Inspection on 05/09/06 for Sloane House Nursing Home

This inspection was carried out on 5th September 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.

Other inspections for this house

Sloane House Nursing Home 05/09/07

Sloane House Nursing Home 09/01/06

Sloane House Nursing Home 17/06/05

Sloane House Nursing Home 31/01/05

Sloane House Nursing Home 28/10/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sloane House Nursing Home Sloane House Nursing Home 28 Southend Road Beckenham Kent BR3 5AA Lead Inspector David Lacey Key Unannounced Inspection 5th September 2006 09:45 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 Sloane House Nursing Home DS0000010141.V298432.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. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sloane House Nursing Home Address Sloane House Nursing Home 28 Southend Road Beckenham Kent BR3 5AA 020 8650 3410 020 8650 5009 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) The Mills Family Limited Ms Traute K M Gladstone Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 28 September 1998 Date of last inspection 9th January 2006 Brief Description of the Service: Sloane House is a large, detached building in a residential area of Beckenham. It has been converted for use as a care home providing nursing care for up to thirty-three older people of either sex. The home has a team of qualified nurses, supported by care and ancillary staff. There are single and shared bedrooms, most of which have en-suite facilities. Accommodation for service users is on different floors, with access by passenger lift. The home has some off-street parking at the front and a back garden with patio. There are bus and rail services nearby, with links to the public tram service. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced visit to Sloane House, carried out by two inspectors. During the visit, the inspectors spoke with service users, visitors, staff members and the home’s manager. The inspectors toured the premises and examined various pieces of documentation. Service users were surveyed to gain their views of the home and its service provision, and their responses have been incorporated into this report. What the service does well: What has improved since the last inspection? Improvements to the home’s environment since the previous inspection include renewal of the central heating and hot water boilers, and redecoration and new carpeting in the lounge and dining room on the ground floor. Some former shared bedrooms have been refurbished, to become single rooms with en-suite facilities. The provider is now supplying the commission with monthly reports of visits to the home by a senior manager to monitor the quality of service provision. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 6 The manager has developed a system for undertaking regular audits of various aspects of care delivery. Some improvements have been made to the operation of the home’s recruitment procedures but there is more to do in this respect. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3 (6 does not apply to this home) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users usually receive enough information about the home to decide if they wish to move in. Service users have contracts with terms and conditions. Service users are assessed before being offered a place in the home. All necessary assessment information should be recorded. EVIDENCE: As part of the inspection, service users living in the home were invited to give their views about choosing the home. Seven of the nine service users or their representatives who returned completed questionnaires to the Commission stated they had received a contract. Two respondents did not reply to this question. Eight respondents stated they had received enough information about the home before moving in so they could decide if it was the right place for them. One respondent said insufficient information had been received. A recently admitted service user said that a relative had chosen the home. The relative had visited the home to see what it was like and had got information Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 9 about the services and accommodation provided. The service user was happy with the choice made, “I knew he wouldn’t choose anywhere I wouldn’t like, and the home’s very nice”. Service user guides were seen in bedrooms. The inspectors examined assessment information on a sample of service users’ files. The service users had been assessed before admission to the Sloane. In general, the information seen was satisfactory although it did not in all cases provide a comprehensive assessment of needs (see recommendation). In one file seen, the assessment information included the service users’ personal details and those of his next of kin. The assessment information was in a short summary format and included the service user’s past medical history, allergies, contact details of GP and district nurse. In addition, there was a hospital letter. The dependency profile and activities of daily living were not completed. The inspector was unable to assess what information the service user or the family had received before admission, including whether a trial/introductory visit to the home had been offered. Another service user file seen contained a pre-assessment record, a hospital discharge letter, and the acceptance letter from the Sloane. However, the dependency profile had not been completed. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. All service users have care plans, though these do not always reflect fully all needs. Service users have good access to health care services, including physiotherapy services provided by the home. The administration of medicines was satisfactory. EVIDENCE: Care plans sampled for inspection had been signed either by the service user or their representative and had been reviewed regularly. The plans seen addressed physical health needs but were limited with regard to social and psychological aspects. Also, when issues had been identified through risk assessments there was little documentation about action taken to address the problem. The care plan for a service user with high dependency needs detailed a number of physical health problems, which needed to be addressed. One care plan for wound care had daily reassessments included, however the turn chart when inspected at midday had not been completed since 06.30 am. This service user also had a very high Waterlow score, which had increased from the previous Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 11 month’s assessment. Care reviews had signatures of the staff member completing the information and either the service user’s or the advocate’s signature. Also in place were risk assessments relating to manual handling and nutrition. The service user’s nutritional score was at a level where dietetic advice should be sought. This risk had increased and the service user was losing weight. The inspector was unable to locate the referral made for specialist dietetic input and the frequency of reviews had not increased with the identified risk. The care plan did not reference the service user’s deafness or level of confusion, both of which were very apparent when the inspector attempted to interview the service user. In the daily events, there was reference to aggression and confusion. Another service user’s care plan addressed the main physical health problems. These had been reviewed and there were service user’s or advocate’s signatures in place. The supporting risk assessments indicated a high risk for skin integrity and “at risk” in respect of nutrition issues. However, the manager described several behaviour problems associated with this service user, none of which were reflected in the care plan documentation. The service user had been referred to a psychiatrist. The inspector met the service user, who was clearly distressed, confused and disorientated in time. Care plan documentation should always fully reflect the service user’s needs, including psychological and social issues (see recommendation). A recently admitted service user who was case-tracked by the inspector had been registered with the home’s visiting GP on admission to the home, and had been seen by the GP. The service user was happy with the health care services received since moving into the home. The home employs two qualified physiotherapists on a part-time basis. They were seen working with service users, assisting them to mobilise as part of their rehabilitation. Service users said they found the physiotherapy provided in the home to be both helpful and enjoyable. A service user who needed help to mobilise explained that, because of sitting for long periods, the staff gave regular pressure area care – “they use cream on me regularly and they make sure I’m comfortable and not sore”. The inspector met with a service user and her visitor. The service user was enjoying chatting with her friend in the home’s lounge. The visitor said she calls into the home regularly and her friend always appears well looked after, clean and well groomed. Staff were seen to treat service users with respect, knocking on bedroom doors before entering, using service users’ preferred names, and explaining what they were going to do when starting to give care. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 12 As part of the inspection, service users living in the home were invited to give their views about health and personal care. Of the nine service users or their representatives who returned completed questionnaires to the Commission, six stated they either always or usually receive the care and support they need. Three respondents stated they sometimes receive this. Eight respondents stated they either always or usually receive the medical support they needed. One respondent stated s/he sometimes received this. The medications were inspected and it was noted the home operates the Nomad system. In her action plan for the CSCI following a requirement and recommendation from the previous inspection, the manager had confirmed that all nurses working in the home had been reminded to be accurate in their recording of medication administration and that two staff members should sign hand transcriptions to medicine administration records. Medication administration records were generally well completed, except that those medications to be given as required needed full instructions including duration, maximum dose and the specific reason for administration. Some charts did not have the allergies recorded. Each chart had the service user’s photograph in place. The records and stock balance for controlled drugs were checked and found to be correct with all records completed. Medications were safely stored and in an orderly manner. Dates of opening were detailed on those medications that needed it. Qualified staff had signed for those medications received into the home. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users have opportunities to take part in various activities. A balanced diet is provided and service users like most of the food served. However, the home needs to do more to ensure its routines meet service users’ individual expectations and preferences. EVIDENCE: The inspector observed routines and activities for the morning and the afternoon period. Service users were seen to spend time in their own bedrooms or the communal areas. TV’s, radios and newspapers were available in many bedrooms. Visitors were seen to come and go, and service users stated that visiting was open and could be in private as preferred. Many service users had their own private telephones. There were mixed views from service users about the home’s arrangements for giving care. A service user unable to wash and dress independently told the inspector that normally he received his morning wash and assistance to the lounge between 10.00 and 11.00, and that he was happy with this arrangement. On the day of the inspection visit, a carer came to the service user’s room just before 11.00 to give personal care and assist the service user Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 14 to the lounge. It was noted that as late as 11.00 several other service users remained in their night attire. This was not by their choice, as some remarked upon the delay. This was because staff were busy attending to service users’ needs, however this led to delays for some service users. Staff felt that the dependency of service users was high, hence some service users were not attended to at the time they wished. The inspector also received comments regarding the night routines, which meant that service users were either put to bed quite early or late “depending on which side of the corridor they started”. This should be looked at, as service users should have choice and have their care tailored to their wishes. It is recommended that attention be given to promoting individual choice rather than relying on giving care orientated to tasks and routines. The inspector met with several service users either individually or as a group. They made varied comments about their stay in Sloane and the treatment that they received. Food was said to be good. One service user said she would like more contact with “downstairs”. On being asked to clarify this, she said she felt the manager’s and administrator’s offices were not accessible and that phone messages were not always forwarded. Staff attitudes and approach were said to be variable, with some very good, caring and patient, but others less so. Lunch was a relaxed, unhurried affair. The lunch served did not match that on the printed menu but the kitchen assistant said she did not know why this change had been made. Special diets were catered for, choices were available and juice was served during the meal. A carer was observed to assist a service user with feeding at lunchtime. This was carried out sensitively and in an unhurried manner. Action had been taken by the manager to ensure a previous requirement about records of food provided and nutritional assessments was met. As part of the inspection, service users living in the home were invited to give their views about daily life and social activities. Of the nine service users or their representatives who returned completed questionnaires to the Commission, six stated the home either always or usually arranged activities that they could take part in. Three respondents stated activities were sometimes arranged. Seven respondents stated they either always or usually liked the meals at the home. Two respondents stated they sometimes liked the meals. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are protected from abuse and can be confident any complaints they raise will be listened to and acted upon. EVIDENCE: There is a complaints procedure, which is displayed in the home and includes details on how to contact the CSCI. The home’s management of a recent complaint was discussed during the inspection. It was evident that the provider had followed its complaints procedure in dealing with the complaint. The manager keeps a record of any complaints she receives. As part of the inspection, service users living in the home were invited to give their views about complaints. Of the nine service users or their representatives who returned completed questionnaires to the Commission, all stated they either always or usually knew who to speak to if they were not happy. Eight stated they either always or usually knew how to make a complaint. One respondent did not reply to this question. A nurse and two carers were spoken with, all said they were aware of the term whistle blowing and that if they had any concerns regarding the practice of colleagues they would discuss the matter with the manager. Another nurse Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 16 interviewed by the inspector demonstrated sufficient knowledge of adult protection and whistle blowing. The home’s manager liaises with Bromley social services department, and staff can attend adult protection training offered by Bromley Council, as well as adult protection training courses arranged in-house by the company. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 17 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, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Areas of the home used by service users are clean, comfortable and well maintained. EVIDENCE: The home was clean, tidy and odour free. Individual bedrooms were personalised and those service users in their bedrooms had call bells and fluids at hand. The communal areas were pleasant and homely in nature. The service users seemed to enjoy spending time in the conservatory. The dining area was nicely presented and tables had been laid before lunch. Areas of the home, such as lounge and dining room, had been redecorated since the last inspection. Some of the bathroom areas were congested with items of equipment and were also used as storage areas. As part of the inspection, service users living in the home were invited to give their views about its environment. Of the nine service users or their representatives who returned completed questionnaires to the Commission, five stated the home was always fresh and clean. Four respondents stated this Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 18 was usually the case. Two service users who the inspector met in their own bedrooms said they were happy with their rooms, they liked the décor and the rooms were always kept clean. They said their beds were comfortable and they slept well. There were enough aids and adaptations to meet service users’ needs, and enable them to maximise their independence. The inspector suggested to the manager that consideration be given to installing grab rails that are fixed to and fold back to the wall in all en-suite toilets, rather than using only the portable lavatory supports (see recommendation). The home is gradually converting shared bedrooms to single rooms with ensuite facilities. The manager said it is planned to retain two shared rooms in case friends or couples wish to share. This will mean an eventual reduction in the numbers of service users the home can cater for, which the CSCI has already advised will need to be formalised through a variation to the home’s registration. The planned kitchen refurbishment has not yet taken place and the manager was not aware of any definite start date for this work to commence. A recent environmental health inspection had been carried out by the local authority (Bromley), and the home provided a copy of the report to CSCI as part of its pre-inspection information. The home had complied with the reports recommendations and received a Clean Food Award, valid until May 2007. The home had been recommended to fit door locks to service users’ private accommodation. The locks were recommended to be appropriate for service users’ capabilities and accessible to staff in emergencies. The provider’s action plan for CSCI confirmed service users are now asked if they wish to have a lock fitted. If they do, a suitable lock is fitted to their door. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 19 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, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Suitably qualified and competent staff are employed to meet the needs of service users. The staffing levels should be reviewed to ensure they continue to meet service users’ dependency needs. The operation of the home’s recruitment procedures needs further improvement to safeguard service users. EVIDENCE: As part of the inspection, service users living in the home were invited to give their views about its staffing. Of the nine service users or their representatives who returned completed questionnaires to the Commission, eight stated that staff listened and acted on what the service user said. One respondent stated that staff do not do this. Eight respondents stated staff were either always or usually available when they needed them. One respondent stated staff were sometimes available. A service user told the inspector that staff are very kind “I can’t fault them” and that they respond promptly to requests for assistance. A qualified nurse and a carer (interviewed separately by the inspector) each said they thought the home had enough staff. The carer said that if she needed help, for example to transfer a service user, she used the buzzer and another carer would come to help. She said she rarely had to wait, as a second carer would come promptly. The nurse said that the home has enough carers on duty at each shift and that “they’re good, they know what they’re doing”. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 20 Since the previous inspection, the manager and CSCI have corresponded about the home’s staffing levels. The CSCI wrote to the manager in February 2006 confirming that the minimum staffing levels must remain as set out in the home’s existing staffing notice. During this present inspection, it was evident that many service users service user in the home have high dependency needs. The inspectors heard from staff how dependency levels had been increasing. In view of this, it was suggested to the manager that a formal review of staffing levels and mix should be carried out (see recommendation). The inspector spoke with the housekeeper who explained how work was organised to ensure the whole home was kept clean. She was covering additional work because of staff holidays but said there were still enough cleaning hours to get the work done. The home was clean and tidy on the day of the inspectors’ visit (and see service users’ comments above in the ‘environment’ section). Recruitment procedures had been reviewed following a requirement made at the previous inspection. A sample of staff files was examined at this inspection visit. They were found to be generally satisfactory but the previous requirement had not been met in full. The CRB disclosure for one newly appointed staff member was neither available in the home nor from the company’s head office when the home’s administrator made a telephone request. This meant that the staff member had completed her induction, was working unsupervised with service users, but the home was not aware whether her CRB and POVA checks were satisfactory. This was discussed with the manager and a requirement has been made. The inspector also suggested to the home’s manager and administrator that the authenticity of references should be enhanced by asking referees to use either their company-headed paper or adding their company stamp to the reference questionnaire sent out by the home (see recommendation). A nurse outlined her experience of the home’s recruitment process. She said she had applied for her post, been interviewed, submitted her documents and had a CRB check before beginning work. She said that on taking up her post, she had initially undergone a period of induction that included a tour of the premises with identification of fire exits, and seeing videos relating to health and safety matters. She had taken part in a fire drill. Her induction also included working on all shifts (including nights) to experience how 24-hour care is delivered in the home. The inspector later examined this nurse’s recruitment file, which contained the information required, including an enhanced CRB check through the provider and NMC confirmation of her nursing registration. Another nurse who met with the inspector confirmed she had two weeks’ supernumerary induction, working various shifts to get a feel for the routines. Her induction covered health and safety, manual handling, medications, and Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 21 other relevant topics. She was currently undertaking a distance learning infection control course with Croydon College. She was able to give a lot of information about her key service users. A carer interviewed by the inspector confirmed she had completed an induction programme on taking up her post. She had just completed NVQ 2 and was taking NVQ 3. She said that she had received a lot of training, including manual handling, first aid, communication, adult protection and whistle blowing, a two-part dementia course, as well as statutory topics. She said that she received supervision regularly and a copy of the meeting notes was issued to her. The inspector had seen this carer using good practice in basic infection control, and noted she was knowledgeable about the topic. An agency carer had worked in the home the month previously as well as on the day of the inspection. She said that on her first day the home was very short staffed and she had arrived late morning. She had no checks requested, including of her identity. She said that on that day she “just had to get on with it” and was not provided with any induction. The permanent staff were friendly and helpful but “too busy to show you anything”, particularly in the morning period. This was discussed with the manager, who confirmed that the normal checking procedures had clearly not happened on that occasion. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 22 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, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager is fit to run the home. Quality assurance strategies have improved but should be developed further to include the publication of results of satisfaction questionnaires. Care audits and monthly provider visits are taking place. Staff must be enabled to always follow procedures to ensure safe hot water temperatures when assisting service users to bathe. Risk assessments must always be followed when assisting service users to move around the home. EVIDENCE: The manager is registered with the CSCI for Sloane House, following a process of assessment. The manager is a registered nurse and is required to undertake continuous professional development to maintain her registration with the NMC. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 23 Two service users spoken with said the manager was easy to talk with and kind towards them. The inspector heard (separately) from two members of staff that they got good support from the manager. Minutes of staff meetings and meetings with service users were on file. Since the previous inspection, the CSCI has been supplied with monthly reports of the provider’s visits to the home, in compliance with regulation 26. The company’s nursing director has carried out these visits. It is evident from the reports that all aspects of service provision are kept under review and improvements are recommended as the need is identified. The views of service users and staff are sought and taken into account. A previous recommendation to publish the results of service user surveys had not yet been met. The company’s nursing director was contacted by the manager during the inspection visit and confirmed that the survey report will be completed and a copy supplied to the CSCI. The manager outlined to the inspector the systems she has developed for auditing the care given at the home. She now audits care plans, MAR sheets, and environmental matters. Examples of these audits were seen during the visit. Issues identified for improvement, for example, aspects of a care plan had been raised with the relevant staff member, for example, the named nurse, and an improvement strategy agreed. In two communal bathrooms, the hot water temperatures were higher than the acceptable safe levels. The water from both baths was uncomfortable to the inspector’s touch. One bathroom did not have a thermometer, but the thermometer in the other bathroom showed the water temperature to be over 50 degrees Centigrade. The inspector raised this finding with the manager as a matter of urgency. She arranged for the company’s maintenance technician to visit the home immediately and the hot water temperatures throughout the building were checked and adjusted where necessary before the inspector left the premises. It was understood that current plumbing work being carried out had affected the temperatures at the hot water outlets. The manager and maintenance technician reassured the inspector that the temperatures would be monitored. A requirement has been made that thermometers are always available in all bathrooms so that staff may follow the home’s written procedure for safe bathing of service users. A service user said that sometimes one carer helped to transfer the service user with a hoist. The service user preferred to have two carers, as this felt safer and more physical support could be given to limbs. A carer attending the service user said that sometimes one carer did this but that she was intending to ask for assistance today, as this was better for her and for the service user. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 24 On examination of the service user’s file, it became evident that a risk assessment was in place stating that there should always be two carers to transfer this service user with a hoist. This was discussed with the manager who agreed that risk assessments must either be followed or amended if no longer applicable. A requirement has been made. Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 25 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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 26 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 OP29 Regulation 19 Requirement Recruitment procedures must be developed so as to be robust and comply with Regulation 19 of the CSA 2000. Previous requirement with timescale of 30/01/06, met in part only. The registered person must ensure that unnecessary risks to service users’ health and safety are identified and so far as possible eliminated, specifically, thermometers must be available in all bathrooms at all times to enable accurate checks of the hot water temperatures. The registered person must ensure that moving and handling risk assessments are followed at all times. Timescale for action 30/09/06 2 OP38 13 19/09/06 3 OP38 13 19/09/06 Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 27 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 OP33 Good Practice Recommendations The results of service users surveys are published and made available to current and prospective users, their representatives and other interested parties, including the CSCI. (Previous recommendation). The registered person should consider installing folding grab rails that are fixed to the wall in all en-suite toilets. The registered person should carry out a formal review of staffing levels and mix, taking the assessed needs of the service users into account. The registered person should ensure referees are asked to use either their company-headed paper for references or to add their company stamp if completing the reference questionnaire sent out by the home. The registered person should review routines to ensure service users’ choice is promoted and whenever possible given priority over task-oriented care. The registered person should ensure pre-assessment information is in all cases sufficiently robust to ensure needs are met. The registered person should ensure each service user plan sets out in detail the action to be taken by staff to ensure all aspects of the service user’s needs are met. The registered person should ensure that medications to be given as required have full instructions, including duration, maximum dose and the specific reason for administration. 2 3 OP22 OP27 4 OP29 5 OP14 6 OP3 7 OP7 8 OP9 Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Sloane House Nursing Home DS0000010141.V298432.R01.S.doc Version 5.2 Page 29 - 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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