Inspection on 08/05/07 for Selena House Nursing & Residential Home

This inspection was carried out on 8th May 2007.

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

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

Other inspections for this house

Selena House Nursing &... 22/04/08

Selena House Nursing &... 28/07/06

Selena House Nursing &... 29/09/05

Selena House Nursing &... 20/04/05

Selena House Nursing &... 10/11/04

Selena House Nursing &... 13/05/04

Selena House Nursing &... 12/12/03

Similar services:

The Vicarage

Fairfields Country Rest Home

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Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

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 Inspection 09:30 8 – 9th May 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000015943.V334103.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000015943.V334103.R01.S.doc Version 5.2 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 F/P01793 822982 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Yogindrananth Abhee Vacant Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (2), Terminally ill (2) of places DS0000015943.V334103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 28th July 2006 Date of last inspection Brief Description of the Service: Selena House is registered to provide personal care and nursing care and accommodates up to 28 people 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. Fees are currently £330 to £580 per week. Accommodation is provided on two floors. Residents’ 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 and there is access to a large garden to the rear of the home. 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. DS0000015943.V334103.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days on the 8th and 9th May 2007 in order to inspect all of the key minimum standards relating to care homes for elderly people. The lead inspector visited the home on both days and the Commission’s pharmacy inspector carried out a visit on the first day to review the home’s arrangements relating to the management of medication. This related to a total of 14.5 inspection hours. The lead inspector then met with Mrs Cain, the acting manager, at the end of the second day, in order to discuss the outcome of the visits. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives, the manager and staff, and visiting frail residents. A number of records were inspected, including care plans, medication records and staff records. The inspector reviewed the care of five residents in detail, four females and one male between the ages of 70 and 90. They had varying physical, social and mental health needs. Some were new to the home and others had been at Selena House for some time. The care of other residents was reviewed in less detail. Consideration was given to issues of ethnicity and diversity. Comment cards were received from eight residents’, two residents’ relatives and one general practitioner (GP) prior to the inspection and their views are incorporated in this report. The judgements contained in this report have been made from evidence gathered during the inspection and take into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? There has been an improvement in the standard of care planning, but further is required. The frequency of staff training has got better, particularly in relation to mandatory training and abuse awareness. There have been some DS0000015943.V334103.R01.S.doc Version 5.2 Page 6 minor improvements to the environment and cleaning products are now being stored safely. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000015943.V334103.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000015943.V334103.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply to this home. Some, but not all people, felt that they received enough information to be able to make a choice about moving into the home, although improvements could be made to the statement of purpose as some sections do not accurately reflect the service given. People are assessed before they move into the home to ensure that their needs can be met. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In response to the comment card question ‘Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?’ Six residents replied ‘yes’ and two said, ‘no’. One added the comment Our Mum moved into the home very quickly’ and another DS0000015943.V334103.R01.S.doc Version 5.2 Page 9 stated ‘Yes, but information not accurate’. The owner and manager need to review the current statement of purpose to ensure it is accurate and that the home is delivering the service it states. At this inspection there was no evidence to confirm that the statements relating to social activities, the content of care plans and residents involvement in care planning, were being met. Also the statement relating to confidentiality is in the form of guidelines for staff, where it should be a statement on how the home views confidentiality. Copies of the service users guide were available in residents’ rooms and also included a copy of the homes ‘terms of reference’ for residents. It was unclear when the statement of purpose or the service users guide, were last reviewed. Pre admission assessment documentation was reviewed. The registered manager, who is a registered nurse, had filled out assessment forms that were included in residents’ care plans. The assessments were satisfactory and in some cases it was evident that other relevant people were present during the assessment procedure. Other information, such as assessments from the person’s care manager was also available. Two residents were able to confirm that the manager had visited them prior to admission. DS0000015943.V334103.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Peoples health care needs appear to be addressed and they are supported to acess health care professionals, however some areas of care planning require improvement. Many, but not all residents were happy with the support they receive and the home should review these findings. Residents privacy and dignity appears to be respected. Medication is handled according to procedures that protect the safety of residents, however out of date items have been allowed to accumulate in the storage areas, which does compromise this safety. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the care plans of five residents in detail. These were generally clear, contained assessments of peoples needs and were reviewed at least monthly. DS0000015943.V334103.R01.S.doc Version 5.2 Page 11 Some aspects of care planning required improvement. For example, not all residents who had been assessed as at risk of developing a pressure sore had care plans in place to direct care and facilitate review. This was a finding of the previous inspection. One resident who had been assessed as being nutritionally risk, was recorded as steadily loosing weight. The home had ensured that a GP and a dietician had seen the person but a care plan had not been instigated in order to direct care in line with their recommendations. It had been reported that the same person had ‘blistering’ on their thigh. A wound-care assessment had been carried out, but no further information had been recorded in respect of treatment and progress. Another resident had a pressure wound reported but no record of any assessment or follow up was recorded. Some plans contained contradictory information. One person had two pressure area risk assessments that indicated different levels of risk and another’s plan contained differing advice as to how often blood glucose levels should be checked. Others contained plans that were no longer relevant as the person’s needs had changed. This would indicate that plans are not thoroughly checked when being reviewed. Not all residents who had bedrails had a risk assessment undertaken or consent obtained for their use and this was discussed with the acting manager and immediate action taken. The inspector visited the residents and found that interventions were generally in place to meet their assessed needs, such as pressure relief equipment, continence aids and manual handling equipment. Residents are weighed monthly and a record is kept. This is regularly reviewed and any action required is detailed. By their appearance, people seemed to be having their personal hygiene and grooming needs met and those who were unable to dress themselves were dressed in clothing that maintained their dignity. Records indicated that staff were prompt in referring residents to their General Practitioner (GP) when required and to other health care professionals, such as hospital consultants. All residents have an allocated GP and one visits the home weekly to see any residents with health care problems. A comment card received from the GP indicated that he was satisfied with the overall care provided by the home and that he was able to see his patients in private. Residents who returned comment cards were divided in their opinion of the support given to meet their care needs. In reply to the question ‘do you receive the care and support you need?’ Five stated ‘always’, two ‘usually’ and one ‘sometimes’ adding the comment ‘not enough staff’. One relative stated: ‘I find the staff here very good, especially Lynette (manager) if it wasn’t for her, my mum would not be alive today.’ When asked ‘Do you receive the medical support you need?’ Five said ‘always’, two ‘usually’ and one ‘sometimes’ and a relative added the comment: ‘If my mum has anything wrong, Lynette has the doctor in’. DS0000015943.V334103.R01.S.doc Version 5.2 Page 12 All eight residents who returned comment cards felt that staff listened and acted on what they say, one stating ‘Always, they are very caring’, but when asked ‘Are staff available when you need them?’ Three said ‘always’ three ’usually’ and two ‘sometimes’. Other comments received raised some concerns about staff availability. One relative commented ‘The response to the assistance alarm is often so long that the patient becomes distressed’. This issue is addressed further in the Staffing section of this report. The pharmacist Inspector looked at arrangements for the handling of medicines. Medicines were stored appropriately including controlled drugs and items requiring refrigeration. There were no residents self-medicating. Some out of date items were found including injections and sterile equipment. This could be a potential hazard if they were to be used. Blood monitoring equipment did not comply with recent safety guidelines from the Medicines and Healthcare Regulatory Authority. Medication administration records were completed and photographs and useful information about residents’ medication were kept in the file. The medicine reference book in use was from 2005; a new version should be obtained. The printed medication administration records supplied by the pharmacy contained some out of date information, which the nurses had to amend. The pharmacy records should be checked and updated. Medicines received and returned are recorded. The local pharmacy arranges the collection of waste medicines and the home should check the legality of this practice, as special arrangements need to be in place for homes registered with nursing beds. DS0000015943.V334103.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. Social activity is minimal and is not tailored to meet residents’ individual needs. Residents are able to maintain contact with family and friends and there is a commitment to help them exercise control and choice over their lives. The home provides the residents with nutritious meals in a suitable environment. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In response to the question ‘Are there activities arranged by the home that you can take part in?’ No resident responded ‘always’, one replied ‘usually’, five ‘sometimes’ and one ‘never’. One person added the comment ‘we were misinformed on this matter -- we were told activities would take place – nil’ and another said ‘we had a wonderful Christmas party, everyone enjoyed it’. Nearly all the residents spend time in the large communal lounge and the TV was on throughout the day. There were few social activities listed in the pre inspection questionnaire provided by the home and minimal social activity took place throughout the two days of the inspection. Not all residents had a plan in DS0000015943.V334103.R01.S.doc Version 5.2 Page 14 place that related to their social needs and although these documents were available in care plans, they were not always completed. One resident commented, “It’s OK here but there is not much going on” and another said, “There’s not much to do”. The home does not have an activity coordinator and conversations with residents, staff and the manager confirmed that there was limited social activity provided in the home and few opportunities for residents to get out into the local community. This has been a recurring issue in previous inspections and every effort should be made to improve the current situation and to avoid enforcement action by the Commission. Relatives were around the home at different times during the inspection and there were no restrictions on visiting. Residents confirmed that they could receive visitors in their rooms or the communal sitting room. Residents and relatives reported that they were able to keep in touch with each other. Of the two relatives who returned comment cards, one said they ‘always’ felt that they were kept up to date with important issues affecting their relative and the other responded ‘usually’. Many of the residents were dependant on staff to meet their needs however some of their comments during the inspection indicated that they had some control over how they lived their lives, with some people confirming that staff endeavoured to assisted them to go to bed and get up at the times they requested. People were are able to bring in personal items and furniture if required and some bedrooms showed evidence of personalisation. The manager reported that there were no residents who were able to handle their own financial affairs. Residents spoken to were generally complimentary about the meals available and those who returned comment cards stated that they either ‘always’ or ’usually’ enjoyed the food although one replied ‘sometimes’. The cook informs them of the choice of meal for the day and the meals provided during the inspection appeared well cooked and nutritious. The manager demonstrated a strong commitment to ensuring people received adequate nutrition. Residents were observed eating in their own rooms or in the dining room or lounge if preferred and staff were observed assisting some residents to eat and giving them sufficient time. DS0000015943.V334103.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The majority of people are aware of how to complain if they need to and staff are aware of procedures in place relating to reporting alleged abuse, and receive training in abuse awareness. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints policy and procedure is available and on view and also contained in the homes service users guide, which is available in each persons bedroom. Comment cards received indicated that residents either ‘always’ or ‘usually’ know who to speak to if they are unhappy, one comment was - ‘There is always someone available’. Seven of the eight residents who returned cards said that they knew how to make a complaint. Of the two relatives who returned comment cards, one stated that they were aware of how to make a complaint but the other replied ‘no’. One replied ‘usually’ to the question ‘has the care service responded appropriately if you or the person using the service has raised concerns about their care?’ One replied sometimes’ but did not elaborate. Review of the complaints log indicated that the home had not received any complaints in the period following the last inspection, nor had the Commission DS0000015943.V334103.R01.S.doc Version 5.2 Page 16 received any. The GP also reported that he had not received any complaints about the home. Staff spoken to demonstrated an awareness of correct abuse reporting procedures and records indicated that staff had received abuse awareness training. This is an improvement on the previous inspection. There had been one referral to the vulnerable adults unit since the previous inspection the result of which confirmed that the staff had made every effort to meet the needs of the vulnerable person. Review of recruitment records confirmed that POVA checks and references are obtained on staff prior to starting work and that enhanced CRB checks are undertaken. DS0000015943.V334103.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The home is generally well maintained but refurbishment of some areas would enhance the environment. Most of the home was clean, but some areas need more attention. People have access to communal areas, including a pleasant garden. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information supplied in the pre inspection questionnaire indicates that essential equipment and services are regualry maintained. There is a large communal lounge on the ground floor of the home with an adjacent dining room. Furnishing is of a domestic nature and the lounge benefits from a good level of natural lighting. Wheelchair access is available DS0000015943.V334103.R01.S.doc Version 5.2 Page 18 from the lounge to the rear garden, which is well kept. Redecoration of the lobby between the lounge and dining room has been carried out. The inspector toured the building. A toilet seat in the downstairs bathroom required replacement and the bath seat required cleaning underneath. This bathroom would benefit from refurbishment in order to enhance the facility for the residents. Many of the bedroom doors and doorframes upstairs are marked and gouged at their base. In the first floor bathroom, the wheels and legs of the commode chair needed cleaning, as did the base of the bath hoist.The two sluice rooms required improved cleaning and any old or unused equipment should be removed. Conversation with the manager and staff indicate that commode pots, bottles and bedpans are currently disinfected in a bath on the first floor, this was said to be carried out weekly. The manager needs to review this practice to ensure that it meets the guidelines published by the Health Protection Agency and as this is a home providing nursing care, the owner should fit an automated sluicing disinfector in order to improve protection for residents and staff alike. In response to the comment card question ‘Is the home fresh and clean?’ Six residents responded ‘always’, one ‘usually’ and one ‘sometimes’. One resident added – ‘continual smell of urine’, although the inspector’s findings and the comments of other residents did not support this. DS0000015943.V334103.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The numbers and skill mix of care staff available appears to meet the residents’ needs, although some residents views indicate that a review of staffing levels may be necessary to ensure that this is the case throughout the day. Recruitment procedure supports and protects the residents. There is a commitment to staff training although induction training needs to be improved and the number of care staff with an NVQ increased. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There appeared to be enough care staff on duty to meet the needs of the residents during this inspection, although some comments received suggest that, on occasions, this might not be the case. When asked ‘Are staff available when you need them?’ Three residents said ‘always’ three ’usually’ and two ‘sometimes’ and one relative commented ‘The response to the assistance alarm is often so long that the patient becomes distressed’ although during this inspection it was noted that staff responded promptly to bells and no residents reported any undue delays. DS0000015943.V334103.R01.S.doc Version 5.2 Page 20 One relative commented that, ‘There appears to be a high level staff turnover’. The manager agreed in part with this, but felt that there was currently a period of stability. A review of the duty rota indicated that the agreed number and skill mix of staff were on duty in relation to the homes staffing notice. Care staff spoken to felt that their numbers were adequate, but two felt that the provision of another electric hoist would enable them to provide a more efficient service. The recruitment records of four recently recruited staff members were reviewed. Record Bureau (CRB) checks had been obtained and references and Protection of Vulnerable Adults (POVA) checks had been obtained prior to the person starting employment. Other documentation required was in place. Records indicated that staff had received training in mandatory subjects such as moving and handling, food hygiene, fire safety, infection control and health and safety. 19 of the staff currently had an NVQ level 2 or above, which is below the required standard of 50 , although it is acknowledge that further staff are currently undertaking an NVQ. Staff spoken to confirmed the training they had received. There were minimal records relating to the induction training of three new staff members. DS0000015943.V334103.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the time of the report the manager was not registered with the Commission but was undergoing the ‘fit person’ procedure, however there were positive comments from people about her management of the home. Quality assurance could be enhanced by improving the quality of the monthly audits by the owner, to ensure that they take into account the views of people living in the home and by carrying out audits of clinical practice. Some health and safety measures in the home require improvement to ensure the protection of residents. EVIDENCE: DS0000015943.V334103.R01.S.doc Version 5.2 Page 22 Lynatte Cain, a registered nurse, is currently acting manager and has applied to CSCI for registration and is currently undergoing the Commissions ‘fit person’ procedure. Mrs Cain has worked in the home since 2004 and was previously deputy matron. Mrs Cain confirmed that the owner, Mr Abhee, visits the home weekly and supports her in her role. There were positive comments about the manager from residents and staff and a visiting GP felt that the home had improved under the current manager. The manager and owner need to ensure that any statutory requirements that have been carried over from previous inspections are addressed within the given timescales, in order to avoid possible enforcement action by the Commission. The quality assurance systems in the home were reviewed. The manager stated that monthly residents meetings were held and the records of these were seen. The owner, Mr Abhee, visits the home weekly and also provides the Commission with monthly reports under regulation 26 of the Care Home regulations 2001. However these reports are photocopied from month to month and the only section that varies is that relating to the review of accidents. There is no evidence to suggest that the views of the residents are reflected in these reports. It is also recommended that audits of clinical practice be introduced to enhance the current quality assurance systems. There were no service users who handled their own financial affairs. The health and safety arrangements in the home were reviewed. There were no records to evidence that monthly-checks of fire escape routes and visual checks of equipment were being undertaken, although the manager stated that they were being carried out. This issue was reported at the previous inspection. Records also indicated that not all staff had received regular fire instruction. It was noted that one resident’s bedroom door was wedged open. This was designated as a fire door and was brought to the attention of the manager who has subsequently informed the Commission that an automatic door closure has been fitted. Environmental risk assessments were in place, although it was noted that these were due for review in April 2007. Accidents were being recorded, but it is recommended that a regular audit of accidents take place in order to monitor any trends. Some comments received would indicate that the home would benefit from purchasing another electrical hoist in order to further protect staff and improve availability for residents, therefore reducing potential delay in delivering personal care. DS0000015943.V334103.R01.S.doc Version 5.2 Page 23 The temperature of cooked food had not been taken or recorded since September 2006. The cook stated that she had not been shown how to use the temperature probe. The temperature of one freezer was not being checked on a daily basis. DS0000015943.V334103.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 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 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 DS0000015943.V334103.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1) 6(1,a) Requirement Timescale for action 01/07/07 2 OP7 15 (1) 3 OP7 15 (1) 4 OP8 17 (1,a) Schedule 3 (p) The registered person should ensure that the homes statement of purpose is reviewed to ensure that it is accurate. In relation to: • Social activities provided. • The content of care plans. • Service users involvement in care planning. • The statement relating to confidentiality. The registered person should 01/06/07 ensure that care plans are in place for all service users assessed as being at risk of developing pressure damage. Partly met requirement of the inspection held 28/7/06.Previous timescale for action 07/08/06 The registered person should 01/06/07 ensure that care plans are in place for all service users assessed as being nutritionally at risk. The registered person should 10/05/07 ensure that the incidence of pressure sores, their treatment and outcome, are recorded in the service users care plan. DS0000015943.V334103.R01.S.doc Version 5.2 Page 26 5 OP9 13 (2) 6 OP9 13 (2) 7. OP12 16 (2,m,n) 8 OP19 23 (2,b) 9 OP26 13 (3) 16 (2,j) 10 OP26 13 (3) 11 OP26 13 (3) 12 OP30 12 (1) 18 (1) 13 OP38 13 (3) (4,c) The registered person should ensure that all medicines no longer in use must be sent for disposal and no expired items must be kept The registered person should ensure that arrangements for the collection of waste medication must be reviewed to ensure that it complies with the Special Waste Regulations 1996. The registered person should ensure that service users have the opportunity to exercise their choice in relation to social activity. Unmet requirement of the inspection held 28/7/06.Previous timescale for action 01/09/06 The registered person should ensure that the toilet seat in the ground floor bathroom is replaced. The registered person should ensure that the areas and equipment referred to in the report are kept clean at all times. The registered person should ensure that the current method for the cleaning and disinfection of commode pots, bedpans and urine bottles meets the guidelines published by the Health Protection Agency. As this is a home providing nursing care, the registered person should provide an automated sluicing disinfector The registered person should ensure that all new care staff members undertake induction training that relates to Skills For Care minimum induction standards, within 12 weeks of employment. The registered person is required to ensure that the core DS0000015943.V334103.R01.S.doc 01/06/07 01/06/07 01/07/07 01/06/07 10/05/07 01/06/07 01/08/07 01/06/07 10/05/07 Page 27 Version 5.2 14 OP38 23(4a) 15 OP38 13 (3) temperature of cooked foods is checked and recorded at all times. Unmet requirement of the inspection held 28/7/06.Previous timescale for action 01/08/05 The registered person is required to ensure that all fire safety checks are undertaken at the intervals recommended by the local fire authority. In relation to: • Checking fire escape routes monthly and recording. • Visual checks of fire equipment monthly and recording. Unmet requirement of the inspection held 29/09/05 and 28/07/06. Previous timescale for action 01/08/06. The registered person must ensure that the safety of staff and residents is not compromised by the use of inappropriate blood testing devices. Recent guidance from the MHRA (Medicines and Healthcare Regulatory Agency) must be followed. 10/05/07 10/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP8 Good Practice Recommendations It is recommended that plans that are no longer current be removed from care plans and stored separately. It is recommended that service users’ opinion be sought in relation to the support given to meet their medical and care needs. DS0000015943.V334103.R01.S.doc Version 5.2 Page 28 3 4 5 6 7 8 9 10 11 OP9 OP9 OP12 OP19 OP19 OP27 OP27 OP33 OP38 12 OP38 Medication administration records would be clearer if the printed information was kept up to date and required less alteration. The medicine reference book in use was from 2005; a new version should be obtained. It is recommended that extra staffing hours are made available to support the residents with social activity. It is recommended that the ground floor bathroom be refurbished in order to enhance the facility for the residents. It is recommended that the bedroom doors and doorframes upstairs are repaired or replaced as they are marked and gouged. It is recommended that another electric hoist be purchased. It is recommended that a review of staffing levels be undertaken to ensure that they meet residents’ needs throughout the day. It is recommended that audits of clinical practice be introduced to enhance the current quality assurance systems. It is recommended that self-closing mechanisms linked to the alarm system should be fitted to fire doors in instances where residents’ wish to stay in their rooms with the door open. It is recommended that a regular audit of accidents take place in order to monitor any trends. DS0000015943.V334103.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000015943.V334103.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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