Inspection on 24/05/09 for Silk Court Nursing Home

This inspection was carried out on 24th May 2009.

CQC found this care home to be providing an Adequate service.

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

Silk Court Nursing Home 04/08/08

Silk Court Nursing Home 18/09/07

Silk Court Nursing Home 03/04/06

Silk Court Nursing Home 27/07/05

Silk Court Nursing Home 04/05/05

Silk Court Nursing Home 12/10/04

Silk Court Nursing Home 10/05/04

Silk Court Nursing Home 16/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR Lead Inspector Anne Chamberlain Unannounced Inspection 24th May 2009 09:00 DS0000007367.V375606.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silk Court Nursing Home Address 16 Ivimey Street Bethnal Green London E2 6LR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7729 6490 020 7739 6023 bonita.witt@anchor.org.uk www.anchor.org.uk Anchor Trust Mrs Maricor Balinbin Care Home 51 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (51) of places Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only : Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE (Maximum number of place: 12) The maximum number of service users who can be accommodated is: 51 29th December 2008 Date of last inspection Brief Description of the Service: Silk Court is a care home providing accommodation personal, nursing and dementia care for up to 51 older people. However only 12 places are for dementia care. The home is registered to meet the needs of residents who require nursing or enhanced residential care. Silk Court is owned and operated by Anchor Care Homes, which is a voluntary sector care provider. The home is located in Bethnal Green, close to shops, the post office, local amenities, bus routes and rail and underground stations. The home was opened in 1994 and is purpose built. The premises are three-storey and contain passenger lifts. All the bedrooms are single occupancy and have en-suite facilities. There is a limited amount of parking space at the front of the building and a patio area for sitting. The current fee range for the home is £450-£650 per week. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The inspection was carried out on behalf of the Care Quality Commission and the terms ‘we’ and ‘us’ are used throughout. The inspection was carried out over two days, a Sunday and a Tuesday. Two inspectors inspected on the first day and one on the second. We viewed the files of six residents, we spoke with residents, relatives and staff and we were assisted by the manager and her deputy. We inspected the environment, including the kitchen, and the arrangements for the administration of medication. We also viewed key documentation and records, including records of staff training. We would like to take this opportunity to thank the residents, relatives and staff of Silk Court for their co-operation and assistance with the inspection. What the service does well: The manager and her deputy have a good working partnership. The bathrooms and toilets at the home are satisfactory. The indoor activities at the home are well developed. Complaints and protection issues are well processed. Staff training is well managed at the home. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 7 order line – 0870 240 7535. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have an assessment before admission but this could be improved. The home does not generally offer intermediate care. EVIDENCE: We viewed the files of six randomly chosen residents. They all contained assessment information gathered prior to admission. However one assessment we considered to be poor. The service user view was not completed and under the heading ‘Can the Home Meet the Needs’ was entered just two words ‘Residential Placement’. Under the Main Aims of the Placement, heading were no specific outcomes just the words ‘Residential Placement’. The assessments should be appropriate for service users to sign but contained abbreviations like Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 10 Hx for history and 2x for two times. Under controlling body temperature was entered “able to inform the weather conditions”, we felt that this was not meaningful. Description of any nursing care needed had been left blank. The assessment had not been signed by the family and no reason was given for this. The assessment had been completed by the manager of the home. Once a person is admitted to the home there is no more social assessment, although Waterlow charts and health monitoring forms are completed. The home has not taken up the recommendation made at the last inspection of using the MUST nutritional assessment tool. The home does not generally offer intermediate care. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were individual care plans of an adequate standard, health care and medication practice were also adequate. Respect and privacy were not fully upheld. End of life arrangements had been addressed. EVIDENCE: All service users had numbered care plans and these also had individual evaluation/review sheets. In addition there were monthly review sheets to review the care plans according to their identifying numbers. However we were concerned to see written an entry ‘Care Plans All – No changes’. We found this an unacceptable short cut and found it hard to believe that that all the individual care plans had actually been properly reviewed. One sheet stated ‘No changes’ four times in 2009. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 12 A resident had been noted to have lost a significant amount of weight, with loss of appetite and had been referred to her GP and the dietician. Review documentation on 19/11/2008 stated that the service user needed ‘one to one prompting to encourage and stimulate her mentally’. However there was no evidence that the care plan’ had been updated to reflect this. A review on 29/11/08 stated, ‘no changes to the care plan. A review on 21/3/09 stated “will converse with peers, can be confused at times no other changes at present”. There was no evidence that one to one interaction had been given to the resident. On another file we noted that there were many care plans dated 2007, these make it difficult for care staff to access the forms they need and should be cleared out. We found the paperwork generally quite overwhelming, as so many different care plans had been created. Some of the care planning was excessive for example one personal care plan had eleven elements including one for testing the temperature of washing water. Another stated that toiletries should be kept out of reach and the domestic trolley is to be locked away in the Control of Substances Hazardous to Health (COSHH) cupboard, with the expected outcome to maintain safety and minimize hazardous accident. This is not an individualised plan but describes the health and safety practice in the home. Another care plan for personal hygiene stated that the carer would ‘clean the shower room after using it’ – this is normal practice and not individualised to one resident. We noted that a care plan stated that a resident was ‘suffering’ from left sided weakness. These days the less emotive term ‘experiencing’ is favoured. We noted that a Waterlow chart scored 9 under special risks with paraplegia and major surgery below the waist making up this score. The resident has a hip replacement and uses a Zimmer frame. We felt that this high score was not justified and the manager agreed. The falls risk assessment stated that the resident is continent of urine. The care plan for elimination states that the resident is totally incontinent. When we queried this the manager agreed that the resident is occasionally incontinent of urine. A care plan states that the assistance of two staff is needed for transfers, but the falls risk assessment states that one person is needed. An alert sheet for the above resident dated 29/05/09 identified that he had been sun burnt, however this information had triggered no changes in the care plan, which could have advised a sun hat, protection cream etc. We noted that falls clinic was spelt ‘Klinic’ on an annual review form. This is misspelling to the point of confusion as to what is actually being discussed. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 13 A monthly physical checklist stated a blood pressure of 145, there was only one reading and no indication of whether this was systolic or diastolic. The pulse had gone from 57 – 84 a significant rise which appears not to have triggered any response. The temperature was stated at 54 which is a totally nonsensical figure. On another care plan no ethnic origin had been recorded on the personal details. We noted on one form that religion is asked for twice! This could lead to confusion. We noted on another Waterlow chart that a resident’s score had dropped from 11 to 4 on one section. There was no explanation for this and we could see no reason for it. Neither could the manager. One resident had had her pulse taken and it was 47. This is very low but the pulse had not been taken again. A resident had recorded a blood pressure of 189 over 114. This is very high but we could find no information on file to show us what had been done about this high blood pressure. A carer told us that he would have referred the resident to her doctor, but he had not taken the blood pressure on the day, and there was no evidence to suggest this action had been taken. We noted that a care plan had been made for myocardial infarcts with an expected outcome ‘for resident X to be free from myocardial infarcts’, which is unrealistic. The care plan for rheumatic mitral valve disease referred to CVA which a carer might not be familiar with. Cerebral vascular accident is the medical term for stroke. The care plan needs to explain that the resident has right sided weakness. A resident was doubly incontinent according to their care plan but was not correctly scored for this on their Waterlow chart. The elimination care plan had no mention of a catheter but Waterlow and falls assessment state urinary catheter. The falls risk assessment states ‘had catheter in situ and incontinent of faeces’. The client has not got a catheter. We noted one resident had signed a form twice, once to say he could selfmedicate and once to say he needed support with medication. This resident does indeed need support with medication. We suggest that if this happens the form be destroyed and a new one used. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 14 A risk assessment for pressure sores had been created but made no mention of barrier creams. We had received information prior to the inspection that a certain resident is often heard to call nurses with no response from them. On the first day of the inspection we heard this resident calling from her room at about 2.30p.m. We went to see her. She is bed bound and extremely dependent. We asked her what she needed. She said that she was uncomfortable having had her position raised to eat her lunch, and wanted to have her bed put down so that she could lay flat. She said that she had asked the person who cleared her plates to put her bed down, but she had not done it. We asked if she had used her nurse call alarm and she said that she had, more than once. We tested the alarm which did not ring. We called the nurse and asked her to attend to the resident and we reported the alarm not working. The nurse checked it and found that the plug was slightly pulled out of the socket in the wall, disconnecting the alarm. She pushed it in again. On the second day of the inspection, two days later, we again visited this resident. She had visitors with her. We asked the resident how she felt about the service at the home. She said that some things are alright but some are not and that she felt that since Christmas there had been a shortage of staff and this resulted in her having to wait a long time for attention. She said that “some staff are alright but some are a bit aggressive” and that “if they would be a bit more amicable you would feel better”. She said that she cannot recover any object which falls to the floor and she feels that staff “get the needle” when she has to ask them to recover things. The resident further stated that she has been told to ask carers their name if they are unpleasant but that she has been told by carers on several occasions “I haven’t got one”. The resident said she had been called a liar on more than one occasion and it hurt her very much. She was clearly upset and became tearful. Carers do wear a name badge but the names are not in large print and would be hard for residents to decipher. We tested the residents alarm bell which again did not work. We checked the resident’s nurse alarm call and found it in the same position as before, not quite connected but not obviously out of the socket. The cable to the socket is not tight, there was slack in it and there was also cable in the bed where the alarm button was. We did not believe that the resident had pulled the plug from the wall and were very concerned that the disconnection was not accidental. We informed the manager of our fears. We noted a half empty 500 gms jar of Sudacream in a residents en suite bathroom, which was dated 22/8/2008. This cream seems to have lasted longer than one would expect which suggests it may not be being applied Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 15 routinely. The jar had no label to say where the cream should be applied, so staff have no guidance. In another room we found an unlabelled jar of Sudacream. If a resident needs this cream then the manager can request that the general practitioner (GP) prescribe it, and the pharmacy label will state where it is to be applied. In a room on Satin Unit we noted Sudacream in a bathroom along with two tubs of white soft paraffin dated December 2008 and January 2009. The December tub had not been finished. In this resident’s wardrobe were two unopened tubs of sudocream and two of petroleum jelly. A stock like this indicates over ordering. Another resident had Diprobase, Sudacream and Drapoline stored in their room, none of which had been prescribed. The home should advocate with the GP for these preparations to be prescribed if they are needed. Another resident had a tub of Sudacream in his room which had not been prescribed. Another resident had two aqueous creams which had not been prescribed. In another room there was a tub of prescribed thickener on the resident’s table. We noted on the MAR chart for one resident that there were fourteen gaps where her Thick and Easy had not been signed for. On checking the records of a diabetic service user there were three incidences when insulin had been given (as demonstrated on diabetes monitoring green sheet) but not signed for on the medication chart. We noted on the residential floor the British National Formulary (BNF) was dated March 2007. A recommendation was made at the last inspection that out of date BNF books be replaced with current publications. The BNF should have been replaced with the March 2009 edition. This recommendation has not been complied with. However it should be noted that the Nursing floor had the March 2009 edition of the BNF. The door to a bedroom was wide open although the resident was in the course of receiving personal care and was wearing only a T shirt and incontinence pad. This was not dignified or private. Under health we have reported on a resident who seems to experience lack of response and non-amicable interaction with carers, we do not feel that demonstrates respect and dignity. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 16 The files of service users are left out on a trolley in a communal space. Residents or visitors could pick out a file and read it if staff were not around. The previous inspection carried a restated requirement that residents information must be kept confidential to respect their privacy. It has not been met. One service user had been referred to in her review minutes as ‘Miss’, however she is a widow and should be referred to as ‘Mrs’. We noted from the files we inspected that end of life wishes are addressed, Under End of Life there was a family opinion that a resident should not be resuscitated. The resident had not been consulted. We have spoken to this resident and found her to be orientated, rational and very able conversationally. We can see no reason why she should not be consulted for her views on her own end of life care. We noted that End of Life decisions asks ‘Would you like to give instructions about the arrangements to be made towards the end of your life, for example, spiritual support or special visitors. An entry stated “Resident X says if his general health deteriorates whilst living here he would rather stay here. He would not mind if there were any chances for him”. This had already been pointed out to the manager at the last inspection who had agreed then to amend it, as it is not meaningful. Another entry stated ‘Resident X would like a spiritual support no’, again we did not understand what this means. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities in the home are developed, visitors are welcomed and meals are well cooked and presented. EVIDENCE: We noted displayed in the reception of the home a list of birthdays for the month of April. The date was 24th May but no birthdays for May had been displayed. There was a list of ‘staff on duty today’, but it did not state the date. Whenever we have visited at the home we have seen visitors and they are made welcome by the home. We spoke with the home’s activities co-ordinator. She has no assistant but does work full time and the staff assist her. She said there is normally an Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 18 activity am and pm every day. The co-ordinator said quizzes are quite popular and some residents who have dementia answer a lot of questions correctly. She said that quizes spark off discussions. Exercise class is a popular activity with ball throwing and balloon batting very popular. Once a year there is a reminiscence day when residents who have died are remembered. The coordinator attends the national organisation NAPPA meetings. We asked about residents going out into the community. One resident goes out independently and the activities co-ordinator takes people out with her on shopping trips. Staff also take people out occasionally if they are shopping for toiletries etc. The activities co-ordinator told us that they try to give residents turns so that no-one is left out. It is obvious that some people would like to go out more. We are sorry that with their current staffing ratios the social need of community contact cannot be included in residents care plans, and provided. The manager stated that the home had held a Barbecue the week before and individuals had the option to attend, or just have the food indoors if they preferred. The chef and the residents meet every three months to prepare a rolling menu programme. This is posted up in the reception and in the dining room. On the first day of the inspection the menu stated roast chicken and this is what the cook was making. We noted she was preparing the roast potatoes herself. On the second day of the inspection we observed service users eating their lunch and they seemed to be enjoying it. We noted that two residents were having omelettes which was their preference, again they had obviously enjoyed the meal, having nearly cleaned their plates. A tray service is available for people who choose to eat in their rooms. The manager stated that there is an after hours service. The nurse in charge has the key to the kitchen and service users can have sandwiches, biscuits and fruit or toast and butter, if they want a snack. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are listened to and taken seriously. Concerns are dealt with appropriately through the established polices and procedures. EVIDENCE: The manager stated that the complaints file went missing in September 2008. She was able to restore some of the previous information from copies she had kept for herself. She has also started another folder and twenty-three complaints had been logged since September, 2008. These complaints were well recorded and the complaints procedure had been followed. Whilst we were with the manager a relative came into her room to commend the staff and thank them for checking on her mother whilst she was in hospital. The manager told us that staff often visit people in hospital particularly if they think they are not eating well. The number of safeguarding alerts in the home has been high since the last inspection and the commission has worked with the home on several of them. We have been satisfied that the processing of safeguarding alerts has been robust and the home has followed its own policy, and that of the local authority, London Borough of Tower Hamlets. The manager and her deputy Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 20 said that a percentage of the safeguarding alerts had been unsubstantiated and some really were complaints and not safeguarding matters. We felt that there is a level of dissatisfaction with the service with some service users and relatives as well as more serious issues which have been processed as safeguarding alerts. The manager and her deputy are managing the safekeeping of service users monies. They are responding to any requests for cash promptly and following the home’s usual system with receipts and petty cash vouchers. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, clean in parts, and reasonably well maintained. However there were many shortfalls in terms of pleasant homeliness. EVIDENCE: We inspected the premises. The environment which the service users live in is generally safe and well maintained, but looking rather tired now. There were a number of issues which we brought to the attention of the manager. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 22 In an identified room there was faeces smeared on the wall by the bed, the floor of this room was sticky with crumbs. In Satin unit the optical notes for a resident were on a dresser in the lounge, along with a Tegaderm dressing, not prescribed for any individual. Also on the dresser was an empty aromatherapy vaporiser box and a screwdriver. On the dresser there was a spigamometer (blood pressure machine). This should be stored away when not in use. There were two sheets of dietary information on a resident who passed away some time ago. In every bedroom we visited we noted numbers of cardboard boxes of incontinence pads. We asked the manager why they were stored in this way. She explained that she has the option to order pads once a month or once every three months. She said she found that when they ordered once a month they tended to run out too soon, but when they order for three months this does not happen. She said the calculations are made by the incontinence nurse. As the pads would present a fire risk if stored all together they are distributed around the rooms. We felt that this was not pleasant or homely for residents and would encourage the manager to engage in a frank and professional discussion with the incontinence service, explaining how the abundance of pads is detracting from a homely environment. Perhaps pads could be ordered once a month with a fall back supply to prevent running out. In the hairdressing salon there were stored black bags of old clothes and items of furniture. The ceiling had an electrical fixture where the cables were exposed. The hairdressing salon was not maintained in a proper state for service users. The treatment room had a bin with no lid. The flower vase on a table in one dining room was dirty. On the first floor the kitchen unit doors were greasy. We found the environment of the home very disappointing and had the impression that things were kept around for the convenience of the staff rather than to present a homely, comfortable appearance for the residents. Communal parts of the home were not particularly clean. We noted the wooden parts of chairs were sticky and dirty and we felt that many of the carpets needed shampooing. However all the bathrooms and toilets were clean, and the home generally was free from mal odours. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 23 There were several shortcomings which were picked up on the tour of the environment which have been reported under standard 38. The manager stated that at present in the home there were no pressure sores, no MRSA and no C diff infections. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We are concerned that the nursing cover for the home has been reduced since the last inspection, from two nurses per shift to one on the nursing unit only. There is therefore only one nurse on duty in the home at any given time. At a safeguarding meeting for a resident in the home their GP expressed the view that the nursing care in the home had deteriorated since this reduction. We were told that this staffing level is Anchor policy and cannot be increased by the manager of the home. We feel that the shortcomings which have been identified in care plans and health and safety monitoring and recording may be attributable to the low level of nursing care in the home. We strongly recommend that this policy be reviewed at a senior level. In discussion with the manager she disclosed that bank staff do not read care plans before assisting with residents. We were concerned about this and the manager stated that it is more important for bank staff to assist busy staff who Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 25 are working with service users, than to read the care plans, which they can do later. We recommended it might be helpful for there to be a sheet where the basics of care plan needs are stated in bullet point form. The manager has undertaken a check of the staff files to ensure that all necessary recruitment checks have been made. She has discovered some gaps, one nurse who has been at the home for years had no Criminal Records Bureau (CRB) disclosure on file, another had a CRB with no Protection of Vulnerable Adults (POVA) check on it. The manager is working with human resources to obtain the necessary documents to fill these gaps. We are glad that this important work is being done. However it is time consuming and we felt it could be undertaken by an administration worker rather than the manager. At the last inspection in January 2008 we made a requirement that checks with previous employers contain the dates which the applicant has claimed to have worked with them. The manager stated that Anchor are still considering this, as a decision would have to be made for the whole organisation, and the manager cannot deviate from national practice in her own home. We are disappointed that Anchor have been so slow to follow this very obvious suggestion to improve the safety of their recruitment practice. The requirement will not be restated as it is apparently beyond the power of the manager to meet it. We looked at the record for staff training. The home is going to use interactive computer software for some of its training in future. Trainees will be given a shift in the office to complete the training. The home was able to evidence a pro active approach to keeping carers training in core basics up to date. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 35, 37 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is being supported to discharge her duties. Residents best interests are considered in the running of the home. Their financial interests are safeguarded. Health and safety are only adequately protected. EVIDENCE: The manager is currently receiving help from two other managers within the group. One is calling one day a week and the manager was not sure how often the other manager will come. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 27 The manager and her deputy have had a period without an administrator as she is on sick leave. She is however calling in one day a week to undertake certain tasks. The manager and deputy have been managing most of the administrative work themselves but are having some help from bank staff now. The maintenance man is also on long term sick leave and the home is receiving some help from the maintenance man for another Anchor home locally. The home has a health and safety calendar and certain tasks are performed each month to keep health and safety matters up to date. We checked the records for Gas which was checked on 21.5.09 and the Lift which had been inspected on 12/2/09. The fire inspector came on 11/2/09 and checked the extinguishers but the manager said his report has not come through yet. On March 10th 2009 the London Borough of Tower Hamlets made an inspection and recommended the lift be examined but the manager stated, this had already been done. The manager stated that the fire alarm is tested every Wednesday, including the smoke alarms. The fire exits are also checked by staff to make sure they are clear and working. Fire drills are overdue, the last one having been done in May last year. Most COSHH items are stored in a locked cupboard and the manager had data sheets and risk assessments for the items, however some COSH items were also inappropriately stored. There was a quantity of Ensure drinks in an unlocked low level refrigerator on the top floor. These drinks are prescribed and should be locked away. There was no lid on the bin in a bathroom opposite Cotton unit lounge. On the first floor we found an aerosol of wound irrigation fluid dated 27/01/2009, on a side table next to a pot plant. This is not appropriate storage as the aerosol should be stored with the medications or in the en suite bathroom of the resident. In the lounge on the first floor we inspected the First Aid box. It was open and a staff member said it was broken. We noted 11 items in the box which were expired. In the servery in Satin unit there was an unlocked low level cupboard containing Brillo oven cleaner and Sprint cream cleaner. These are Control of Substances Hazardous to Health (COSHH) products which should be locked away. On the ground floor in the refrigerator was a covered plate of sandwiches which had no date on them, there was also an opened tub of double cream Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 28 which had not been labelled with an ‘opened on’ date. There was a bottle of salad cream which had been open for over eight weeks and had therefore expired. The rubbish bin had no lid. On the ground floor in the First Aid box were five items which had expired. The contents of the box did not match the recommended contents list in the lid. The servery on this floor had an unlocked cupboard which contained Brillo cleaner, a five litre bottle of Milton and Enhance carpet cleaner. These are all COSHH items which should be locked away. We inspected the kitchen, and we noted pink wafers wrapped in clingfilm with no date. We noted burger buns uncovered in the freezer and a yellow carrier bag of unidentified undated ‘lumps’. There was also a green bag which the cook said contained staff food and a large tub of yoghurt which she stated belonged to her. The staff have a refrigerator in their staff room and are not allowed to store their food in the kitchen refrigerator. In the refrigerator on the first floor we noted marmalade, jam and margarine with no ‘opened on date’ label. The manager stated that the home receives regular monthly Regulation 26 visits from the person in charge. They look at files, complaints, the environment and speak to residents, relatives and staff. We were surprised that some of the issues which have been highlighted in this inspection have not been raised at these visits. For example one room has a notice on it ‘Quite Room’. We supposed this is for ‘Quiet Room’ and the manager agreed. It seems the error has either not been spotted or not thought worth correcting. Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 29 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 x x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 x x x x 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x 2 2 Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 Requirement Assessments of need must be fully completed and comprehensive (previous timescale of 01/02/09 not met). Assessments must be signed by residents or their families wherever possible. Care plans must record all relevant information (previous timescale of 01/09/08 and 01/02/09 not met). Timescale for action 01/08/09 2. OP7 15 01/08/09 3. OP7 15 4. OP8 12 5. OP8 12 Care plans must be properly reviewed at regular intervals, whenever there is change or as appropriate to the resident’s individual state of health. Resident’s health care needs must be fully met – this includes accurate and comprehensive monitoring of their health. The home must be conducted so as to promote and make proper provision for the health and welfare of service users (previous timescale of 01/02/09 DS0000007367.V375606.R01.S.doc 01/08/09 01/08/09 01/08/09 Silk Court Nursing Home Version 5.2 Page 31 not met). 6. OP9 13 The manager must ensure the recording, handling, safekeeping and safe administration and disposal of medicines received into the care home. Information about residents must be kept confidential to respect their privacy (previous timescale of 01/09/08 and 01/02/09 not met). Residents must have their respect, dignity and privacy protected. Staff must maintain good personal and professional relationships with residents. The views of residents must be sought for End of Life planning wherever possible. The environment of the home must be in a, safe welcoming, presentable state including the hairdressing salon. Medical equipment should be properly stored away and not left around in communal areas. The manager must ensure that the environment of the home clean and hygienic. COSHH products must be safely stored in locked cupboards. Stored foods must be properly identified. Perishable foods opened in the refrigerator must have ‘opened on’ dates attached to them. First Aid boxes must not be broken and must be properly stocked with unexpired products. The manager must ensure that regular fire drills are held at least six monthly DS0000007367.V375606.R01.S.doc 01/07/09 7. OP10 12 (4)(a) 01/07/09 8. OP10 12(4)(a) 01/07/09 9. 10. 11. OP10 OP11 OP20 18 12 23 01/07/09 01/08/09 01/07/09 12. 13. 14. 15. OP25 OP26 OP38 OP38 23 23 13(4)(a) 13 01/07/09 01/07/09 01/07/09 01/07/09 16. 17. OP38 OP38 13 13 01/07/09 01/07/09 Silk Court Nursing Home Version 5.2 Page 32 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. Refer to Standard OP9 OP9 OP13 OP27 OP28 Good Practice Recommendations We recommend the 2005 copy of the BNF be discarded and replaced with a 2008 version. Where residents are using pharmaceutical products regularly the home should advocate for them with their GP’s to get the products prescribed. We recommend that the home meets the social needs of residents, to access the community, including this need in their care plans. We strongly recommend that the level of nursing care provided at the home be reviewed at a senior level. We recommended that the main points on a care plan be produced as bullet points on an A4 sheet so that bank workers and others can quickly familiarise themselves with the information. We recommend that out of date information be removed from residents files. 6. OP37 Silk Court Nursing Home DS0000007367.V375606.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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