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Inspection on 04/05/05 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 4th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Silk Court provides a good homely, physical environment for service users. Meals are varied, well cooked and appetizing and served in pleasant surroundings. A programme of indoor activities is in place and residents meetings are held. Relatives are welcomed.

What has improved since the last inspection?

Plans have been put for improved training including for the activities coordinator. Specialist equipment mattresses are on the premises (but not actually on the beds). A supernumerary part-time RMN is working in the home in the capacity of senior nurse.

What the care home could do better:

The home has many areas to address as detailed in the main body of this report. Their priorities should be to improve the quality of care for service users with an overhaul of the assessment, care planning and reviewing functions and with the introduction of standardised paperwork. They must focus on addressing the healthcare needs of service users including making urgent referrals for psychogeriatric assessment where indicated. The home should ensure the proper safety checking of staff and improve staff training levels. It is also important that the home organise an audit of the administration of medication.

CARE HOMES FOR OLDER PEOPLE Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR Lead Inspector Anne Chamberlain Announced Inspection 4th May 2005 10:00am 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 Version 1.10 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 Mr Hakim Issop Care Home 51 Category(ies) of Old Age, not falling within any other category registration, with number (51) of places Silk Court Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2004 Brief Description of the Service: Silk Court is a care home providing personal care, accommodation and nursing care for 51 older people. The home is registered to meet the needs of service 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 house was opened in 1994 and was purpose built. The premises are three-storey and contain passenger lifts. All of the bedrooms are single occupancy and have en suite facilities. There is a limited amount of parking space at the front of the building; the home does not have a garden. Silk Court Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspectors visiting the home comment cards were distributed to service users, relatives and involved professionals. Some responses were received by the inspector. The inspection was carried out over two days and two inspectors were present for the first day, one for the second. During the course of the inspection several service users were talked with, and a number of staff including the administrator and the activities co-ordinator. The acting manager, the area manager and a senior nurse were interviewed. The visiting Tissue Viability Nurse was also interviewed by the inspectors. Some relatives were spoken with. As part of the inspection files for service users and staff were randomly selected and viewed. Five service users were case-tracked. The administration of medication was observed. The storage and recording of administration of medication was inspected. Complaint, accident and incident, financial, safety and other records were examined. The inspector toured the premises and inspected catering arrangements as well as disposal of clinical waste and the storage of substances hazardous to health. The maintenance of safety and other equipment was checked. The inspector observed service users dining and ate a meal herself. Of thirty seven applicable standards thirty were inspected. The standards relating to management and administration 31 – 38 were not inspected on this occasion. Thirty three legal requirement were made and five recommendations. The inspectors would like to take this opportunity to thank the service users, families and staff at Silk Court Nursing Home for their co-operation with the inspection. What the service does well: Silk Court provides a good homely, physical environment for service users. Meals are varied, well cooked and appetizing and served in pleasant surroundings. A programme of indoor activities is in place and residents meetings are held. Relatives are welcomed. Silk Court Nursing Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Silk Court Nursing Home Version 1.10 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 Version 1.10 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) 1,2,3,4,5 and 6. Information is made available to service users and some visit the home before moving in. Service users are made aware of the terms and conditions and they have an agreement. Service users are assessed before they enter the home and their needs discussed. The home does not offer intermediate care only respite care. EVIDENCE: The home has produced a Statement of Purpose which fulfils almost all the required criteria under this standard but omits the terms and conditions which are in the service user guide. The statement of purpose must be amended to include the terms and conditions of the home. This is a requirement. The home has produced a Service User Guide. This contains some of the information required. It lacks a section on complaints. There is a reference to complaints procedure under ‘Our policies’ and a long section on whistleSilk Court Nursing Home Version 1.10 Page 9 blowing and staff raising concerns which is not, in the view of the inspector, really appropriate to a service user guide. The guide does not include any reference to inspection reports and should at least refer service users to how to access these, and state that a copy is available at the home. The guide does not include service users views of the home, although there is a section in the Statement of Purpose about how views are collected for quality assurance. There is no reference to the Commission for Social Care Inspection or how to contact the local office and the local offices of social services and health care authorities. The service user’s guide must be amended to include all the information required under the standard. This is a requirement. Both the Statement of Purpose and the Service User Guide would be more accessible with a contents page and page numbers. This is a recommendation. Service users have a licence agreement which states their contribution and is kept on their file. The inspectors found that these agreements were not always signed by the service user or their family. The manager ensure that a signature is obtained on all licence agreements. This is a requirement. The home has a procedure for assessing the needs of service users prior to admission. Information is sought from the referring agency and the deputy manager or another qualified nurse will visit the proposed service user, probably in hospital, to assess them and determine if their needs can be met at the home. There was some documentary evidence that this procedure is being followed. There is an opportunity for service users or their families to visit the home prior to acceptance of a place there. The manager stated that this happens, and there was some evidence to support this. However she acknowledged that in some cases, for various reasons, no visit is made. The first visit of a service user contributes to the early assessment of needs and the home must make a record of service users visits and retain it on their file. This is a requirement. Silk Court Nursing Home Version 1.10 Page 10 The inspector found much information missing from the admission details, where questions were simply left blank. The early assessment of needs was not standardised or comprehensive. The forms were mixed up with pages from other forms attached and many blank pages. There was repetition of social history and lack of care and nursing needs information. There was no space to record how a service user likes to be addressed. There was no consistent assessment of risk. The manager must ensure that care assessments are recorded on standardised forms and that they are comprehensive. The assessment must address tissue viability nutritional status and risk of falling. The forms must be fully completed with all elements of need covered. This is a requirement. Silk Court Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11. The home does not set out the health, personal and social care needs of service users clearly in their care plans. The system of reviewing is flawed. Health and care needs are not always fully met. The homes policies and procedures for dealing with medicines are not fully protecting service users. Structures are in place to protect the privacy of service users but they are not always observed. Service users are not always treated with respect. In practice the home supports families with bereavement. However it is not training staff adequately to engage with service users regarding their wishes for the time of their death. EVIDENCE: Needs assessments and care plans were examined. The care plan is termed Independent Lifestyle Agreement. The paperwork provided does not support staff well in care planning and reviewing tasks. There was little evidence of linking between needs assessment, care planning and care plan reviewing. In some cases care plans failed to address essential areas like nutrition. The care plans did not state service users wishes regarding resuscitation. Reviews did not relate to plans. What appeared to be an impromptu review had taken place with some new service users and notes had been taken which documented concerns and complaints. The paperwork was neither signed nor dated. Silk Court Nursing Home Version 1.10 Page 12 The assessment and care planning and reviewing process in the home must be overhauled with an improvement agenda in order to better meet the health care needs of service users. This is a restated requirement. There was evidence that service users health care needs are not being fully met. The home does not take service users who have been diagnosed as having alzheimer’s disease or severe dementia as their primary diagnosis. The deputy manager advised, however, that there are ten client’s who now have behaviour which indicates that they might be categorised as ‘elderly mentally infirm’ EMI. The home is not currently registered or set up to provide care for this category of service user, although it is seeking this registration. These clients need early assessment by a psychogeriatrician. The service users have been referred via their General Practitioner’s and are awaiting appointments. The deputy manager must make urgent referrals for these service users for immediate psychogeriatric assessment. This is a requirement. The deputy manager must forward the names of the service users in question to the inspector. This is a requirement. If any service user is deemed to need EMI care their placement at the home must be urgently reviewed. This is a requirement. There were other examples which indicated to the inspector that service users health care needs are not being fully met. An example was failure to regularly weigh service users including those with compromised nutrition and history of weight loss, also a failure to refer those needing nutritional programmes. One service user who had significant weight loss had a nutritional profile which stated that she was ‘low risk’ and no action was necessary. Service users must be regularly weighed and their nutritional needs addressed. This is a requirement. The issue of tissue viability was a particular concern to the inspectors. There was an absence of correlating care plans for pressure sores. The recording was muddled and inconsistent. Staff are not demonstrating competence in the area of skin care, for example how to grade a pressure sore, and the take Silk Court Nursing Home Version 1.10 Page 13 up of training has been poor. The home is able to call on the tissue viability nurse for advice but the inspector was not satisfied that staff were sufficiently knowledgeable in the area to know when this would be indicated. The nurse reported varying descriptions from staff regarding the appearance of sores. The home must adhere to a recognised protocol and tissue viability training must be mandatory for nursing staff. This is a restated requirement. The equipment in the home for the management of pressure sores was described by the tissue viability nurse as “old fashioned”. Clinical Primary Care Trust audit last year required the home to purchase a number of new mattresses. The home has new mattresses and these must be put on the beds as quickly as possible. This is a restated requirement. The inspector believes that in order to meet the above requirement the deputy manager needs additional staff support as well as supervision and guidance from senior managers. This is a recommendation. Medication arrangements were inspected and drug errors were identified. A bottle of eye drops was stored in the medications trolley with no prescription label to identify the service users and no information about the drops or where they should be stored. MAR sheet showed that a service user had been given two of four tablets but three tablets remained in the pack. A service user was noted to be in hospital and unable to receive medication when she was in fact in the home. One service user had been regularly given a dosage of medication two hours before it was due. No explanation for this departure from prescription was recorded. Ticks were used on the MAR sheet for application of cream. This is only acceptable if the nursing evaluation or diary sheet record the application which they did not. On one MAR sheet initials had been recorded in incorrect boxes with arrows pointing to other boxes. A medication round was observed by the inspector. The nurse combined the giving out of medication with other tasks, like chatting to service users and serving a drink. She twice left the trolley unattended and left the room. On the first occasion she left the doors of the trolley open. On the second occasion she closed the doors but left the keys on the top of the trolley. Silk Court Nursing Home Version 1.10 Page 14 The manager must ensure that nurses renew their training on the administration of medication. This is a requirement. In view of the drug errors which were identified during the inspection the manager must arrange for a pharmacist to undertake an audit of the medication administration arrangements in the home. This is a requirement. Feedback from service users and their relatives was mixed. One relative said that “some staff have endless compassion and some have none”. Indications were that not all staff treat service users with respect. Staff were said to be “abrupt” and to “pick you up sharp” and “make you feel uncomfortable”. A complaint had been recently received by the home that a staff member had used a negative term to refer to a service user. The home has a booklet entitled ‘Rights and Responsibilities’ with a policy statement and commitment to respect the dignity and rights of individuals. The manager outlined the ways in which service user’s privacy is respect for example their mail being delivered to them unopened. However a complaint had been received recently regarding staff walking into a service user’s room without knocking. The previous inspection required facilities to be provided for service users to be able to make telephone calls from their bedrooms. This has not been achieved. This is a restated requirement. Whilst the inspection was going on the family of a service user who had just died were visiting the home and were clearly at home there and made welcome. The inspector saw photographic evidence of a funeral tea having been held at the home. The home does have a policy regarding death and dying but there is a poor level of staff training around palliative care and issues of ageing and death. Care plans did not reflect individual wishes and views, including with regard to resuscitation. Service users need to indicate if they do not wish to be resuscitated and this is not being routinely recorded. The manager must ensure that staff are trained in the area of ageing, illness, palliative care and death. This is a restated requirement. Silk Court Nursing Home Version 1.10 Page 15 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) 12,13,14 and 15. The home partially meets the social, cultural, religious and recreational needs of service users. More communal activities and outings are needed. Contact with family and friends is encouraged and supported. Some service users are able to exercise choice and control over their lives. Service users have wholesome meals in pleasant surroundings. EVIDENCE: Efforts are made to meet the social, cultural and religious needs of service users. The inspector interviewed the activities co-ordinator. The previous inspection required that she undertake training for her role. This is planned but has not happened yet. The manager must ensure that the activities coordinator is provided with training for her role. This is a restated requirement. The co-ordinator runs a varied programme of indoor activities. Representatives from the Roman Catholic and Church of England churches visit the home regularly. One service user has English as his second language and a Somali visitor calls and talks to him in his own language. Daily recording evidenced service users exercising choice over whether or not to join in activities. Opportunities for community involvement and leisure activities outside of the Silk Court Nursing Home Version 1.10 Page 16 home are very limited. The inspector was told that staff do take service users out for local walks but they have not recorded this. One relative reported that the need for this is greater than can be provided in the current staffing levels. A relative advised the inspector that outings ceased two years ago. The coordinator stated that two seaside outings are planned for the summer she said that escorts are always readily provided by the organisation. The inspector was very concerned to hear that the activities co-ordinator has to raise all funds needed to run the activities programme, including costs of transport as the home has no vehicle. This means that a percentage of the coordinators time is spent in fundraising rather than on direct work. The manager must ask the organisation for an activities budget so that the coordinator does not have a need to raise funds. This is a recommendation. There was evidence that service users maintain contact with family and friends, although there are ten service users in the home who have no visitors. Over the two days of the inspection the inspector saw several visitors and heard about frequency of visits. She was satisfied that the home is welcoming to visitors. The inspector was satisfied that the home theoretically supports choice and control for service users and she believes that the deputy manager is committed to this. An example was given of service users choosing their own clothes each day. However a service user told the inspector that she resists pressure by the day staff to go to bed earlier than she wishes for the convenience of the night staff. The inspector was not satisfied that less able service users are always encouraged to exercise choice and control. Menu plans were viewed and the inspector was shown how service user’s menu preferences are collected. A service user confirmed that she makes her choices for meals and if she does not want what is on offer for tea she can have “anything I like, like toast or bread and marmalade”. The inspector received positive feedback regarding the food at the home and ate a meal of Lancashire Hot Pot which was hot and well cooked. The vegetables were good but the inspector found the hot pot rather salt, although the catering manager had said that she uses as little salt as possible. The inspector was told by a relative that a service user is not being properly supported to avoid food which upsets her digestion i.e. spicy dishes. The manager acknowledged that this has been happening. The manager must ensure that nutritional needs are properly documented on care plans which staff follow and that service users are supported to choose food which will not upset them. Silk Court Nursing Home Version 1.10 Page 17 This is a requirement. The inspectors were very concerned that service users with nutritional requirements, like those who are underweight, are not being referred for nutritional programmes. Please see standard 8. Dining conditions appeared pleasant. However the inspector observed that seating was not suitable for shorter people and chair raises should be used to make reaching the table more comfortable for them. This is a requirement. Silk Court Nursing Home Version 1.10 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 standard(s) 16,17 and 18. The home receives and deals with complaints. The complex information for staff and lack of a logging system do not support efficient resolutions of complaints within timescales. The lack of a dedicated policy for the home and the low level of staff training are poor indicators for adult protection. EVIDENCE: The home has a complaints policy and procedure. It is long and wordy and dense and there is a need for an easy step-by-step guide with timescales for staff to follow. A box of complaints forms is kept by reception. The forms have a blank space at the back where the name and contact details of the Commission for Social Care Inspection (CSCI) should be. There is also a “How to Complain” document. This needs to be updated to advise that complainants can come direct to the CSCI and give the local address and contact details. The “If you have a comment or complaint” document also needs to be similarly updated. The paperwork needs to be updated and clearly state timescales. This is a requirement. The inspector viewed the complaints folder which evidenced complaints being dealt with and complainants being written to. No log is kept of complaints so it Silk Court Nursing Home Version 1.10 Page 19 is difficult to track the progress of a complaint. The manager must introduce a system for logging complaints. This is a requirement. The inspector viewed the financial arrangements which appeared satisfactory. Two service users are wards of the Court of Protection, which protects them financially. The manager stated that the adult protection policy used is that of Tower Hamlets in conjunction with the Department of Health guidance for care homes and domiciliary care agencies. The area manager advised that the organisation’s adult protection policy is being updated. The old policy was not available at the home. Although more training is planned the level of staff training at the time of the inspection was inadequate. The inspector was advised that staff frequently fail to turn up for training. Training in adult protection must be made mandatory for all staff. This is a restated requirement. The organisation has produced a booklet entitled Rights and Responsibilities which has a helpful section on ‘Abuse’. It is not an adult protection policy. Silk Court Nursing Home Version 1.10 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 standard(s) 19,20,21,22,23,24,25 and 26. The home environment is safe and well maintained with comfortable homely surroundings and sufficient facilities. Independence is supported with specialist equipment but updated equipment is needed. The home is clean and hygienic. The indoor communal facilities are good but the outdoor facilities are very limited. EVIDENCE: The indoor facilities are spacious and comfortable although the number of armchairs provided is not generous. There is much specialised equipment provided but mattresses need replacing, as previously stated under standard 8. The outdoor facilities are very limited with no garden and a patio area to the front of the house adjacent to a car park. The deputy manager advised that a large sunshade is being purchased for this area for service users to sit under in the summer. The inspector suggested some tubs of flowers would enhance the area too. The is a recommendation. Silk Court Nursing Home Version 1.10 Page 21 The bathroom and toilet facilities are adequate and specialist equipment is provided for example ARJO bath and hoisting equipment, wheelchairs and walking frames. Specialised mattress are needed to support tissue viability as previously mentioned. An alarm call cord was broken in an upstairs bathroom and must be repaired. This is a requirement. The bedrooms in the home are comfortable, generally well decorated, and furbished. They are all en suite. The inspector observed much personalising of rooms with furniture, photographs and pictures. Many service users have their own televisions. One service user has a very pretty mirror brought from home which she is awaiting hanging on the wall. The manager must ensure that this is done. This is a requirement. In at least one case the possessions of a service user, including TV and furniture have not been itemised on his file. An inventory of possessions must be made for all service users and placed on their files. This is a requirement. Whilst touring the premises the inspectors noted a fire door (marked keep closed) to a clinical waste area propped open. This practice is against fire regulations and must cease. This is a requirement. The inspector also noted some badly cracked tiles in the en suite bathroom of a service user. These tiles must be replaced. This is a requirement. The inspector viewed the safety records for the home including the records for fire safety and the maintenance of equipment. The deputy manager advised that she intends to have the next fire drill at night. The lifts are surveyed periodically by the insurers and safety issues had been raised. These were reported to the head office of the organisation and the inspector was advised that the necessary maintenance has now been done and a document exists to confirm this. The manager must make this document available for inspection. This is a requirement. Silk Court Nursing Home Version 1.10 Page 22 The inspector observed a stained carpet in the bedroom of a service user The deputy manager does not have currently have budget control or a rolling programme for the replacement of carpet. This situation needs to be resolved and will be dealt with under Management and Administration standards. The home is generally clean and odour free. A vacant bedroom inspected had an unpleasant odour and the deputy manager undertook to have the carpet shampoo’d. The inspector noted a couple of deficiencies in the cleaning which the deputy manager will raise with the contractor. The previous inspection made a requirement (restated from 30/11/04) that an enclosed smoking area which cannot be viewed by the public be provided for staff. The manager reported that the organisation has considered this and finds the suggestion impractical. Given the number of serious shortfalls which directly affect service users, which have been identified at this inspection, this requirement regarding smoking arrangements for staff has not been repeated. Silk Court Nursing Home Version 1.10 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 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. The skill mix of the staff is not adequate to meet service users needs. Service users could not be said to be in safe hands at all times. The home’s recruitment practices are not safe and an immediate requirement has been issued. Training levels are poor and staff are not fully trained and competent to do their jobs. EVIDENCE: The home is divided into three floors. Excluding the manager who is a nurse, there are 44 permanent staff including 10 nurses. There are 26 permanent carers. The shift pattern is two nurses and four carers to each “floor” for each shift. The staff rota consists of a sheet and a book, both of which have to be consulted to access rota information. The deputy manager acknowledged that her staff rostering system is confusing and difficult to “read”. She plans to change the system to a large board where all the information can be seen at once. The manager must improve the staff rostering system to ensure clarity. Silk Court Nursing Home Version 1.10 Page 24 This is a requirement. The inspector viewed the staff rota’s and evidenced the shifts to have been fully staffed. She feels however that the staffing level is inadequate and this is born out by the poor practice evidenced throughout this report and the feedback from relatives. The inspector urges the senior managers to review the staffing levels in the home with a view to increasing the establishment. This is a recommendation. The deputy manager is concerned that a high proportion of the night staff have “day” jobs. The deputy manager is concerned that night staff are not sufficiently rested to undertake their duties at the home safely. She must do all in her power to ascertain the work patterns of the night staff. She must ask the staff to give her the information and must act accordingly on that information, making a judgement with senior managers about the competency of night staff. This is a requirement. The level of NVQ level 2 qualified staff is well below50 and this indicates that the skills level of the staff group is not high enough. The deputy manager must ensure that more staff are qualified to NVQ level 2. This is a requirement. At the start of the inspection the inspector was issued with a list of staff and their status in terms of Criminal Records Bureau (CRB) disclosure and proof of eligibility to work in the United Kingdom (UK). Including bank staff 75 of the staff have outstanding CRB checks. 46 of staff have not produced proof of eligibility to work in the UK. An immediate requirement was issued on 4/5/05, which stated that the management of the home must ensure that CRB disclosures are sent off, and POVA first checks are obtained within two weeks of the date of the requirement. In addition to this the management must ensure that proof of eligibility to work in the UK is obtained for all staff where this is necessary. This is a requirement. The level of training evidenced to the inspector was not adequate and not enough staff have essential training on topics like, adult protection and tissue viability. The training checklist does not include whistle-blowing. The inspector was not convinced by the recording of induction training, that it has been Silk Court Nursing Home Version 1.10 Page 25 properly administered. This is a concern as it is likely to be the only time staff are trained in fire safety. The inspector was told that staff are reluctant to train and often do not turn up for training sessions they are booked on. She was told that the night staff see themselves as somehow “separate” and not subject to management direction. The inspector suggest the manager must make it clear to the staff that some training is mandatory and failure to complete training is a disciplinary issue about which action will be taken. The manager must improve training levels within the staff group. This is a requirement. The manager must keep staff training profiles up to date and on their files. This is a restated requirement. Silk Court Nursing Home Version 1.10 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 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) these standards have not been assessed at this inspection. These standards have not been assessed at this inspection. EVIDENCE: Silk Court Nursing Home Version 1.10 Page 27 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 2 3 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 2 3 2 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 x x x x x x x x Silk Court Nursing Home Version 1.10 Page 28 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. 2. Standard 1 1 Regulation Requirement The Statement of Purpose must be amended to include the terms and conditons of the home. The Service User Guide must be amended to include all the information required under the standard. The manager must ensure that a signature from a service user or their relative is obtained on all licence agreements. A record must be made of service user visits and retained on file. Care assessments must be recorded on standardised forms and must be comprehensive. The quality of assessment and care planning must be improved. This is a restated requirement (previous timescale of 31/10/04 not met) The deputy manager must make urgent referrals for service users who need assessment by the psychogeriatrician. The deputy manager must forward to the inspector the names of service users who need urgent referral for psychogeriatric asessment. Version 1.10 Timescale for action 01 August 2005 01 August 2005 01 July 2005 01 july 2005 01 July 2005 01 July 2005 3. 2 4. 5. 6. 5 3 7 and 8 24 (1) (a) (b) 7. 8 24 (1) (a) 12 (1) (b) 01 July 2005 01 July 2005 8. 8 Silk Court Nursing Home Page 29 9. 10. 8 8 12 (1) (a) 12 (1) (a) 11. 8 12 (1) (a) 12. 9 12 (1) (a) 13 (2) 12 (1) (a) 13 (2) 13. 9 14. 10 16 (2) (b) 15. 11 18 (1) (c) 16. 12 18 (1) (c) 17. 15 15 Service users must be regularly weighed and their nutritional needs addressed. The home must adhere to a recognized protocol for tissue viability and training must be mandatory for nursing staff (previous timescale of 12/10/2004 not met). Specialised mattresses required by Clinical Primary Care Trust audit must be put on the beds for service users who need them (prevous timescale of 12/10/ 2004 not met). The deputy manager must ensure that nurses renew their training administration of medication. The deputy manager must arrange for a pharmacist to undertake an audit of the medication administration arrangements in the home. The deputy manager must ensure that facilities are provided for service users to be able to make telephone calls from their bedrooms (previous timescale of 31/10/04 not met). The manager must ensure that staff are trained in palliative care, ageing, illness and death (previous timescale of 30/11/04 not met). The manager must ensure that the activities co-ordinator is provided with appropriate training for her role (previous timescale of 31/12/04 not met). The deputy manager must ensure that nutritional needs are properly documented on care plans which staff follow and that service users are supported to choose food which will not upset them. Version 1.10 01 July 2005 01 July 2005 01 July 2005 01 July 2005 01 August 2005 01 August 2005 01 August 2005 01 July 2005 01 July 2005 Silk Court Nursing Home Page 30 18. 15 16 19. 20. 21. 16 16 18 22 22 18 (1) 22. 23. 24. 25. 26. 27. 22 24 24 25 25 26 23 23 12 (4 ) 17 23 (4) 23 (2) 28. 29. 27 28 18 19 30. 31. 28 29 19 19 32. 30 19 Chair raises must be provided so that shorter service users can reach the dining table comfortably. All complaints paperwork to be updated as described in the body of the report. The manager must introduce a system for logging complaints. The manager must ensure that staff receive training in adult protection (previous timescale of 30/11/2004 not met). A broken alarm call cord in a bathroom must be replaced A mirror which is the personal possess of a service user must be hung in her room. An inventory must be made of service users possessions and placed on their files. Fire doors marked keep closed must not be propped open. Badly cracked tiles in the en suite bathroom of a service user must be replaced. The manager must make available for inspection the document which confirms that the lift is safe. The manager must improve the staff rostering system to ensure clarity. The manager must ensure that staff are not overworking and that they can undertake night duties safely and competently. The manager must ensure that 50 of the care staff are are trained to NVQ level 2. The management of the home must ensure that CRB disclosures are sent off, and POVA first checks are obtained within two weeks of the date of the requirement (4/5/05). The deputy manager must Version 1.10 01 July 2005 01 August 2005 01 August 2005 01 August 2005 01 August 2005 01 July 2005 01 July 2005 01 July 2005 01 August 2005 01 July 2005 01 July 2005 01 July 2005 01 august 2005 Immediate requirement issued on 4.5.05. 01 August Page 31 Silk Court Nursing Home 33. 30 18 improve the training levels within the staff group. The deputy manager must ensure that each staff member has a personal training profile (previous timescale of 30/11/04 not met). 2005 01 July 2005 34. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 1 8 13 20 27 Good Practice Recommendations The Statement of Purpose and Service User Guide would be more accessible with a contents page and page numbers. In order to meet the requirements the deputy manager needs support from additional staff as well as supervision and guidance from senior managers. The manager must ask the organisation for an activities budget so that the co-ordinator does not have a need to raise funds. Flower tubs would enhance the outside facilities. The inspector urges the senior managers to review the staffing levels in the home with a view to increaasing the establshment. Silk Court Nursing Home Version 1.10 Page 32 Commission for Social Care Inspection 4th Floor, 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. 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