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Inspection on 29/09/05 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 29th September 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. Residents` were receiving appropriate support and those who were very frail had their hygiene needs met and appeared comfortable. Care plans and records of care were good and staff were good at assessing any possible risks to residents, such as the development of pressure sores, and then taking appropriate action. Action was also taken to ensure residents` health needs were addressed.

What has improved since the last inspection?

A `satisfaction questionnaire` has been introduced in order to find out residents views about the home and monthly meetings are also held. There have been no complaints about the home this year. Staff training has improved and is more structured. There are more care staff who have obtained, or are undertaking NVQ. The recording of medicine administration has improved and the homes service user guide is now a lot clearer. Wheelchair users can now get in and out of the building more easily and there had been a general improvement in the decoration of the home and some of the furnishings. New laundry equipment has been provided.

CARE HOMES FOR OLDER PEOPLE Selena House Nursing & Residential Home 192 Oxford Road Stratton St Margaret Swindon Wiltshire SN3 4HA Lead Inspector Steve Cousins Unannounced 29 September 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 Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Selena House Nursing & Residential Home 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 Vacant Care Home with Nursing 28 Category(ies) of OP Old age 28 registration, with number PD Physical disability 2 of places TI Terminally ill 2 Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No more than 2 physically disabled persons at any one time No more than 2 persons in receipt of terminal care at any one time No more than 20 service users in receipt of nursing care at anyone time Date of last inspection 20 April 2004 Brief Description of the Service: 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. Accommodation is provided on two floors. Residents rooms do not have ensuite facilities, but all have wash hand basins. The main sitting room and adjoining dining room are situated on the ground floor of the building. There is an accessible garden to the rear of the home. 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. The home is privately owned by Mr Y Abhee, who also owns another home in Purley, Greater London. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.15am and 4.30pm on the 27th September 2005. There were 25 residents in the home. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives, staff, deputy matron and the owner; and visiting frail residents. A number of records were inspected including care plans and staff files. Service users are known as residents in this home and will be referred to as such throughout this report. The findings were discussed with Mr Abhee, the owner, and Lynetta Cain the deputy matron, at the end of the inspection. What the service does well: What has improved since the last inspection? A ‘satisfaction questionnaire’ has been introduced in order to find out residents views about the home and monthly meetings are also held. There have been no complaints about the home this year. Staff training has improved and is more structured. There are more care staff who have obtained, or are undertaking NVQ. The recording of medicine administration has improved and the homes service user guide is now a lot clearer. Wheelchair users can now get in and out of the building more easily and there had been a general improvement in the decoration of the home and some of the furnishings. New laundry equipment has been provided. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 6 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. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 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 Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 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) 1,3,4 and 5. Satndard 6 dose not apply to this home. Potential residents have the information available and the opportunity to make an informed choice about where to live. Residents’ needs are assessed prior to admission and the home has the capacity to meet those needs. EVIDENCE: The home has a statement of purpose and a service users guide, both have been updated since the previous inspection. Pre admission assessment documents were available in the care plans. A new resident confirmed that they had been visited prior to admission for assessment purposes. Not all residents had the opportunity to visit the home prior to moving in; some had been in hospital and stated that relatives had visited on their behalf. Selena House is registered to provide nursing and residential care for up to 28 elderly people. The environment is suitable and the adaptations and equipment appropriate. The positive comments of the residents and the inspectors observations indicate that the home has the capacity to meet the needs of the client groups. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 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) 7,8,9 and 10 The standard of personal and health care delivered meets the assessed needs of residents, their privacy is respected and they are treated with respect. The systems for the handling of medication ensure that the residents are protected. EVIDENCE: Care plans seen were satisfactory but not all assessments had been dated and/or signed. Comments of the residents and their relatives indicated that health care needs were being met and records indicated that GP’s and other health care professionals were consulted. Pressure relief equipment was in use and records were kept of interventions such as position changes and fluid intake. There was good evidence to suggest that staff were meeting the needs of a resident with challenging behaviour and that advice had been sought from appropriate professionals regarding the resident’s management. Residents spoken with were complimentary about the staff. One stated that they were ‘settled and safe’ another said that ‘the staff are lovely’. Four satisfaction questionnaires received in August and records of residents meetings indicated that residents were satisfied with the home. Their further comments, allied to the observations of the inspector, indicated that staff endeavoured to respect residents privacy and dignity. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 10 Procedures regarding the storage and administration of medicines were generally satisfactory and there had been an improvement in the recording of drugs administered. One discrepancy regarding the administration Temazepam during July was discussed during the inspection. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 11 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 and 13. Residents’ social and recreational needs are not always met but they are able to maintain contact with friends and relatives. EVIDENCE: The home does not have an activity coordinator and some residents felt the home was a bit quiet. Some in-house activities were held but these were infrequent and residents are not consulted about what social activity they would like. However, fifteen residents, along with carers and relatives, had recently enjoyed a visit to Bourton-on-the-Water. A more structured activity programme may enhance the current level of social activity. Residents were able to maintain contact with friends and relatives and there were no restrictions on visiting, unless at the request of the resident. They could receive visitors in private or in one of the communal areas. Visitors were present in the home throughout the inspection. Residents stated that they were happy with the meals provided in the home however this standard was not fully assessed during this inspection. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 12 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 A complaints procedure is in place that should ensure complaints are dealt with appropriately. Staff have an awareness of abuse issues and the homes policies and recruitment procedures ensure residents are, as far as possible, protected from abuse. EVIDENCE: The complaints procedure has been amended since the previous inspection and was on display in the home. There had been no formal complaints to the home or CSCI since December 2004, which is an improvement, and there were no complaints from residents or relatives during the inspection. A relative said they had approached the owner with a concern regarding a bedroom which was ‘dealt with straight away’. A selection of staff recruitment files indicated that POVA checks had been obtained prior to staff commencing work. CRB checks had been obtained, along with references and identification documents. Records indicated that staff received training in abuse awareness, which was allied to local procedures for the reporting of alleged abuse. Staff spoken with confirmed this and showed an awareness of abuse issues. Systems are in place with regard to the handling of small amounts of residents’ money. These could be enhanced by routine checks by the registered provider. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 13 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 and 26 The home is generally well maintained and improvements have been made with regard to furnishings and decoration. Cleanliness and hygiene measures are satisfactory in most areas. EVIDENCE: Wheelchair access to the front and rear of the home has been improved and new commode chairs had been purchased. There was a general improvement in residents’ rooms, including some new curtains and carpets and evidence of redecoration in areas. Some dining room chairs were very worn and require replacing. Rooms 12, 21 and 23 needed some redecoration. A staff room has been converted into a storage area for wheelchairs and hoists. Maintenance files indicated that an electrical wiring certificate was required this year. The homes water systems had been checked for Legionella, hoists, lift and call bells had been serviced, a current gas safety certificate was available and electrical equipment had been PAT tested. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 14 The home was generally clean, tidy and odour free, however there was a strong odour confined to one area of the home and methods to control this were discussed with the owner. New laundry equipment had been installed but tiling work needed to be completed. The assisted bath chair in the first floor bathroom needs to be recoated or replaced. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 15 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, 29 and 30 Staff levels are currently high enough, they receive training and the number of care staff with NVQ has improved although more are required to fully meet the standard. The recruitment practice protects the residents’. EVIDENCE: The comments of the residents, relatives and staff members, allied to the observations of the inspector, indicated that there are enough care staff members normally on duty. 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. Cooks were employed to cover weekdays and weekends but catering assistants were not always available, this was discussed with the owner. A laundry person and a cleaner are also available each day. Records indicated that staff received mandatory and induction training covering manual handling, health and safety, food hygiene, infection control and abuse awareness. Three staff members had obtained an NVQ2 and two others were starting a course during October 2005. There are two staff with an overseas nursing qualification working as care assistants. Care staff members spoken to confirmed that they had received training and stated that they enjoyed working in the home. The recruitment files of new staff members were reviewed. The recruitment procedure was satisfactory and all appropriate documentation was in place. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 16 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) 30, 33 and 38 The service does not have a registered manager but satisfactory interim arrangements are in place. The residents are consulted about their views on the service. Some aspects of the health and safety arrangements, particularly fire safety, are placing residents and staff at risk. EVIDENCE: The home does not currently have a registered manager. The deputy matron, Lynetta Cain, a registered nurse, has responsibility for the day-to-day running of the home and the inspector acknowledges her efforts in maintaining the overall improvement. The owner, Mr Abhee, visits the home weekly and supports her in her role whilst efforts to recruit a manager continue. Satisfaction questionnaires had been given out in August and monthly residents meetings are held and recorded. Issues discussed include the service provided by the home and there was evidence to suggest that action was taken in response to residents’ comments. Mr Abhee undertakes monthly visits in accordance with Regulation 26. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 17 A tour of the home indicated that it was generally free from health and safety hazards, however the cupboard containing hazardous substances (COSHH) was unlocked. The fire log indicated that checks were not being carried out at the required intervals, records of staff fire training were incomplete and the fire risk assessment required updating. A fire door was found propped open. These issues were discussed with the owner following the inspection. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 3 x x x x 2 Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 19 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 OP 12 Regulation 16 (2,n) Requirement The registered person is required to consult with residents regarding what social activities are provided. Requirement outstanding from inspection held 20/4/05. The registered person is required to ensure that an elecrical wiring safety certificate is obtained and a copy sent to the CSCI. The registered person is required to replace or recoat the assisted bath chair in the first floor bathroom. Requirement outstanding from inspection held 20/4/05. The registered person is required to ensure that all parts of the home are kept free from unpleasant odour. The registered person is required to ensure that the laundry walls are tiled to ensure they are readily cleanable. 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 Timescale for action 29/09/05 2. OP 19 13 (4,a) 01/12/05 3. OP 21 23 (2,c) 01/12/05 4. OP 26 23 (2,d) 29/09/05 5. OP 26 13 (3) 16 (2,j) 18 (1,a,b,c,i) 01/11/05 6. OP 28 31/12/05 7. OP 31 8 (1,2) 01/12/05 Page 20 Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 9 (1,2) 8. OP 38 13 (4) 9. OP 38 23 (4,a) 10. 11. 12. OP 38 OP 38 OP 38 23 (4,d) 13 (4,c) 23 (4,a) 23 (4,a) 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 to ensure that all hazardous substances (COSHH) are stored safely. The registered person is required to ensure that all fire safety checks are undertaken at the intervals recommended by the local fire authority. The registered person is required to ensure that all staff attend fire safety training annually. The registered person is required to ensure that the homes fire risk assessment is updated. The registered person is required to ensure that fire doors are not propped open. 29/09/05 29/09/05 29/09/05 29/09/05 29/09/05 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 OP 7 OP 9 OP 12 OP 18 OP 19 OP 19 Good Practice Recommendations It is recommended that assesments contained in care plans be signed and dated by the person completing them. It is recommended that two persons, one of whom is a registered nurse, sign for and witness the administration of temazepam. It is recommended that a person responsible for arranging social activities for residents be appointed. It is recommended that the registered person routinely undertakes checks of residents money held in the home. It is recommended that the older dining room chairs be replaced. It is recommended that rooms 12, 21 and 23 be DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 21 Selena House Nursing & Residential Home redecorated. Selena House Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 22 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 Nursing & Residential Home DD51_D01_S15943_SELENAHOUSE_V247221_290905_STAGE4.doc Version 1.40 Page 23 - 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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