs further work so that changed needs are picked up quickly and changes in care needs can be set out clearly and delivered promptly. The plans need to show how and when residents or their relatives are involved in developing them. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 6 Records need to be dated accurately and signed, so that everyone can be confident they are up to date, and who has completed them. Residents’ social and recreational needs are not properly set out showing how these are to be met. Some people’s records show that a social activity has taken place if the person has been “spoken to”. This does not reflect that residents’ needs are met and is important in overall welfare, particularly psychologically. Care is needed to ensure that residents’ overall health and risk (for example from getting pressure sores) is not damaged by large weight gains. Staff must have enough time during their working shifts, to attend to the needs set out in care plans to help and encourage people to move around, and to spend in social or recreational activities with people. Where the doctor has said that tests are needed (for example urine or blood tests), records need to show that samples have been taken and results followed up, so that residents can receive any treatment they might need without delay. Similarly, treatment provided by nurses (for example application of dressings) needs to be recorded properly so that the success of the treatment (or the need to change it) can be monitored. The investigation of complaints, and whether they are proved or not needs to be improved. Staffing levels must be reviewed in the light of residents’ need for assistance, so that it can be shown these are enough to meet the needs of people living at the home. Whenever staffing levels fall below the minimum set out in the home’s historical “staffing notice”, the Commission must be told, as this affects the welfare of residents. An audit of the skills and abilities of nursing staff should be carried out so that the manager can be confident when people are admitted, that their needs can be fully met. Staff must undergo the full range of checks set out in regulations, and contained in Department of Health guidance for people who run care homes, to ensure that vulnerable people living at the home are protected, and records kept. Please contact the provider for advice of actions taken in response to this inspection. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 7 The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 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 standard(s) 3 Pre-admission assessments have improved and contain a better range of information than previously. EVIDENCE: The pre-admission assessment for one person admitted just over a week before the inspection shows a range of information including religious and spiritual needs and risk of falls. Those admitted previously, before the current manager assumed her role, still contain gaps in information. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7. 8 and 9 (see below) Gaps in existing assessments and setting out the care needed make it difficult to determine how residents’ individual needs are to be fully met. There is some evidence of improved frequency of review during the course of this year, but this is not consistent and it is unclear how accurate the information provided is, or how changes are properly followed up. Social and recreational needs of residents are not met. Standard 9 regarding medication has been inspected in detail by the Commission’s specialist inspector who identifies that “Whilst inspectors have noted improvements, there continue to be shortfalls in practices relating to the safe handling and administration of medicines at the home that could impinge on the health and welfare of service users” Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 11 EVIDENCE: Biographies are not consistently completed. The falls risk assessment for one person was undated and so evidence of regular review cannot be seen. The risk assessment for one person regarding vulnerability to pressure sores has been reviewed in December 2004, January and March but not subsequently. The risk assessment for another, also for pressure sores, and who is identified as needing nursing intervention in this area, has been reviewed in September and December of last year, and March 2005 but not subsequently. One person does not have a continence assessment. The continence assessment for the same person has been more regularly reviewed, but not monthly (September and December last year, and March, April, and May of this year). The manual handling assessment has been reviewed more regularly – monthly between November 2004 and March 2005. A review in April has been missed, but the assessment was revisited in May. A Waterlow assessment shows that a person’s risk has decreased by one point, the risk being quoted for a person aged between 65 and 74. Previously the person is recorded as “81 ”. The date of birth shows the person is 74. The review sheet for one person records dates in sequence as 4/11/04, 4/12/04, 5/1/05, 4/1/05 (out of sequence), 4/2/05 and March 2005. The summary of activities of daily living for one person is undated and unsigned. The oral hygiene needs for one person are not clearly assessed and set out, and there is nothing specific about the frequency with which the person should be offered a bath/bed bath. “Activity therapy” for a resident shows irregular activities. There are none recorded between 3rd and 7th January. There are 8 entries from that date, 7 showing that the person was “spoken to every day”, and one that they were in bed. Staff report having little time to spend socially with residents. Activities are not entered on records since March. The file for one person shows the resident’s representatives wishes to participate in care planning (dated May 2004) but not whether they have been involved in reviews and updates. Files seen do not show that they are agreed and signed by the resident and/or their representative, as set out in standard 7. One relative spoken to has not seen the resident’s care plan. One relative felt that they were kept informed about care needs. A care plan aim for one person identifies the need to ensure good nutrition in order to help prevent pressure sores from developing. The nutrition Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 12 assessment for the person shows them at very high risk and has been reviewed in March and April of last year. The person’s weight has been monitored in June and July of last year, but not again until February this year, despite the “eating and drinking“ care plan, set out in November 2003, saying the person should be weighed at least once a month. However, weights were monitored in April and May. The malnutrition universal screening tool on file has not been used at all. The care plan for another person, identifying the need for a health nutritional diet shows that they manage a vegetarian diet well (dated December 2004), but there is no update to the actions and interventions on the front of the care plan sheet. The person is identified on file in May 2004 as wishing to be involved in care planning but there is no evidence on record to show this, other than for signing a risk assessment for self-administration of medication. This was set up in October 2004 showing the medication involved. The reassessment in January does not record whether the medication has changed, and identifies that is was due for review in January 2005. This review is not documented and there are no subsequent entries. (Standard 9 was inspected separately – see above.) A care plan goal sets out the need for staff to continue assistance with the person’s mobility. A further care plan sets out in detail how the person should be encouraged to walk short distances with their frame, and to be encouraged to put their right foot on the floor (written in February this year). Another care plan shows that the person was receiving input from a physiotherapist for a regime of exercises in October 2004, but there has been no update of the care plan to show the role of staff in helping deliver these. (The record of collaborative care used for such visits does not record any physiotherapist’s visits since July.) Staff report that they are unable to spend time encouraging residents to mobilise. See staffing standards. Review notes for one person on an “eating and drinking” care plan, show that the person has developed difficulties in swallowing in July 2004, but the care plan goal itself shows it was not updated until September 2004. Recorded weight changes have not resulted in corresponding updates to nutrition assessments or clear indication of any interventions necessary. Weight monitoring for one person shows that they weighed 68kg in February 2004, that this increased to 76kg in July, to 81kg I October, and is now up to 89kg. The person is recorded as “moderately nourished” on the Burton nutrition assessment in December 2004 but without further entry. The dietician was involved until October last year when the person’s weight Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 13 reached 80kg, and they were discharged. Notes say that staff should discuss with relatives providing less treats. However, the person has clearly gained another 9kg (nearly 20 pounds), and there is no follow up or other intervention documented. There are separate sheets within care plan files for recording input from other health care professionals. One person’s notes record no chiropody input since October 2004. One person’s notes record no GP visit since March 2004. The notes for two others show that additional investigations have been required (in on case for a swab analysis, and in the other for blood and urine tests). There is no record of completion of these tests and results. The regional manager reports difficulties in securing pressure relieving equipment and is actively engaged in discussions with the primary care trust. The equipment provided for one person is small. The person concerned is recorded as weighing 90kgs (over 14 stones) and is nursed on a bed of minimum width (900mm) with a pressure relieving mattress overlaid and 840cms wide). Nursing staff gave a clear explanation of how MRSA infection is managed, and say they have adequate protective clothing (disposable aprons and gloves). The person had a wound dressing plan for two hips needing nursing intervention. This set out the types of dressings to be used in each case. However, the record of dressing changes and condition does not distinguish between each wound and therefore the differing treatments administered. The care plan identifies the need for daily monitoring. This is shown as carried out on 11th and 12th May, but then not until 16th May. One is now said to be healed but the care plan for the remaining wound is not visible as this is sleeved behind the one for the healed wound. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 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 standard(s) None None of the above standards has been inspected on this occasion. EVIDENCE: Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Relatives are not confident that their complaints are always appropriately dealt with. EVIDENCE: Two complaints have been referred to the Commission in recent months. One had not received an appropriate response when concerns were raised in the home, and the second was not confident in raising concerns. One person spoken to during the inspection has not been given feedback from a concern raised verbally with the manager and is not sure whether any action has been taken. The results of complaints investigations for the last 12 months were checked and showed that 6 were partially substantiated, 5 were substantiated, 3 were not, and 5 had no recorded conclusion. One complaint found unsubstantiated contained two elements – that a person was left in bed until late and that this was due to staffing levels. It is clear that the person was left in bed until late, but that records show this due to illness. However, staffing levels when cross referenced with returns to the provider’s headquarters, show that staffing levels for the weekend when the complaint was made, did not reach the required minimum for the numbers of people in residence, and did not take into account dependency. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None None of the standards has been inspected on this occasion. EVIDENCE: Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29, The staff team are not able to carry out their duties as they would wish and are working long hours. This means that sickness is difficult to cover. This must compromise the ability of the staff team to ensure the safety of the service users at all times, and staff morale is affected. Staffing levels do not adequately take into account the dependency of some people, both physically, and due to dementia. EVIDENCE: The roster shows that the home is operating most of the time at minimum staffing levels specified in the staffing notice issued by the health authority when the home was originally registered. However, there are occasions, based on information provided by the manager, duty roster and staff, when the minimum staffing levels are not met. The last inspection highlighted this area as of concern and the Commission will consider enforcement action. The manager says there are 38 people in residence. The minimum staffing is for six carers in the morning and five in the afternoon. The manager states there are six carers on duty for the morning of the inspection. Staff on duty say there are five. The duty roster shows five carers with one other on “Induction.” The roster for the afternoon shift shows five carers but that one is marked for the kitchen. Two staff on the roster, working on the day of the inspection, have only recently been recruited. One started work on 5th May, and one started on 17th, Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 18 three days before the inspection. Although this person has worked at the home before, existing staff are under pressure from not feeling confident that their colleagues are able to fully carry out their duties and to understand the instructions they are given. Call bells for two rooms rang for 9 minutes before staff were able to answer the first of these, with the second ringing for longer than 10 minutes. At one point 5 bells rang at once. Staff were heard telling people who wished for assistance to use the toilet before lunch that they will “be with you as soon as we can.” One staff member said of a person “she can’t want to go on the toilet again, she’s only just got off.” This was said clearly and loudly and in front of other relatives in the corridor. Two residents say that there are not enough staff and one added that although it did not affect them, as they were able to do a lot for themselves it is hard for the others. Staff express concerns about the reliability of colleagues, reporting that records show people are washed but their flannels are dry, and that people with continence difficulties are not always promptly changed at night. Staff say that morale is “not good”. Staff report regularly working over their contracted hours and being tired. One person is contracted for 36 and working for 56 during the week of the inspection, including duties in the kitchen. Duty rosters also show nursing staff working long hours. Over a four-week period one nurse has worked 54 hours, 70 hours, 60 hours and 48 hours weekly. Another is shown as working 60 hours, 48 of which are on night duty. The following week the same person does three 12-hour night shifts followed by two 12-hour day shifts. The person then finishes work at 8 in the morning, and returns for a late shift the same day. This is a break of only 6 hours and is followed by another 12-hour day shift the following day. This makes a total of 76 hours. The following week the person is rostered a total of 66 hours, 48 of which are on night shift, and the final week is working 60 hours. Care plans show that some people are to be encouraged with mobility and there are exercises identified as beneficial by the physiotherapist. Staff say that they are unable to carry out instructions like this, that they do not have time to spend with residents “socially” and that on occasions people miss out on drinks. They say these difficulties are due to there being insufficient staff. The manager does not have a skills matrix for qualified nursing staff. Staff say that workers are not given sufficient time as supernumerary before they are included in minimum staff numbers. Records for two newly recruited members of staff were checked. One shows that a reference, obtained in Polish, is not translated and therefore the Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 19 manager has inadequate evidence that the person is fit to work at the home. Additionally, neither staff member has evidence of POVA clearance to prove they are fit to work with vulnerable adults. One person does not have written explanation of why they left a caring job, and one person has not photograph on file. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None None of the standards has been inspected on this occasion. EVIDENCE: Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 1 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x x x x x x x x x Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 14(2) Requirement The registered persons must ensure that assessments of residents needs are kept under review. OUSTANDING FOR MORE THAN LAST TWO INSPECTIONS WITH MOST RECENT TIMESCALE OF 30/11/04 NOT MET. The registered persons must ensure that where changes are identified, care plans are updated promptly and are consistent with assessments. The registered persons must ensure that residents and/or their representatives are consulted about the care that they need and involved in review. The registered persons must ensure that records are kept up to date.) The registered persons must ensure that residents personal and social care needs are assessed and clearly set out in care plans. The registered persons must ensure that residents health care needs in terms of nutrition are not compromised by weight Timescale for action 30/06/05 2. 7 15(2) 30/06/05 3. 7 12(3) and 15(2) 31/07/05 4. 5. 7 7 17(3) 12(1), 15(1), 16(2)(n) 12(1), 16(2)(i) 30/06/05 31/07/05 6. 8 30/06/05 Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 23 gain/loss. 7. 8 12(1), 18(1) The registered persons must ensure that sufficient time is available from staff to ensure identified needs for socialisation and mobilising are met. The registered persons must ensure that needs for input from other health related professionals are met. The registered persons must ensure that investigations required by the GP are carried out promptly so that treatment can be provided. The registered persons must ensure that each intervention made by nurses (e.g. for dressings) are recorded. The registered persons must ensure that complaints are fully investigated so that the outcome can be determined. The registered persons must review stafffing levels in the light of residents needs, and demonstrate to the Commission, and in the professional judgement of registered nursing staff, that staffing levels are adequate to meet needs in respect of health and welfare. The registered persons must ensure that the Commission is notified promptly on each occasion when staffing levels fall below those specified in the staffing notice. The registered persons must ensure that checks on working history and references are adequate to acount for reasons why the person left their last caring position and provide sufficient detail to make a meaningful decision about fitness for employment. TIMESCALE OF 30/08/05 8. 8 12(1), 13(1)(b) 12(1) and 13(1) 30/06/05 9. 8 30/06/05 10. 8 11. 16 12(1), 17(1)(a) Schedule 3, 3(k) 22 30/06/05 30/06/05 12. 27 12, 18(1) 30/06/05 13. 27 37 30/06/05 14. 29 19 30/06/05 Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 24 30/11/05 NOT MET.. 15. 29 19 Schedule 2 The registered persons must ensure that statutory staffing records are maintained at all times. 30/06/05 16. 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. 3. Refer to Standard 3 and 7 8 27 Good Practice Recommendations The registered persons should audit gaps in the assessments completed historically, and ensure information is obtained to complete the process. The registered person should ensure that care plans (particularly wound dressing plans) in current use are clearly accessible. The registered persons should carry out a skills audit of nursing staff. Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF 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 Sanford House Nursing Home I55 s15678 Sanford House v220918 (un) 200405 Stage 4.doc Version 1.20 Page 26 - 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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