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Inspection on 27/07/05 for Silk Court Nursing Home

Also see our care home review for Silk Court Nursing Home for more information

This inspection was carried out on 27th July 2005.

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

The inspector 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

The environment at Silk Court is homely and generally safe and well maintained. The meals are varied, well cooked and served in pleasant surroundings. Residents meetings are held and relatives and visitors are made welcome.

What has improved since the last inspection?

The management and staff at Silk Court have made some genuine attempts to respond to the requirements of their last inspection. A number of standardised forms have been produced for the assessment of service users needs. The files for new service users are better organised and labelled, as are the files for staff. It is now easier to locate documents on files. Inventories are now being taken of the possessions of new service users. A medication audit was undertaken by the home to help them improve their administration of medication. Appropriate referrals have been made for service users whose needs have changed and who may no longer meet the home`s criteria.There has been an improvement in the specialist equipment in the home (new mattresses). Chair raisers have also been provided for the greater comfort of service users. Adult protection training has taken place with the staff. A number of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been obtained. Steps have been taken to ensure that night staff are not overworking. Staff now have individual training profiles and it is easier for the manager to identify their training needs. Flower tubs and garden furniture have been purchased and placed on the patio outside making a sitting area for service users and visitors.

What the care home could do better:

The inspection resulted in 20 legal requirements and the separate inspection of the administration of medication resulted in 29 legal requirements. As with the previous report a number of areas to address are detailed in the report. The priority is to improve the quality of care for service users with appropriate training for staff, timely referrals to specialists, and correct use of specialised equipment. The home must ensure that comprehensive assessment of service user needs is undertaken before service users are admitted (including those accessing respite care) and proper plans made for their care. The need for clear standardised paperwork has been recognized by the home and it must now be uniformly applied and properly completed. The home also needs to improve the communication between management and staff with good leadership, direction and supervision to promote higher standards of care.

CARE HOMES FOR OLDER PEOPLE Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR Lead Inspector Anne Chamberlain Unannounced Inspection 27th July 2005 at 09.45am 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. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 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 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 Anchor Trust vacancy Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: Silk Court is a care home providing accommodation personal and nursing care for 51 older people. The home is registered to meet the needs of servie users who require nursing or enhanced residential care. Silk Court is owned and operated by Anchor Care Homes, which is a voluntary sector provider of care services. The home is located in Bethnal Green, close to shops, the post office, local amenities, bus routes and both the overground and underground stations. The home was opened in 1994 and was 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. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted for seven and a half hours. The deputy manager who is currently managing the service was unavailable and the inspector interviewed a senior nurse for the purposes of the inspection. The inspection focussed mainly on areas which had been the subject of previous requirements. The inspector spoke to nurses, carers and administrative staff as well as service users, and viewed files for four recently admitted service users and four staff personnel files in addition to other records and documentation. The inspector toured parts of the premises and looked at specialist equipment provided. The arrangements for the administration of medication were inspected separately by a CSCI Pharmacist Inspector. The inspector would like to take this opportunity to thank the service users and staff at Silk Court Nursing Home for their co-operation with the inspection. What the service does well: What has improved since the last inspection? The management and staff at Silk Court have made some genuine attempts to respond to the requirements of their last inspection. A number of standardised forms have been produced for the assessment of service users needs. The files for new service users are better organised and labelled, as are the files for staff. It is now easier to locate documents on files. Inventories are now being taken of the possessions of new service users. A medication audit was undertaken by the home to help them improve their administration of medication. Appropriate referrals have been made for service users whose needs have changed and who may no longer meet the home’s criteria. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 6 There has been an improvement in the specialist equipment in the home (new mattresses). Chair raisers have also been provided for the greater comfort of service users. Adult protection training has taken place with the staff. A number of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been obtained. Steps have been taken to ensure that night staff are not overworking. Staff now have individual training profiles and it is easier for the manager to identify their training needs. Flower tubs and garden furniture have been purchased and placed on the patio outside making a sitting area for service users and visitors. 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. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.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 Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.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) 3,4,5. 6 is not applicable. Service users move into the home without adequate assessment and without the assurance that the home will fully meet their needs. They do not have an opportunity to visit and assess the home. The home does not offer intermediate care. EVIDENCE: Since the last inspection there have been several admissions to the home, including emergency and respite admissions and the inspection of files was focussed on these service users. There was some documentary evidence on files of pre-admission and post admission assessments being undertaken but care assessment stand alone documents, from referring agency and completed by the home were not present on files. In the case of a service user who had been in the home for one day, forms for base-line information including past medical history, had not been fully completed and his main diagnosis was not on file. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 9 Asessment documents - including medical information - were not located on the file. This particular service user was non-verbal and the home had no guidance for communicating with him. The senior nurse stated that he arrived in pyjamas with no clothes or possessions, and they believe his family to have left the country for a holiday whilst he was in respite care. The new files were well divided and the sections labelled. A number of standardised forms have been produced. There was however a lack of uniformity and consistency as some forms and charts appeared on some files and not others. Some charts, particularly those relating to nutrition and hydration were only partially completed, one chart identified an action although the scores required to determine the action had not been completed. Some forms were not signed or dated. The inspector formed the impression that pre–admission preparation and assessment is very basic and proper assessment is undertaken over the first weeks following admission. This practice renders service users vulnerable to not having their needs fully met in the first days following admission. The deputy manager must ensure that no service user moves into the home without having his or her needs fully assessed and recorded on file. This is a requirement. The deputy manager must ensure that the home can meet the needs of service users who are accepted for admission. This is a requirement. The senior nurse acknowledged that since the last inspection none of the service users admitted had visited the home prior to their admission. This is only acceptable in the case of emergency admissions or emergency respite admissions. The manager must ensure that service users (including those who have not used the home before and who are being admitted for planned respite) must have the opportunity to visit before being admitted. This is a requirement. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 9, 10 and 11. The health needs of service users are not fully met at the home. The policies and procedures for the administration of medication have not ensured the full protection of service users. Service users do not always enjoy respectful attitudes from staff and do not have enough privacy. More assurance is needed that staff will treat people appropriately at the time of their death. EVIDENCE: The inspector was very concerned about a particular service user whose health care needs have not been met. This service user has a grade 4 sacral pressure sore and the inspector enlisted the specialist assistance of the tissue viability nurse. The nurse had been asked to advise on this sore on 11th July 2005 when she happened to be in the building to see another service user. She was concerned that by that time the sore was necrotic. The nurse who asked for her help had incorrectly diagnosed the sore to be due to incontinence. In the professional opinion of the specialist nurse the sore had been caused by constant pressure due to the special mattress in use having partially deflated. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 11 The service user had pressure from laying on the bed base only thinly covered by the deflated mattress. The mattresses have been in the home since May 2005 and the staff only had the necessary training on the equipment on 25th July 2005. The inspector found that the service user in question had the inflation of her mattress incorrectly set on the day of the inspection. This was the case for two other service users, and another service user’s mattress had been switched off and was totally deflated. The inspector spoke to a nurse in charge of this patient who advised that she had not received training on the appropriate use of the mattresses. A replacement mattress could not be delivered until the following day. The specialist nurse was concerned that having explained the problem and the need for an immediate replacement mattress to her, the deputy manager was reluctant to move a mattress from another bed, and seemed unaware that she could hire a substitute mattress, whilst awaiting the delivery of the replacement. The specialist nurse said that the deputy manager was not aware that the weight to inflation chart must be followed and is on the back of the pump. There is no plan in place to physically check mattresses on a regular basis. The deputy manager must ensure that mattresses are periodically checked physically to ensure that they are correctly set and inflated. This is a requirement. This service user in addition to her current pressure sore has a healed sore and an almost healed sore. Documents for the three sores were not separately numbered and were mixed up together in the file. The inspector and tissue viability nurse separated out two forms relating the sacral sore. There are two types of care plans for pressure sores, one has no space for a date. The nurse in charge acknowledged that she found the paperwork confusing and this is obviously an issue for agency and bank nurses who are currently working at the home. The paperwork identified that the sacral sore had first been noticed in April 2005. It had been graded as a 2, on 4th May 2005. On 12th July 2005 skin assessment graded the sore at 3 when it had been graded a 4 by the tissue viability nurse the day before. Care plans and skin assessment were not up to date. A care plan which had been completed when the sore was known to be necrotic did not state that it was necrotic. One care plan was completed with incorrect terminology referring to a ‘second degree’ (which is a term relating to burns) pressure sore. The inspector and nurse asked to see the protocol which is followed (yellow book supplied by the tissue viability team) as previous inspection had required that a recognized protocol be adhered to. The nurse in charge was not sure what the protocol was and could not produce it. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 12 The carers attending the service user advised they have had no tissue viability training. The inspector was advised that tissue viability training had been run in May 2005 and had not been attended by any staff from Silk Court. The inspector saw the tissue viability training schedule and noted that the main training for wound and pressure ulcer management is scheduled for the late autumn and next year - 2006. Legal requirements for mandatory training were made with previous timescales of October 2004 and July 2005. The inspector was very concerned to see that the service user has lost almost 9kgs in weight over the last eight months. The nurse advised that the service user eats very well and is on a high protein diet. The documentation on file graded appetite/nutrition at 0 which is the lowest level of concern. The service user is weighed only monthly. The nutritional state of this service user is concerning and a referral should have been made to the dietician and or GP. Requirements have twice previously been made concerning staff training in tissue viability and provision of equipment in relation to the prevention of pressure sores. Also, the weighing and nutrition of service users. The Commission for Social Care Inspection (CSCI) will be taking enforcement action to secure compliance with the applicable regulations for the health and wellbeing of service users. The fluid chart for the above discussed patient had a lack of entries for 24th, 25th and 26th July 2005. The Registered person must ensure that fluid intake charts reflect the activity undertaken and are fully completed, timed and signed, without gaps. This is a requirement. The nursing plan for 10th July 2005 states that the service user is to be turned hourly. The turning chart commenced on 9th July. There is a gap between 9th and 12th and only one entry on 12th. Entries are missing from 13th to 18th July, 2005. The Registered person must ensure that turning charts reflect the activity undertaken and are fully completed, timed and signed, without gaps. This is a requirement. The previous inspection required nurses to renew their training in the administration of medication. This has not been achieved and the requirement is restated. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 13 The Registered person must ensure that nurses renew their training on the administration of medication. This is a restated requirement. On this occasion the inspection of the arrangements for the administration of medication was undertaken by a CSCI Pharmacist Inspector. He has written a separate report which details 29 separate requirements with timescales. The Registered person must ensure that the above requirements are complied with within the timescales stated. This is a requirement. A requirement at the previous two inspections was that service users have facilities to make telephone calls from their bedrooms. The inspector understands that the organisation is considering this. In the meantime the requirement is again restated. This is a restated requirement. In conversation with a service user the inspector was told by her that she felt that the staff generally have a certain ‘attitude’, although there was one member of staff who the service user felt was really pleasant. The home has now developed paperwork to ascertain from service users their wishes for the time of their death. There was evidence that these views are being recorded. The staff have not yet had training in palliative care, ageing, illness and death. This was a requirement of the two previous inspections. The inspector understands that training is planned for October and November 2005. In the meantime the requirement is restated. This is a restated requirement. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. The home satisfies some of the social and cultural needs of service users. EVIDENCE: The last inspection report made a requirement that the social activities coordinator receives training for her role. The co-ordinator is not currently working in her post and has not been replaced. This requirement will be reviewed when she resumes her duties. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18. Service users are not fully protected from abuse. EVIDENCE: The senior nurse advised that the home has secured adult protection training for around 75 of the staff working in the home. They will arrange for the remaining staff to also receive the training. There was evidence however (please see stardard 8 in this report) that a service user has experienced neglect of her health care needs in the home. The Registered person must ensure that staff apply the adult protection training they have received to their practice. This is a requirement. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,24,25 and 26. Service users have specialist equipment to maximise their independence. Their rooms are personalised and suit their individual needs but beds could be more comfortable. The environment is safe but documentation is awaited for the lift. There are some unpleasant odours in the home. EVIDENCE: A broken alarm pull cord - subject of a previous requirement - had been repaired. The senior nurse advised that the mirror, a personal possession of a service user and subject of a previous requirement has now been hung in her room. There was evidence that inventories of possessions are now taken when service users are admitted to the home. The manager must ensure that these inventories are signed by the staff responsible for taking them. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 17 This is a requirement. The inspector did not see any fire doors propped open during the course of the inspection. The document confirming that the lift is safe has not yet been made available for inspection The manager must make available for inspection the document which confirms that the lift is safe. This is a restated requirement. In conversation with a service user in her room the inspector noted the shallowness of the mattress on her bed and remarked upon it. The service user said that she found the mattress very thin and it made her sides hurt. The manager must ensure that the mattresses on the beds are deep enough to support service users comfortably and in accordance with their assessed clinical needs. This is a requirement. The inspector entered a service user’s room (no 27) and was struck by a strong and unpleasant odour. The manager must ensure that offensive odours are eliminated from the home. This is a requirement. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 18 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. Service users needs are partially met by the numbers and skill mix of staff. There are concerns regarding capability. The home’s recruitment policy offers some protection to service users. Some staff have nursing qualifications but levels of training and competency are unresolved issues in the home. EVIDENCE: The senior manager advised that the staff rostering system is being changed to be more clear but this has not yet been achieved. The deputy manager must improve the staff rostering system to ensure clarity. This is a restated requirement. The deputy manager has written to all the night staff to clarify whether they are working for other establishments. There has been a good response and only one reply has raised concern. An immediate requirement was issued at the previous inspection for CRB checks to be undertaken and POVA first checks obtained for all staff who did not have them. The management of the home have stated that CRB disclosures have been sought for all staff who do not have them. They have further furnished information which shows that no disclosure has been returned for a significant number of staff, some of these staff have not had POVA first checks. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 19 The Registered person must ensure that POVA first checks are obtained for the staff who have not had them. The Commission for Social Care Inspection (CSCI) must be advised in writing, stating the relevant reference number, as and when each CRB check is received for the staff. This is a restated requirement. The inspector was pleased to view staff training profiles. As previously stated a substantial proportion of the staff have undertaken adult protection training. Also there is a programme of planned training for the forthcoming months. However until the courses have been successfully uncompleted the level of staff training remains a concern. Particular training needs include tissue viability, drug administration and palliative care. The Registered person must ensure that training levels within the staff group are significantly improved. This is a restated requirement. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34, 36 and 37. The current management situation at the home is not satisfactory. Service users do not entirely benefit from the ethos or leadership as staff are not adequately supervised. Accounting and financial procedures are not of concern. Record keeping shows some improvement and offers some safeguards to service users. EVIDENCE: The post of manager in the home remains unfilled and the deputy manager who is a registered general nurse continues to act up. A new manager has been appointed and should commence in August. It is expected that this person will be put forward to the Commission for Registration without delay. The inspector viewed a flow chart which demonstrates clear lines of accountability within the home. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 21 The inspector viewed the minutes of staff meetings which demonstrated that the deputy manager attends and communicates direction and leadership to the staff. The inspector was advised that meetings are held monthly but she noted that several sets of minutes were missing. The manager must ensure that minutes of monthly staff meetings are available to demonstrate communication with and guidance to staff. This is a requirement. The home demonstrates a commitment to equal opportunities and has a culturally diverse staff group. The deputy manager was not available on the day of the inspection. The senior nurse was not able to access budgetary paperwork but assured the inspector that suitable accounting and financial procedures are in place. Also that there is a business and financial plan for the establishment. The inspector viewed the policy for staff supervision. Whilst not strictly in line with the standard it does prescribe regular and fairly frequent supervision for all staff. The inspector viewed the records of supervision. Of the four staff personnel files reviewed, none of the staff had received formal documented supervison this year. The Registered person must ensure that staff have formal supervision not less than six times per year. This is a requirement. The record keeping policy was not present in the manual for viewing. The senior nurse thought it may be under review. The inspector was pleased to note a big improvement in staff personnel files which are now neatly divided and labelled. As previously stated an improvement was also noted in the files of new service users and the manager understands that the home is working through the files of all service users. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 22 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 x x 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x 3 x 2 2 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 3 2 x 3 x 1 3 x Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 23 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 3 Regulation 14 Requirement The Registered person must ensure that no service user moves into the home without having his or her needs fully assessed and recorded on file. The Registered person must ensure that service users (including those who have not used the home before and who are being admitted for planned respite) must have the opportunity to visit before being admitted. The Registered person must ensure that fluid charts reflect the activity undertaken and are fully completed, timed and signed, without gaps. The Registered person must ensure that turning charts reflect the activity undertaken and are fully completed, timed and signed, without gaps. The Registered person must ensure that mattresses are periodically checked physically to ensure that they are correctly set and inflated. -----------------------------------Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 24 Timescale for action 01 September 2005 01 September 2005 2. 5 14 3. 8 12 (1) (a) 01 September 2005 4. 9 12 (1) (a) 13 (2) 5. 10 16 (2) (b) 6. 11 18 (1) (i) 7. 24 12 (4) 17 8. 25 23 (2) In addition to the above an enforcement notice has been issued in respect of elements of this standard. The Registered person must ensure that nurses renew their training in the administration of medication (previous timescale of 01 July 2005 not met). ------------------------------------The Registered person must ensure that the requirements of the separate inspection of the arrangements for administration of medication, are complied with within the timescales stated. Facilities must be provided for service users to be able to make telephone calls from their bedrooms (previous timescales of 31/10/04 and 01/8/04 not met). The Registered person must ensure that staff are trained in palliative care, ageing, illness and death (previous timescales of 30/11/04 and 01/08/05 not met). The Registered person must ensure that inventories of service users possessions are signed by the staff responsible for taking them. The Registered person must make available for inspection the document which confirms that the lift is safe (previous timescale of 1/7/05 not met). The Registered person must ensure that the mattresses beds are deep enough to support service users comfortably. The Registered person must ensure that offensive odours in the home are eliminated. The Registered person must improve the staff rostering 01 September 2005 01 November 2005 01 December 2005 01 September 2005. 01 September 2005 9. 10. 26 27 16 (2) (k) 18 01 September 2005 01 September Page 25 Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 11. 29 19 system to ensure clarity (previous timescale 1st July 2005 not met). The Registered person must ensure that POVA first checks are obtained for the 7 staff who have not had them. She must advise the Commission for Social Care Inspection (CSCI) in writing stating the relevant reference number, as and when each CRB check is received for the 24 staff (previous timescale Immediate Requirement dated 4/5/05 not met). The Registered person must ensure that training levels within the staff group are significantly improved (previous timescale of 01 August 2005 not met. The Registered person must ensure that minutes of monthly staff meetings are available to demonstrate communication and guidance of staff. The Registered person must ensure that staff have formal supervision not less than six times per year. The Registered person must ensure that the home can meet the needs of service users who are accepted for admission. The Registered person must ensure that staff apply the adult protection training they have had to their practice. 2005 01 September 2005 12. 30 19 01 September 2005 01 September 2005 01 September 2005 01 September 2005 01 September 2005 13. 32 24 (1) (a) 14. 36 18 15. 4 14 1 (c) 16. 18 12 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 26 Silk Court Nursing Home 1. Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 27 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ 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 Silk Court Nursing Home G57 G06 S7367 Silk Court V241699 270705 Stage 2.doc Version 1.40 Page 28 - 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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