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Inspection on 20/04/05 for Selena House Nursing & Residential Home

Also see our care home review for Selena House Nursing & Residential Home for more information

This inspection was carried out on 20th April 2005.

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

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

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

What the care home does well

There were favourable comments from the residents and relatives about the care and support provided by the staff. Those residents who were frail were receiving appropriate support and were clean and comfortable. Care plans and records of care were comprehensive and staff were good at assessing any possible risks to residents, such as the development of pressure sores, and then taking appropriate action. Residents were also happy with the meals provided by the home, particularly during the week

What has improved since the last inspection?

There had been an overall improvement in the cleanliness of the home and the catering had also improved. Staffing levels were more stable and care staff did not have to provide as much cover in the kitchen, which had previously been a problem. Arrangements for obtaining the checks required on staff before they start work in the home have improved, as has the level of staff training. The home had met the statutory requirements set at the last inspection regarding treating residents with dignity and respect, care planning, the use of pressure relief equipment, control of hot water and some minor building maintenance work.

CARE HOMES FOR OLDER PEOPLE Selena House 192 Oxford Road Stratton St Margaret SWINDON, Wiltshire SN3 4HA Lead Inspector Steve Cousins Unannounced 20th April 2005 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. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Selena House Address 192 Oxford Road Stratton St Margaret SWINDON Wiltshire SN3 4HA 01793 822982 01793 822982 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) Mr Yogindrananth Abhee No registered manager at time of inspection Care Home 28 Category(ies) of OP Old Age - 28 registration, with number PD Physical disability - 2 of places TI Terminally ill - 2 Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 No more than 2 physically disabled persons at any one time. 2 No more than 2 persons in receipt of terminal care at any one time. 3 No more than 20 service users in receipt of nursing care at any one time. Date of last inspection 10th November 2004 Brief Description of the Service: Selena House is registered to provide personal care and nursing care, and can accommodate up to 28 persons over the age of 65. A registered nurse is on duty at all times supported by care assistants. Support services include catering, domestic, laundry and maintenance staff. Accommodation is provided on two floors. Service users rooms do not have ensuite facilities, but all rooms have wash hand basins. The main sitting room and adjoining dining room are situated on the ground floor of the building. Selena House is located in a residential area of Stratton St Margaret, on the outskirts of Swindon. All local amenities are a short drive away. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.30am and 4.30pm on the 20th April 2005. Two inspectors visited the home. The manager was not available, however the lead inspector met with the deputy manager in the afternoon. The inspectors toured the premises and spoke to the majority of the residents and several relatives and staff members. A number of records were inspected, including care plans and staff files. What the service does well: What has improved since the last inspection? What they could do better: There is a need to improve the level of social activity available to residents as many said that there was little to do and little opportunity to get out of the Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 6 home. There were also some comments about the standard of the meals available at the weekends. The home could also benefit from further redecoration, some equipment needs to be replaced and adjustable beds provided for some residents. Levels of cleanliness had improved although there were areas that required further attention. Access in and out of the building is difficult for people using wheel chairs and needs to be improved. The home does not currently have a registered manager, which is a requirement by law, and one needs to be appointed soon. Information available, such as the service users guide and the statement of purpose, needs to be improved in order for people to find out if the home is suitable for them. There is also a need for staff to be made aware of the complaints procedure to improve recording and investigation of complaints. There was only one care assistant with an NVQ. Some arrangements regarding providing NVQ training for care staff had been looked into but training had yet to commence. These arrangements need to be finalised as soon as possible. There were three statutory requirements unmet from the previous inspection regarding the homes statement of purpose, service users guide and the complaints policy. The registered person is reminded that the CSCI will consider enforcement action should these requirements not be met within the given timescale. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2, 3 and 4. Standard 6 does not apply as the home does not offer this service. Pre admission assessment procedures ensure that admissions are appropriate. Current information available to residents does not allow them to make an informed choice as to whether the home can meet their needs, as it is conflicting and not easily accessible. EVIDENCE: The current information made available to residents and purchasers, in the form of the statement of purpose, service users guide and terms and conditions (for private residents) were a mixture of, sometimes conflicting, information and were not in a format easily understood by the reader. The registered provider should refer to the relevant guidance given in the Care Homes Regulations and the National Minimum Standards and amend the documents appropriately. Pre admission assessment documents were available in the care plans reviewed. Residents were not all able to confirm that they had visited the home prior to moving in, but many had been in hospital and stated that relatives had visited on their behalf. Two relatives confirmed this. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9. Health and personal care needs appeared to be met and comments of the residents indicated that they were receiving adequate and appropriate support from staff. The arrangements regarding medication were mainly satisfactory. EVIDENCE: Care plans seen were satisfactory and reviewed regularly. Some supplementary care plans kept in service users rooms had not been reviewed since 11/04. The need for these plans was discussed with the deputy matron. Comments of the residents and their relatives indicated that health care needs were being met. Evidence found in care records, and the observations of the inspector confirmed this. Pressure relief equipment was in use and records were kept of interventions such as position changes and fluid intake. The procedures regarding the storage and administration of medicines were mainly satisfactory, although there were not always two signatures evident for hand written amendments to MAR sheets and there were occasional gaps where medications administered had not been signed for. Residents and relatives were complimentary about the support received from the staff. Personal care was given in private and those unable to see to their own personal hygiene needs were receiving appropriate support. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Residents are supported to have control and choice in some areas of their lives, but their social and recreational needs are not being met. There are good relationships established between the home and the relatives or representatives of residents. The quality of meals provided lacks consistency. EVIDENCE: Residents stated there is little or nothing to do during the day and no activities are being provided. The home has employed an activities person for two hours per day on weekdays. There was a record of activities provided for the period 7th – 25th March but the appropriateness and quality of activities recorded would indicate that residents had not been consulted regarding activities they wanted. One resident stated that they had not been out of the home for some considerable time. Residents did state they are able to make choices about the time they get up and go to bed, and regarding meals. There has been a general improvement in the quality of meals provided at the home. Residents were complimentary about the meals provided and confirmed a choice is offered at each meal. Comments received indicated that the quality of meals at the weekend was not of the same standard found during the week. There are no restrictions on visiting times and relatives commented they are always made welcome. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is not a definitive complaints procedure and little recording and investigation of complaints. There are measures in place to protect service users from potential abuse. EVIDENCE: There were several versions of a complaints procedure. Two different ones were on display in the hallway and a further version in the service users guide. There was one recorded complaint, which had been dealt with appropriately. The person making the complaint confirmed this. The comments of a service user indicated a need for all complaints to be recorded and investigated and this was discussed with the deputy matron. The CSCI received a complaint regarding the home on the 30th December 2004. An inspector made an additional visit to the home the following day and found that the complainant’s concerns about the cleanliness of the home and the food available of an evening were justified. Statutory requirements regarding these matters were issued. The cleanliness of the home had improved by this inspection and the comments of the residents and staff indicated an improvement in the evening meals. Review of staff recruitment documents indicated that POVA and CRB checks on staff were being obtained. Two staff members confirmed that they had not commenced work before their POVA check had been received. There was also evidence that staff had undertaken training regarding protection of vulnerable adults. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26 The home is generally safe and well maintained and there had been gradual improvements in decoration and furnishings, however those areas that have not been attended to detract from the improvements made. Access for wheelchair users is poor and limits their independence. Bathing and toilet facilities are adequate and residents were satisfied with their accommodation. Cleanliness and hygiene measures had improved in most areas. EVIDENCE: Residents commented they were satisfied with the standard of accommodation although several stated they would like a lock on their bedroom door. Residents with mobility problems commented on the difficulties getting in and out of the building. The general décor, furnishings and fittings were showing signs of wear although some improvements had been made, such as replacing carpets. There was a noted improvement in the standard of cleanliness at the home however there were unpleasant odours in some rooms and a pressure mattress required cleaning. Individual tables in the dining room required cleaning and Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 13 some were rusty. The assisted bath chair in the first floor bathroom needs to be replaced. Thermostats have been fitted on all hot water taps to reduce the risk of scalding. Residents were complimentary about the laundry service and stated laundry is returned quickly after it is washed. Improvements to the laundry facility were planned. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 14 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) 27,28,29and 30 Staff levels are currently high enough, however the number of care staff with NVQ is inadequate and affects the skill mix available to meet the residents’ needs. The recruitment practices protected the residents’. EVIDENCE: The comments of the residents, relatives and staff members, allied to the observations of the inspector, indicated that there were enough care staff normally on duty. It was reported that care staff were very seldom asked to provide cover in the kitchen, which had been a problem in the past. The duty rota indicated that in most cases there was a minimum of one registered nurse on duty throughout the day, supported by five care assistants in the morning, four in the evening and two overnight. There was only one care assistant with an NVQ level 2. A local provider of NVQ training had been approached and it was hoped that a further seven care assistant would commence NVQ. There were records of mandatory training and some records of induction. It was recommended that a record is kept which would easily indicate which staff had, or had not, attended mandatory training and that induction training be more formalised to meet NTO timescales. The recruitment records of three new staff members were reviewed. All contained evidence of POVA and CRB checks, two did not contain copies of the required identification documents. Two references had been obtained in all cases, however it was recommended that, where possible, at least one of these should be from a previous employer. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The service does not have a Registered Manager. Some aspects of the health and safety arrangements are placing residents and staff at risk. EVIDENCE: The home does not currently have a manager who has been registered with the Commission. Rosemary Turner, a registered nurse who had been the registered manager in the past, presently runs the home with the assistance of a deputy, who is also a registered nurse. It was reported that the homes owner, Mr Abhee, visits the home weekly. The Commission contacted Mr Abhee prior to this inspection regarding the current management situation, stressing the need for a registered manager to be in place. There were no concerns from residents or relatives regarding the management of the home. It was noted that some residents who were receiving nursing care were in ordinary divan beds, this, along with the difficulty of getting wheelchairs in and out of the building, could compromise the health and safety of the residents and staff. Fire practices were not being held every three months. Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 16 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 1 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION 2 2 3 2 3 2 3 2 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 3 1 x x x x x x 2 Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 17 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) Requirement The registered person is required to ensure that the Statement of Purpose is amended to contain all of the information listed at Schedule 1 of the Care Homes Regulations 2001. A copy of the amended document should be sent to the Commission within the timescale stated. Requirement unmet from previous inspection held 10/11/04. The registered person is required to ensure that the Service Users Guide is amended to ensure that it includes the information listed at Standard 1.2 of the National Minimum Standards, Care Homes for Older People. A copy of the amended document should be sent to the Commission within the timescale stated Requirement unmet from previous inspection held 10/11/04. The registered person is required to ensure that nurses sign for the administration of medicines in all cases; or enter a code relating to the reason for non Timescale for action 1/6/05 2. OP1 5 (1) 1/6/05 3. OP9 13 (2) 17 (1,a) 19/4/05 Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 18 administration 4. OP16 17 (2) 22 The registered person is required to ensure that there is only one version of the homes complaint policy, which complies with regulation 22 of The Care Homes Regulations, 2001. Requirement outstanding from previous inspection held10/11/04. The registered person is required to ensure that all staff are aware of the complaints procedure and receive training with regard to the handling of complaints. The registered person is required to consult with residents regarding what social activities are provided. The registered person is required to ensure that the quality of meals provided is consistent. The registered person is required to replace/repair the individual tables in the communal room that are rusty. The registered person is required to replace the assisted bath chair in the first floor bathroom The registered person must obtain an assessment from a person qualified, regarding the wheelchair access to the front and rear of the building and impliment any changes identified. The registered person is required to ensure that all parts of the home are kept clean and free from odour. The registered person is required to ensure that a minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) is achieved. The registered person is to ensure that all documents 1/6/05 5. OP16 17 (2) 22 1/7/05 6. OP12 16 (2,n) 1/5/05 7. 8. OP15 OP20 16 (2,l) 23 (2,c) 20/4/05 1/6/05 9. 10. OP21 OP22 23 (2,c) 13 (4,a,b,c) 1/6/05 1/8/05 11. OP26 23 (2,d) 20/4/05 12. OP28 18 (1,a,b,c,i) 31/12/05 13. OP29 19 (1,b) 20/4/05 Page 19 Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 14. OP31 8 (1,2) 9(1,2 ) 15. OP38 OP24 16 (1,2,c) 16. OP38 23 (4,e) required in respect of persons working at a care home, as detailed in Schedule 2 of the Care Homes Regulations 2001, are available. The registered person is to 1/6/05 appoint a manager who meets the requirements of Regulation 9 of the Care Homes Regulations 2001 and Standard 31 of the National Minimum Standards, Care Homes for Older People; and apply for their registration to CSCI The registered person is required 1/7/05 to ensure that adjustable beds are provided for those receiving nursing care. The registered person is required 20/4/05 to ensure that fire drills are carried out every 3 months. 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. 4. 5. 6. Refer to Standard OP7 OP9 OP24 OP30 OP30 OP29 Good Practice Recommendations It is recommended that the need for supplementary care plans (kept in bedrooms) is reviewed. If these are in place, they need to be reviewed monthly. It is recommended that any handwritten amendments/additions to the medication administration records have two witness signatures. It is recommended that residents are consulted regarding their wishes to have locks fitted to their bedroom doors. It is recommended that a record is kept which would easily indicate which staff had, or had not, attended mandatory training. It is recommended that the current induction programme is reviewed to ensure it meets the NTO training targets. It is recommended that for good recruitment practice, where possible, at least one staff reference should be obtained from a previous employer. D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 20 Selena House Commission for Social Care Inspection Suite C, Avonbridge House Bath Road CHIPPENHAM Wiltshire SN15 2BB 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 Selena House D51 D01 S15943 Selena House V221268 200405 Stage 4.doc Version 1.20 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!