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Inspection on 03/04/06 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 3rd April 2006.

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

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

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

What the care home does well

There are a number of key areas where the home now appears to be functioning well and examples are given below. However systems of recording are rather new and need to be in place a little longer for a judgement to be made that the service is really performing well. The home provides a physically supportive environment for fragile elderly people. The provision of specialised equipment is good and there is currently a high ratio of staff to residents. There are sound financial procedures for dealing with resident`s monies.

What has improved since the last inspection?

The home has responded to many of the requirements which have been made. The service has benefited from the strong leadership of recent months and has made considerable progress. Assessment and care planning have improved facilitating better health care for residents. The permanent staff group is organised with clear lines of accountability. There are now clear recording procedures for staff training and supervision. The administration of medication recording is being audited frequently. A full time activities co-ordinator is in post. The home has an extensive redecoration and refurbishment programme underway.

What the care home could do better:

The inspection resulted in eleven legal requirements and three good practice recommendations. The inspector feels that the future success of the service depends on the introduction of staff who have good personal qualities and who will make a long term commitment to the home. The home should recruit more permanent carers.There are still outstanding training issues which the home needs to address urgently. The records of training and supervision are very new and do not yet give a good continuous history. Currently the manager and deputy are both temporary appointments. The inspector would wish to see a smooth transition to permanent replacements and a continuation of the improvements in service which are noted throughout this report.

CARE HOMES FOR OLDER PEOPLE Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR Lead Inspector Anne Chamberlain Unannounced Inspection 3rd April 2006 10:15 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 Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 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. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 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 sharon.blackwell@anchor.org Anchor Trust Post Vacant Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 30 BEDS ELDERLY FRAIL NURSING 21 BEDS ELDERLY FRAIL NURSING OR RESIDENTIAL MINIMUM STAFFING NOTICE Date of last inspection 27th July 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 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 overground 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 ensuite 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 DS0000007367.V287755.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out over three days. It was a full inspection covering all thirty-eight standards The inspector interviewed the acting deputy manager (henceforward described as the deputy manager), the activities co-ordinator, the chef manager and the administrator and spoke with two relatives. The inspector selected four residents. She viewed their files, medication, financial records etc. She spoke with two of them. She inspected the training profiles and staff personnel files for the four keyworkers of the four residents and spoke to two of them. This process is termed case tracking. The inspector toured the premises and inspected key documentation. A complaint which was received by the Commission for Social Care Inspection (CSCI) and investigated at an additional inspection is referred to under the relevant standard. Silk Court had a significant amount of inspection activity in the previous inspection year, two major inspections, a pharmacy inspection and a three additional inspections A large number of requirements were made and there has been an impact on the home’s contractual arrangements. Having reviewed previous requirements a number of them have been deleted in order to be proportionate and to concentrate on issues which directly affect residents. As there have been improvements in basic care the inspector has been able to cover a broader range of issues. What the service does well: There are a number of key areas where the home now appears to be functioning well and examples are given below. However systems of recording are rather new and need to be in place a little longer for a judgement to be made that the service is really performing well. The home provides a physically supportive environment for fragile elderly people. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 6 The provision of specialised equipment is good and there is currently a high ratio of staff to residents. There are sound financial procedures for dealing with residents monies. What has improved since the last inspection? What they could do better: The inspection resulted in eleven legal requirements and three good practice recommendations. The inspector feels that the future success of the service depends on the introduction of staff who have good personal qualities and who will make a long term commitment to the home. The home should recruit more permanent carers. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 7 There are still outstanding training issues which the home needs to address urgently. The records of training and supervision are very new and do not yet give a good continuous history. Currently the manager and deputy are both temporary appointments. The inspector would wish to see a smooth transition to permanent replacements and a continuation of the improvements in service which are noted throughout this report. 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 DS0000007367.V287755.R01.S.doc Version 5.1 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.V287755.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6. The home provides a range of adequate services to prospective residents to support the choice of home. EVIDENCE: The inspector viewed the statement of purpose and service user guide. At Silk Court these are incorporated together in a brochure about Anchor services, which has an inset referring specifically to Silk Court. The inspector noted a number of omissions, some of which were corrected by the deputy manager during the course of the inspection. The number of places at the home was referred to only obliquely. There was no reference to inspection reports or contact information for the local CSCI office, and no contact details for local social services and health care authorities. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 10 The registered person must ensure that the statement of purpose/service user guide are amended in accordance with the above comments. This is a requirement. The inspector viewed four residents files. Three had contracts, signed by both parties and dated. One did not and this was remedied during the course of the inspection. The registered person must ensure that all residents have contracts. This is a requirement. There was a previous requirement that no person move into the home without their needs being fully assessed and recorded. The home has been closed for admissions since the last inspection. However the deputy manager was able to outline to the inspector the process which would be followed with a new referral. An initial assessment would be made by the manager or deputy manager to determine whether the person met the eligibility criteria for Silk Court. If they did there would be a much fuller assessment of need on admission to the home. The inspector viewed the assessments of need on the files of four individuals. Assessment tools include Waterlow scores, Crichton assessments, and nutritional assessments. She was satisfied that assessment is adequate. There was a previous requirement that the home ensure they can meet the needs of persons admitted. The deputy manager was able to demonstrate to the inspector the homes ability to meet the needs of the residents, with the exception of needs relating to dementia. It has been recognized that the home has a number of people suffering from dementia who will not be moved to specialised units. There is a long term aim of establishing a dementia unit at Silk Court. However in the meantime there has been no specialise training for staff on dementia. The deputy manager advised that such training can be accessed within the Anchor organisation. The registered person must ensure that staff who work with residents suffering from dementia have appropriate training. This is a requirement. The deputy manager said that visits before admission can be arranged. When there are good links between the home and professionals or families of Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 11 prospective residents this is quite easy to do. The home encourages and supports such visits. The home rarely receives referrals for intermediate care. However the deputy manager said that if they did they would consider what rehabilitation facilities would be needed, and also assess the effects on current residents. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 7,8,9,10 and 11. The health, personal and social care needs of individuals are generally well met, although there is a need for better staff training on the administration of medication. EVIDENCE: The inspector viewed service user plans for four individuals. She also saw documentary evidence that the home is trying to identify individual to sign plans on behalf of residents who cannot sign themselves. The service user plans were adequately detailed and there was evidence of review. The deputy manager stated that care plans are reviewed on a monthly basis. Health and personal care needs are met through care plans and the inspector saw a range of these including plans for oral hygiene and continence. The deputy manager demonstrated a good understanding of the range of needs which are presented at the home. Nutritional needs are quite prominent with fragile elderly residents. The deputy manager explained the various strategies Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 13 which are used to promote good nutrition and the inspector observed a resident with a nutritious drink. In conversation with a resident she confirmed to the inspector that her personal care is undertaken with respect and sensitivity. One resident had just returned from a spell in hospital with a number of pressure sore areas. The tissue viability nurse visited on the second day of the inspection and care plans were drawn up based on her recommendations. The inspector observed saw that an inflaltable bootee was being used and a fluid chart had been started. The inspector viewed a turning chart for another resident. The entries were contradictory and the chart did not make sense. The inspector interviewed a carer who had been partly responsible for the chart. She was able to explain the purpose of the chart and said that when contradictory entries were made they were mistakes. The registered person must ensure that turning charts reflect the activity undertaken and are fully completed, timed and signed, without gaps. This is a restated requirement. The deputy manager advised that the home now has a weekly three hour visit from the local general practitioner surgery. Staff are able to seek medical advice on the care of service residents. The inspector felt that the health care needs of residents were being met. The inspector viewed the arrangements for the administration of medication. The deputy manager stated that the MAR sheets are audited by nurses daily. The inspector viewed the sheets for four residents and checked the balances of medication. Two sheets had no discrepancy. One appeared to have a discrepancy because a second bottle of a preparation had been started before the first was finished. However the balance proved to be correct. The registered person should ensure that only one container of a medication preparation is opened at once. This is a recommendation. One medication was difficult to balance because the quantity had not been entered on the MAR sheet. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 14 The registered person must ensure that quantities of medication held are entered on the MAR sheets so that medications can be accurately balanced. This is a requirement. There were previous requirements as follows: That the homes policy and procedure for dealing with blood spillages be expanded. This had been done and the inspector saw the pack for dealing with spillages. Regarding the stock control of liquid medicines. The deputy manager stated that the home does not keep any stocks of liquid medications. That medications be ordered in advance to ensure that if they are unavailable alternatives can be prescribed. The inspector was shown a letter to Boots dated 31/3/06 to request the home be informed prior to the delivery date if a medicine is out of stock. That insulin in use be stored at room temperature. The inspector ascertained that this is being complied with. That all nurses renew their training in the administration of medication (previous timescale of 01 July 2005 not met). There are now three permanent nurses working at the home. One of them has renewed her training as above in September 2005. Two have not. Of two bank nurses regularly used, one has renewed her training in September 2005 and one has not. In addition to the above there are six bank nurses covering 42 shifts per week. The registered person must ensure that all nurses working at the home, including bank and agency nurses have up to date training in the administration of medication. This is a restated requirement. A complaint was received by the CSCI in October 2005 regarding the administration of morning medication. The complainant alleged that her relative was being woken up for her medication. This was discussed with the manager at an additional inspection in October 2005. It was investigated by her with a subsequent change in practice. The deputy manager stated that all morning medications are administered by mid-morning but no-one is woken up for their medication. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 15 The deputy manager stated that care plans highlight room door preferences and staff are careful to knock on residents doors. The inspector observed that the deputy manager asked residents how they wanted their doors to be left, open, closed, or ajar. There was a previous requirement that facilities be provided for residents to make telephone calls from their rooms. The inspector noted that residents now have telephone points in their rooms. In discussion with a resident the inspector was told that she selects her clothes herself for the following day the night before. The deputy manager said that the home now has visiting clothing sales. The activities co-ordinator currently organises the purchase of toiletries for individuals, but there is a plan to introduce a trolley shop. Chiropody is now done in the rooms of residents by the visiting chiropodist. The inspector was satisfied that the right to privacy and dignity of residents is being upheld. The deputy manager stated that with new residents their wishes regarding death and dying will be sought on admission and a care plan drawn up. The inspector noted on the file of a residents who was case tracked that his wishes had been recorded. She feels that the home are doing all they can to address this sensitive issue. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 12,13,14,15 and 16. Daily life and social activities in the home provide opportunities for self expression. The meals are wholesome and well presented. EVIDENCE: The activities co-ordinator has been in post since September 2005 and full time since January 2006. She advised that she sees the home administrator for amenities money and is always given what she needs. In addition she raises money with raffles and tombola. The co-ordinator said that she has arranged an entertainer for Easter and is planning a trip to the seaside for the summer, using dial-a-ride. For local wheelchair outings there is no shortage of carers to help push wheelchairs. The co-ordinator said she runs a coffee morning on Wednesdays and uses reminiscence materials, also cooking sessions. There are also tea parties on the patio in the summer. She inspector saw the activities programme and evidence of craft activity in the shape of Easter bonnets being made. She was advised that responsibility for weekend activities lies with the staff on duty. In conversation with a resident the inspector confirmed that she enjoys Bingo and cooking sessions. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 17 The activities co-ordinator has not had training for her role. The registered person should ensure that National Association for Providers of Activities for Older People (NAPA) training is provided. This is a recommendation. The inspector observed various visitors calling at the home during the course of the inspection. She spoke with a husband visiting his wife and a son visiting his mother. They both confirmed that they are made welcome. The policy of the home is that visitors can make themselves a drink in the kitchens attached to the dining rooms, and can pay for a meal should they wish to eat with their relative. The deputy manager stated that residents are encouraged to exercise choice and control over when they wish to get up, what they want to eat, their clothes, hair, personal possessions and toiletries. The inspector saw the record of the residents meetings which are held monthly. The inspector viewed the menu which is on a four weekly cycle and observed meals being served at various times. She had a lunch which was well cooked and presented. The new chef manager stated that she is using less prepared and more fresh ingredients now. She has introduced cake with afternoon tea, which is popular. The chef manager attends the residents meetings. The deputy manager stated that three plate warmers have been purchased for individuals who eat very slowly and like to take breaks. In conversation with two residents the inspector was told that they choose thier food and it is is good. She was told that the chef is responsive to individual tastes. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 16,17 and 18. Complaints are taken seriously and legal rights are protected. EVIDENCE: As previously described above, a complaint regarding medication has been dealt with by the home. The inspector viewed the old complaints folder. A complaint had been received by the home in August 2005. A holding letter had been sent to the complainant (by a previous manager) but nothing else. The registered person must ensure that all complaints are fully investigated and the complainant is advised in writing of the outcome of investigations. This is a requirement. The inspector viewed the new complaints folder which runs from January 2006 but has no entries. The deputy manger advised that no complaints have been received since that time. The format of the folder was satisfactory, including a log to show the progress of complaints received. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 19 The deputy manager said that two advocacy services have been approached to work with residents who are unable to express their views. Advacacy services in the area are generally fully stretched and neither has been able to help. The deputy manager said that the homes administrator will take round polling cards and any resident who wishes to vote will be supported to do so. The inspector was satisfied that residents legal rights are protected. In discussion with a carer the inspector learnt that in the past there had been incidents of aggression between residents suffering from dementia. The inspector had a discussion with the deputy manager who was not sure if incidents of aggression between residents would be referred as adult protection issues. Challenging behaviour of residents can result in “encounters” between them. There needs to be strong liaison between the home, health, social services professionals and families to understand and work with this. Initial assessment of residents and risk assessments need to be robust, and care plans need to reflect the issues. The home has a responsibility to protect residents. Should the above measures fail to avert incidents of abuse between residents, then referrals must be made to adult protection services. Strategy meetings being the forum where risks are addressed and strategies put in place. The inspector understands that currently there are no residents at the home who display challenging behaviour. However the home is in a somewhat vulnerable position because it has demented residents in placement,without having a regulation variation for them and without having staff formally trained in the care of dementia. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 20 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 the following standard(s): 19.20,21,22,23,24,25 and 26. The environment of the home is generally good. EVIDENCE: The inspector made a tour of the premises. The home was very disrupted at the time of the inspection by the presence of workmen decorating the building. They were laying dustcovers over the corridor floors, one at a time. Wallpapering and painting was going on. Safety measures had been taken with good sineage everywhere advising caution. The staff had made the best provision they could to keep residents safe, encouraging them to stay in their rooms when their immediate environment was affected and sometimes to have their meals there. Many of the vacant rooms have already been decorated. Notwithstanding the decorating which is going on the inspector found many areas of the home were not kept clean. In a residents room she observed a fruit bowl containing various small items, a beaker top, etc. very dirty with a big wisp of hair. The light switch in this room was grimy and the wardrobe door Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 21 had marks on it. The deputy manager agreed with the inspector that the room was not clean. One disabled bathroom was thick dust and a tap was running and could not be turned off. Other bathrooms were being used to store furniture. The deputy manager said that the bathrooms are not really used. Although residents have the option of a bath most prefer a shower in their en-suite facilities. Bathrooms which are never used should be given a thorough clean and locked up. Others which are used at times should be kept clean and free from obstacles.The deputy manager said she would report the running tap to the handyman. Areas which the staff use were also not properly clean, the office the inspector used had thick dust on a power socket, the staff room sink area was not clean. The home has two housekeepers and is seeking to recruit a third. In the meantime parts of the home are being cleaned by an agency. The inspector saw the cleaning schedules which the manager has introduced. They did not contain any task to dust the personal possessions (ornaments, photographs, fruit bowls) of residents. During the course of the inspection this task was added, to be done once a week. The registered person must ensure that all parts of the home are kept in a clean condition. This is a requirement. The communal facilities are being redecorated and there are new chairs and tables, and new curtains. The home currently has some small two seater sofas. These have plus points as they look homely and visitors can sit next to residents. However the chairs are an improvement from the point of view of supporting mobility. Two carers can stand either side of an armchair and better assist the resident to rise out of it. The home has acquired a parrot, which provides a diversion in one of the communal lounges. The home has a great deal of equipment to support residents including: mattress overlays and pressure care mattresses, chairs for transfers, grab rails, tap adaptors, specialised baths and beds, hoists, handling belts, sliding sheets, wheelchairs, specialised cutlery, insulated mugs and platewarmers. The inspector noted that wheelchairs had not been named for their individual users. The deputy manager made arrangements for this to be rectified during the course of the inspection. The inspector also noted the hand rests on one Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 22 wheelchair were perished and worn. The deputy manager stated that she would made a referral for these to be replaced. The residents rooms provide good accommodation for residents. They are generally quite spacious and the rooms at the far ends of corridors are a little larger with double aspect. The home supplies as basic furnishing for each room, a bed, wardrobe and chest of drawers. The home does not provide lockable cupboards but residents can have keys to lock their rooms if they wish. The inspector has made several visits to the home and has always observed that residents have their own personal possessions around them in their rooms. One resident has bought herself a state of the art television and told the inspector she gets a lot of enjoyment out of it. There was a previous requirement that mattresses be deep enough to support residents comfortably. The inspector viewed one of the new mattresses which have been provided. It was deeper and more comfortable than that which she had seen previously. The deputy manager advised that the radiators are all individually controlled. They have covers. Emergency lighting is provided and was identified for the inspector by the handyman. The inspector viewed the record of water temperatures which are checked monthly by the handyman. She was advised that the en-suite have a lower water temperature with a failsafe mechanism to prevent any risk of scalding. The kitchen tap has a higher temperature because of the washing up done there. There is however a yellow sticker advising of the risk of scalding from hot water. There was a previous requirement that offensive odours be eliminated from the home. On the first day of the inspection an offensive odour was noted in a corridor outside of a particular room. The inspector pointed this out to the deputy manager who explained what was causing the odour. She undertook to have the carpet in the room vaxed that day and the next day the odour was not present. There were no offensive odours detected in any other part of the home. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 and 31. The level of training in the staff group is not adequate. EVIDENCE: There are nine nurse posts at the home, eight of which are filled with permanent nurses. The rest of the nursing shifts are covered by bank (Anchor relief) or agency nurses. The inspector viewed the staff rotas and noted that on the week of the inspection 25 shifts would be covered by bank nurses (permanent nurses are offered and also work bank shifts). From discussions with carers the inspector formed the view that they find some bank and agency staff can be less easy to work with, the comment was made that some bank staff are good. Carers spoken to felt that the staff group did not generally reflect the ethnicity of the residents. Mention was made of bank carers talking in their own language in the staff room. This is not inclusive and could be potentially divisive within the staff group. The registered person must ensure that staff are encouraged to speak English in the home. This is a requirement. There are thirty carer posts of which 22 are filled by permanent employees. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 24 Discussions with the relatives of residents indicated that being pleasantly treated depends who is on. The inspector was told that the new manager tries to get good carers with the right attitude. Bank carers do not have regular supervision and it is a concern that they cover a significant amount of the work at the home The registered person should recruit more permanent carers. This is a recommendation. The level of NVQ qualifications among the staff group is not satisfactory. One senior carer has level 3 and 2 have level 2, one is currently being assessed. The deputy manger is an assessor and verifier and is currently undertaking her level 4 registered managers award. Two nurses have applied to become assessors and they will need eight candidates to work with. The deputy manager stated that over the next six months there should be a significant increase in the number of staff having NVQ qualification. The inspector viewed the staff files of four care staff at the home. Their files demonstrated a robust recruitment procedure. All staff at the home have Criminal Records Bureau (CRB) disclosures. The inspector viewed the training profiles for four care staff and the chef manager. The training information is now very clearly held with course content and attendance sheets, training profiles, and certificates. The inspector found it easy to cross reference the training of staff. There was a previous requirement that staff be trained in palliative care, ageing, illness and death with previous timescales of 30/11/04 and 01/08/05 and 01/12/05 not met. Of the four staff records examined none had had this training. Two carers interviewed confirmed they had not had this training. The registered person must ensure that staff are trained in palliative care, ageing, illness and death. This is a restated requirement. The deputy manager stated that the training history of bank staff is only checked if the home is using them a lot. This reinforced the concern of the inspector regarding the high use of bank and agency staff in the home. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 25 The chef manager is new. She has catering levels 1 and 2 and a range of other relevant training including basic food hygiene, kitchen management at level 1, and nutritional awareness. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38. The health, safety and welfare of residents is protected but the supervision of staff is not comprehensive. EVIDENCE: The current temporary manager of the home is not a registered nurse but has many years experience of the work and has demonstrated her ability to raise care standards significantly in a short period of time. The inspector heard various positive comments about her from residents and staff. The line manager of the temporary manager, is currently on extended leave and his post is being covered by another manager. The deputy manager is covering her post on a temporary basis. The inspector is confident in the ability of the temporary manager and the deputy but is aware that neither of them are permanent at the home. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 27 The deputy manager stated that she feels the ethos of the home is open and honest there is a growing sense of commitment. The deputy manager agreed that the high use of bank staff is not desirable and undermines progress somewhat. She stated that if the home’s contractual arrangments were restored the management would feel confident to recruit more permanent staff. The inspector was told that nurses meetings are now taking place, the next one is on 14/3/06. The deputy manager said that letters have been sent to night staff encouraging them to attend the nurses meetings. This indicated to the inspector that there is still work to do to discourage the separate culture of the night staff. The inspector feels that if the night staff are all bank nurses this is especially difficult to change. There are also general meetings which are open to all and the inspector viewed the record the last one on 30/3/06. The inspector viewed the record of residents monthly meetings. She was told that meetings are advertised and relatives can come and one residents husband often does. A residents survey has been begun and keyworkers are assisting where necessary. The deputy manager advised that the feedback will be analysed and an action plan made. The home aims to survey residents and staff twice a year. The home is part of the national Anchor organisation and the inspector was satisfied that the financial and accounting procedures in place for the home would safeguard residents. The inspector interviewed the administrator and asked her about the financial dealings for the four residents case tracked, viewing relevant documentation. The administrator said she had no financial dealings with two of the residents. The rent for one is paid by the local authority and for the other by her husband by standing order. Whist the inspector was with the administrator the activities co-ordinator came to ask for money to purchase toiletries for a resident (who happened to be one of the four being case tracked) The administrator demonstrated the system she uses for this kind of transaction, checking the balance for the resident providing the cash, checking the receipts, making the necessary debit etc. The inspector viewed a form which residents sign when they need the home to administer their monies. The administrator is currently trying to identify an independent person to act as witness to these forms. The inspector suggested visiting clergy might be willing to help. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 28 The administrator explained that where the home deals with residents monies, individual bank accounts are being opened and residents will have current and savings accounts. For another resident her financial affairs are dealt with by her neice who pays her rent and keeps a float at the home for small cash transactions. The inspector viewed the contents of the safe which are systematically stored and documented on a sheet on the inside of the door of the safe. There is a property book with a numbering system. The inspector was satisfied that financial arrangements at the home are sound. There was a previous requirement that staff have formal supervison not less than six times per year. The inspector viewed a list of the supervisors and the staff they supervise. The deputy manager said she felt this clear structure of responsibility reinforced accountability. The supervision list however covers only permanent staff. The inspector also viewed the records of staff supervision for the four workers she was case tracking. The system for keeping these records is very new, starting last month. The inspector was able to evidence that three had had supervision since the system began. It will be helpful to inspect the record when it has been operating for a longer period to establish the regularity of supervision. The main concern of the inspector is that a significant number of nurses and carers at the home receive no supervision because they are not permanent staff. Recommendations have been made regarding the recruitment of permanent staff. The inspector viewed various documentation during the course of the inspection including individual records, the shift handover book, the accident and incident book, the complaints folder. She was satisfied that recording is secure, up to date and kept in accordance with data protection legislation. A number of aspects of safe working practice were inspected including the fire protection system. There was evidence that the fire alarm and emergency lighting are tested every week (in-house). An outside contractor makes a Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 29 quarterly inspection and on 30th March 2006 tested the fire alarm system including the lighting. The next fire inspection is due on 3/5/06/ The arrangements for control of substances hazardous to health (COSHH) were inspected.. The inspector viewed the COSHH cupboard and the product information and data sheets kept. The inspector viewed the evidence of portable appliance (PAT) testing which is due to be done again in June, 2006. There was a previous requirement that food hygiene practice be observed including the labelling of food with the date of opening. The inspector viewed the contents of the refrigerators in the main kitchen. She noted mayonnaise opened but without a label bearing the date of opening. The inspector explained to the chef manager the importance of dating all opened food. The registered person must ensure that food hygiene practice is observed including food being labelled with the date of opening. This is a restated requirement. The inspector viewed the recording of fridge and freezer temperatures which were satisfactory. The chef manager keeps a weekly kitchen audit form which was also satisfactorily completed. Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 30 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 2 3 2 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Silk Court Nursing Home DS0000007367.V287755.R01.S.doc Version 5.1 Page 31 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 and 5 Requirement The registered person must ensure that the statement of purpose/service user guide are amended in accordance with the above comments. The registered person must ensure that all residents have contracts. The registered person must ensure that staff who work with residents suffering from dementia have appropriate training. The registered person must ensure that turning charts reflect the activity undertaken and are fully completed, timed and signed, without gaps (previous timescale not met 01/09/05). The registered person must ensure that all nurses working at the home, including bank and agency nurses have up to date training in the administration of medication (previous timescales of 01/07/05 and 01/09/05 not met). The registered person must ensure that quantities of DS0000007367.V287755.R01.S.doc Timescale for action 01/06/06 2 3 OP2 OP4 5 18 (1) (c) 01/06/06 01/08/06 4 OP8 12 (1) (a) 01/06/06 5 OP9 12 (1) (a) 01/06/06 6 OP9 13 (2) 01/06/06 Silk Court Nursing Home Version 5.1 Page 32 7 OP16 22 8 9 10 OP19 OP27 OP30 23 18 18 (1) (c) (i) 11 OP38 38 medication held are entered on the MAR sheets so that medications can be accurately balanced. The registered person must ensure that all complaints are fully investigated and the complainant is advised in writing of the outcome of investigations. The registered person must ensure that all parts of the home are kept in a clean condition. The registered person must ensure that staff are encouraged to speak English in the home. The registered person must ensure that staff are trained in palliative care, ageing, illness and death (previous timescales of 30/11/04, 01/08/05 and 01/12/05 not met). The registered person must ensure that food hygiene practice is observed including food being labelled with the date of opening (previous timescale 01/12/05 not met). 01/06/06 01/06/06 01/06/06 01/08/06 01/06/06 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 OP9 OP12 The activities co-ordinator has not had training for her role. The registered person should ensure that National Association for Providers of Activities for Older People (NAPA) training is provided. The registered person should recruit more permanent carers. DS0000007367.V287755.R01.S.doc Version 5.1 Page 33 Good Practice Recommendations The registered person should ensure that only one container of a medication preparation is opened at once. 3 OP27 Silk Court Nursing Home Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford 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 DS0000007367.V287755.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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