Inspection on 04/08/08 for Silk Court Nursing Home

This inspection was carried out on 4th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Silk Court Nursing Home 24/05/09

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR Lead Inspector Anne Chamberlain Key Unannounced Inspection 4th August 2008 10:00 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.V365204.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silk Court Nursing Home DS0000007367.V365204.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 Maricor.balbin@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Post vacant 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.V365204.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 18th September 2007 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.V365204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The rating for this service is two stars. This means that people experience good quality care. This inspection was undertaken on behalf of the Commission for Social Care Inspection and the terms ‘we’ and ‘us’ will be used throughout the report. The home completed an Annual Quality Assurance Assessment (AQAA) prior to the site visit. This was helpful. In addition we received information from the London Borough of Tower Hamlets commissioners, who monitor the service. Some of the statistics and quotes in this report have been taken from their work. We received 19 surveys returned from service users, relatives staff and stakeholders. The site visit took place on one day between 10.00 a.m. and 7.15p.m. We spoke to several residents, to two relatives and to some staff members. We addressed the handover group at 2p.m. inviting staff members to either raise any issues as a group, or come to see us in private after the handover. We looked at three residents’ files and three staff files. We would like to take this opportunity to thank the manager who assisted with the inspection and anyone else who contributed assistance or views. What the service does well: In surveys there were positive comments from residents…… I have been very happy here the staff work hard I cant fault the staff …always very happy with care you show to my wife. Always very helpful. Thank you. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 6 The service undertakes thorough assessment of residents needs. Care plans are fairly comprehensive but aspects are sometimes neglected. Recording is good. Medication is well administered. The home responds well to complaints investigating them thoroughly. The community areas and bedrooms in the homes are decoratively good. What has improved since the last inspection? What they could do better: The inspection resulted in 14 .statutory requirements. (none of which were restated) and one good practice recommendation. The manager must be registered with the Commission for Social Care Inspection (CSCI). Residents have mixed views about the attitude of carers. I like to be happy with the staff some are not nice Some time one or two care staff get uppity they are alright to me. One or two are a bit (silence)…..I think theyre bossy. They take the plate quickly without looking, abrupt. One relative thought there was not enough activities to keep them stimulated and a …lack of activities and outside excursions of which there appear to be none. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 7 The home must ensure that cultural information is recorded in every case including where residents have dementia. If punched pockets are used for care plans, only the current one must be in place, previous care plans must be archived. Carers must be reminded of what constitutes emotional abuse and must be disciplined if they are guilty of it. If a resident has a need to smoke but cannot organise this themselves, a care plan with a smoking programme must be developed, and a risk assessment. Confidential information must be locked away. A signature from the pharmacist must be obtained for medicines disposed of through them. The temperature in the medication refrigerator must be recorded every 24 hours. Food serving areas must be kept clean including the equipment in them. Food must be labelled upon opening with an opened on date. If food is hard to identify it should be labelled. The temperature for both hot dishes cooked each day must be recorded next to the name of the dish. Equipment which is suspected of being faulty should be taken out of service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Silk Court Nursing Home DS0000007367.V365204.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.V365204.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Residents experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents have their needs properly assessed before they are offered a place at the home. EVIDENCE: We looked at files for three residents. They all had all had their needs assessed prior to admission. The assessments covered all important aspects of need and care. We spoke with a relative whose mother had been recently admitted to the home. She said that the pre-admission assessment which was carried out was very thorough. After admission residents have a base line assessment which is more detailed. However for one service user in the section marked ‘family and cultural needs’ the word ‘yes’, had been entered. We searched the file and found reference to Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 10 the resident being a Roman Catholic. Cultural information must be recorded so that care plans reflect any cultural needs. The home does not admit people for intermediate care. Silk Court Nursing Home DS0000007367.V365204.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Residents experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Individual plans set our personal and social needs. Health care needs are met, medication is properly administered and respect and dignity are upheld. EVIDENCE: All three residents had care plans and these related to the assessment information which had been gathered. Care plans have individual sections for different areas of care. They are two sided and they are contained in plastic wallets. A problem was identified with this arrangement in that if more than one sheet is left in the folder then the front and back of the current sheet cannot be seen at the same time. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 12 The manager must ensure that out of date sheets are archived so that both sides of the current two sided sheet can been seen in the plastic wallets and there is no confusion with old information. It was noted from reading the file of the resident who has dementia and who has demonstrated challenging behaviour, that although the home is aware and has noted that the resident’s behaviour is linked to dependence on cigarettes, there is no ‘smoking programme’ available for him. We were told that the resident is allowed to smoke in his own room only but that he needs to have the one to one supervision of a carer with him as he is not safe to be left to smoke alone. The resident is dependent on relatives to bring his cigarettes in and the home does not know how many they bring or how often. The resident’s lighter is kept on the member of staff on duty so that he cannot smoke unsupervised. A risk assessment has been written on the resident smoking and the only measure identified to reduce risks is for the staff to keep the resident’s lighter. This is not adequate. This whole situation is being inadequately managed. Also it is very hard to see how the home can supervise the smoking of the resident with a ratio of two staff to eight residents on the dementia unit. The issue of staffing is taken up later in the report. The manager must ensure that a proper smoking programme is developed for the resident. The resident and his relatives should be consulted and involved in this programme. The resident’s care plan must include a plan for the management of his smoking. We looked at the care plan of a resident who has a pressure ulcer. It states that the ulcer needs daily dressing. There was insufficient evidence in the file that the ulcer has been dressed every day. The manager explained that this information is sometimes recorded elsewhere in daily records. She agreed that the dressing needs to be consistently recorded in the wound care record. The manager must ensure that the record of wound care is consistently kept and is accessible in the file of the resident. The AQAA points to the value statement of the organisation and states that induction training promotes privacy. We found a file containing resident information in an unlocked cupboard in the servery on the ground floor. The manager must ensure that all confidential information relating to residents is locked away. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 13 We inspected the arrangements for the administration of medication. We looked at two medications each for the three residents whose files we examined. All the stocks of medications were correct. The home keeps a book of medications disposed of. These are generally returned to the pharmacist but the home does not get the pharmacist to sign for them. The nurse returning the medications signs. The manager must ensure that the pharmacist signs for the medications he is taking away from the home. The manager and her deputy audit the medications regularly checking the balance of every medication for every resident. We saw the form they use for this and it was well designed. Medications which require cool storage are kept in a refrigerator in the treatment room. We checked the recording for the temperature of the refrigerator. This had not been entered on 2/8/08 and had not been entered on the day of the inspection 4/8/08, although the nurse said that she had checked the temperature that morning. The manager must ensure that the temperature of the refrigerator is checked every 24 hours and the temperature recorded straightaway. We observed warm and supportive interaction between staff and service users, on the day of the inspection. We also spoke with a resident whose file we inspected, and with her niece. The niece commented that one carer is “so sweet” and another is really “gentle”. She explained that because her aunt is hard of hearing and her vision is impaired she needs people to make eye contact with her and allow her to see their lips move. If carers stand by the resident’s chair and speak into the air above her head she is unaware of what they are asking or telling her they are about to do. She said that unfortunately some carers do this. The above would seem to be a very basic communication skill which all carers should use. We strongly recommend that the manager identify carers who are not practicing skilled communication, and ensure that this is brought to their attention. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Residents received good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home is relaxed with activities and company available. Contact from family and friends is encouraged and supported. Resident choice and control is integrated into every aspect of the running of the home. Food is wholesome, nutritious and pleasantly presented. EVIDENCE: The home employs a full time activities co-ordinator and it is a member of the national association of activity co-ordinators NAPA. The manager stated that the co-ordinator meets regularly with her peers from other local homes, for ideas and support. The manager showed us the programme of activities which are planned throughout the months. There is a good range of appropriate things going on, examples for this month being a barbecue in the garden a raffle draw, and a trip to Southend. We were sorry to see that only one outing out of the home is included for the whole year. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 15 Residents benefit from the Magic Me project which works with them building reminiscence books, making displays and generally affirming residents in their value as individuals. We observed meals being served. Residents are offered a choice between two dishes which are shown to them. The food was nicely presented and looked appetising. A survey undertaken by the London Borough of Tower Hamlets found that 33.30 of residents found the food very good, 20.00 found it good, and 33.30 found it fair. 73 of residents felt that food is served at the right temperature and 80 were satisfied with the portion sizes. 40 of residents said that snacks were available outside of mealtimes and 80 said that hot and cold drinks, are available outside of mealtimes. We received two letters from a stakeholder suggesting that the home is not meeting cultural needs regarding food. We discussed these with the manager. She said that the home is conscious of the range of ethnicity among the residents and the need to provide culturally appropriate food for them. She stated that these foods cannot be produced every day but are worked into the menus on a regular basis. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Complaints are protection are taken seriously by the home and there are good structures in place to ensure that they are properly handled. EVIDENCE: The home’s AQAA states that they have in place a robust complaints procedure which is detailed in the statement of purpose and service user guide, and also displayed on notice boards. It states that the timescales are strictly adhered to. A resident recently made a complaint about a staff member. The worker has been suspended and the complaint is being investigation by an independent person. This is good complaints practice. We picked up the Anchor leaflet Compliments, Concerns and Complaints, which can act as a complaint form. It is easy to use and gives the correct address for CSCI. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 17 Antecedent behavioural consequence (ABC) charts are used to help people who have challenging behaviours. The aim is that triggers for negative behaviours can be avoided. We were very concerned to see written on a chart ‘another staff came to see what was going on and told him to stop shouting at me or you won’t have any cigarettes’. This is emotional abuse and is totally unacceptable. It is a safeguarding issue and the manager will refer it as such. The manager must identify the carer who made the above statement. She must assess whether the carer needs refresher adult protection training. The manager must ensure that all staff have up to date adult protection training and have understood it and put it into practice in the working situation. The home has a policy and procedure for dealing with allegations of abuse. A recent anonymous allegation was thoroughly investigated by an independent person. The home assists residents to manage their personal monies. Subsequent to the last key inspection the CSCI received a complaint that residents monies were not properly accounted for. The procedure was therefore examined as part of this inspection. The homes administrator supplied the following information. • • Any money received a receipt will be issued. Money is entered onto the manual residents account with my signature (the administrator) and a countersignature it is also entered on SMART residents account on the computer, Cash collected will be put in the residents tin in the safe and cheques will be paid into Lloyds RPM account at the bank. Any money paid out for residents is entered onto the manual resident sheet and the receipt is attached with my signature and a countersignature, It is also entered onto SMART residents account on the computer A reconciliation is done at the end of each month with the bank statement and the Home Manager or Deputy Home Manager will sign together with me. Unannounced audit from Anchor Trust Finance department once a year. • • • • (February 2008 a manager from Anchor Trust came in and did an inspection and no issues were raised.) Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 18 We are satisfied that the homes financial procedures safeguard residents personal monies. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Residents experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is safe and comfortable but certain important areas are not clean enough. EVIDENCE: We undertook a tour of the home. The environment is safe and generally well maintained. However there was a bathroom on the first floor where the toilet was leaking a pool of water on to the floor. Rooms are personalised and the community areas are bright and cheerful. The communal areas of the home and residents rooms were clean. However Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 20 we found a large number of shortfalls in the hygiene standards of the home, in other areas. These are listed below: First Floor There were very dusty ledges on the door between the stairwell and the floor. In the servery wall cupboard there was a quantity of spilt sugar on a shelf. The servery fridge including the door were very dirty. The electrical plugs on the wall had dirty finger marks. The wall tiles were dirty with spills on them. The towel dispenser was empty. There was black mould at the back of the sink. The space under the counter top where the rubbish bin stands had food splashed on the wall and the side of the cupboard was splashed. The oven was very dirty indeed. Ground Floor Very dusty ledges on the door between the stairwell and the floor. In the ground floor servery the oven was dirty. We asked the manager who is responsible for keeping the servery areas clean. She stated that it is a shared responsibility between care and cleaning staff. It is not being discharged properly by either. The manager stated that 100 of catering staff and most of the other staff have completed training in safe food handling, but this was not demonstrated in the way they keep the food serving areas. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Residents experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home has a stable permanent staff with a good mix of skills. However recruitment practice can be improved and staffing levels in the dementia unit are no more than adequate. Staff training is satisfactory. EVIDENCE: One part of the home is dedicated to residents who are suffering from dementia. There are eight people currently living there. They are looked after by two staff at a time. We asked the manager how this staff ratio met the needs of residents and she stated that the home only offers care to residents who have early dementia and do not present challenging behaviours. However from the above information regarding one resident, it is clear that he does have some challenging behaviour. He also has a need to smoke, with one to one supervision, so when he smokes a cigarette this leaves the other seven residents in the care of one carer. We are not satisfied that the staffing level in the dementia unit is currently adequate. The manager must review the staffing level in the dementia unit and report back to the CSCI. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 22 Dementia is a progressive condition and residents needs can increase. The manager stated that if residents needs increase the home will consider asking them to move. Moving takes time. Staffing levels must be linked to residents needs and increased promptly if necessary. The manager must demonstrate that if necessary she can promptly increase the ratio of carers to residents in the dementia unit. She must report back to the CSCI. We viewed three staff files. We noted that although two professional references are taken up, the home does not ask referees to confirm dates of employment. This is a flaw in the recruitment practice and needs to be addressed to ensure that recruitment practice is safe and robust. There was evidence that staff have induction training. The manager stated that following this, core basics are renewed on an annual basis. We were satisfied that the manager has a reliable system for ensuring that carers update their training when necessary. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is generally good but there is a specific area where supervision has failed and standards have slipped. EVIDENCE: The manager has been in post for several months and is not yet registered with the CSCI. She is in her first post as manager. She has a good understanding of her role and follows procedures appropriately. The registered manager is a reflective practitioner and aims for high standard of care for residents. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 24 The home is run with the interests of residents at the forefront. Planning is person centred. There are systems in place to ensure that experience is used in a feedback loop to inform and improve practice. The home has administrative support on site and this is in turn supported by the corporate services. We made a check of the environment of the home and found shortfalls is safe working practices. There was butter in the door of the middle servery fridge with no opened on date. It looked very old and totally inedible. The manager must ensure that opened food is dated with the date of opening. The juice in the dispenser on the middle floor had been allowed to go very low. We asked a staff member how the dispenser is usually maintained. She stated that it should be emptied and cleaned before the juice gets down lower than a couple of inches from the bottom. The level of juice in the dispenser was lower than this, and sticky parts of the mechanism were exposed to the air. In a bathroom on the middle floor there was a bin with no lid. In the cupboard was a razor with a blade and a bottle labelled Lactacyd feminine douche. Products belonging to staff should not be stored in communal bathrooms. If the products belong to residents they should be stored in their en suite bathrooms. We inspected the main kitchen in the home. We were assisted in this by the newly appointed chef. There were temperatures recorded for hot food for every day. However there was only one temperature recorded and as stated above there are two hot dishes cooked every day. The temperature must be recorded for both hot dishes cooked. Also there was no identification of the dish so if there was an outbreak of food poisoning, the records would have to be checked against other records to be sure what had been eaten. The manager must ensure that the temperature records for cooked food are adequate. We found in the fridge a plastic box covered with cling film and containing a thick white liquid. It was not labelled in any way. We pointed this box out to the chef who said that she thought it was left over white sauce from the lunch that day. Left over food must be properly labelled, stating what the food is, when it was cooked and when it was placed in the refrigerator. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 25 One of the freezers had a small quantity of food in it. When we questioned this, the chef said it was because the freezer was no working reliably and had on occasions started to defrost itself. She said that kitchen staff take the temperature of the freezer every day and watch for drips of water from it. If a freezer is known to be unreliable it must be put out of service until it is repaired or replaced. In the dry store area we found an opened bottle of salad cream. This should stored be in a refrigerator. We also found a carrier bag on the floor. Inside the bag were two large wrapped lumps. The lumps were hard to identify but the chef said that she thought they were fondant icing which the previous chef had intended to take home with her. We imagine that the organisation has a policy which does not allow kitchen staff to take food home with them. We suggest the manager enforces it. In the dry store on a low shelf we also found a box with no lid. It contained a split packet of fine blend baking power with a teaspoon laying in the bag. We found a bin with no lid and an open bag of Tea bags in it. The manager must ensure that dry food is stored appropriately. The manager must do all she can to ensure that vermin are not encouraged by poor cleaning and storage of food in the home. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 26 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 3 x x 3 3 x x x x x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 2 Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement Care plans must be clear and current so that care is delivered appropriately. Care plans must record all relevant information including cultural needs i.e. a persons religion. Care planning must be comprehensive including activities which are important to residents i.e. smoking. Care, for example wound dressing, must be recorded consistently so that it can be monitored. Information about residents must be kept confidential to respect their privacy. The home must obtain a signature from the pharmacist to whom medicines are returned. The temperature of the medication refrigerator must be taken every 24 hours and recorded straightaway. Appropriate risk assessments DS0000007367.V365204.R01.S.doc Timescale for action 01/09/08 2. OP7 15 01/09/08 3. OP7 15 01/09/08 4. OP8 12 (1)(a)(b) 01/10/08 5. 6. 7. OP10 OP10 OP10 12 (4)(a) 13 13 01/09/08 01/09/08 01/09/08 8. OP14 13 (4) (c) 01/09/08 Page 28 Silk Court Nursing Home Version 5.2 9. OP18 13 (6) must be undertaken i.e. for smoking. Residents must be safeguarded from abuse including emotional abuse. Incidents of emotional abuse must be referred to local authority safeguarding and appropriate action taken to discipline and retrain staff. The manager must ensure that areas where food is served are clean and hygienic. The manager must ensure that equipment used in servery kitchens is clean. 01/09/08 10. OP26 16 (g)(h)(j) 01/09/08 11. OP27 19 (1) (a) The manager must review the staffing level in the dementia unit. She must report back to the CSCI on this. The manager must demonstrate to the CSCI that she can promptly increase the ratio of carers to residents in the dementia unit, if this is indicated to be necessary. 01/10/08 12. OP29 19 The manager must ensure that recruitment practice is robust and safe by ensuing that previous employment dates are confirmed in references. The manager must become registered with the CSCI The manager must ensure that: Food out of its original packaging is labelled. Opened food is labelled with the date of opening. 01/10/08 13. 14. OP31 OP38 8 16 (i) (j) 01/11/08 01/09/08 Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 29 The temperature of cooked food is recorded properly. Leftover foods are labelled with the contents, the date it was cooked and the date when it was placed in the refrigerator. Equipment which is known to be faulty is put out of service until repaired. Dry foods are stored appropriately. Vermin are not encouraged by poor hygiene practices and food debris. 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. Refer to Standard Good Practice Recommendations The manager should ensure that all staff have communication skills for working with people with sensory loss, and use them. Silk Court Nursing Home DS0000007367.V365204.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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