CARE HOMES FOR OLDER PEOPLE
Sloane House Nursing Home Sloane House Nursing Home 28 Southend Road Beckenham Kent BR3 5AA Lead Inspector
Lorraine Pumford Unannounced Inspection 9th January 2006 13.00p 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.V275248.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 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.V275248.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing Notice issued 28 September 1998 Date of last inspection 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 ensuite 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.V275248.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors who were in the home from approximately 1 p.m. until 5 p.m. During this time the manager, a number of members of staff and service users were spoken with. Some policies and procedures were examined and parts of the premises inspected. All Registered Care Homes receive a minimum of two inspections within a 12 months period, the previous inspection concentrated primarily on the service users and their opinions of the service provided, as this inspection may not have covered all the “National Minimum Standard” in sufficient depth, should further information be required it is recommended that a copy of the last inspection report also be obtained. What the service does well:
The home employs suitably qualified and competent staff in sufficient numbers to meet the current needs of the service user group. Staff are provided with good training opportunities and receive training in safe working practices, such as moving and handling and health and safety. Staff have received training regarding adult protection issues and the companys whistle blowing policy. All areas of the home used by service users are clean, comfortable, well maintained and free from unpleasant odours. An activities organiser is employed and the service users have the opportunity to participate in appropriate and meaningful activities both in and outside of the homes. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
A requirement made following the previous two inspections for the kitchen to be refurbished to facilitate effective cleaning has not been addressed. Staff need to ensure that hand transcriptions to medication records are signed by two members of staff to reduce the risk of error. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 7 An accurate record of food provided to service users needs to be maintained, to provide written evidence that service users are receiving a varied nutritional diet. The manager needs to develop a system for reviewing at appropriate intervals and improving the quality of care, service and nursing care provided in the home. The providers need to ensure a copy of the report they produce following their monthly audit of care and service in the home is forwarded to the CSCI. Recruitment procedures must be developed so as to be robust and comply with Regulation 19 of the CSA 2000. Receipts should be issued to relatives depositing money for service users for safekeeping with the home. 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.V275248.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The key standards were inspected during the previous inspection and therefore not inspected again on this occasion. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 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): 9, Although the manager has taken steps to address issues raised regarding storage of medication at the previous inspection. Further action is required with regards the recording of medication to reduce the risk of errors occurring. EVIDENCE: Issues raised at the time of the previous inspection relating to the need for medication to be stored at appropriate temperatures have been addressed by moving the medication store to an alternative location. An audit of medication showed adequate practices in place. Medication records were fully completed and in the main the administration records were satisfactory, although there were gaps on some charts. The home records medication received into the home and some charts had medication hand transcribed. Some transcriptions had two signatures, although others were lacking in one or two signatures and, in some cases, the medication did not show the amount received. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 11 The home is complying with the recent changes in the disposal of medication in nursing homes with a record of medications disposed of. Homely remedies were well recorded, including GP agreement and a list of agreed medications; administration of such medication and also receipt of medication. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 12 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): 13,15, Service users are provided with opportunities to participate in various activities. A more detailed record is required in relation to the food provided, to enable people inspecting the records to clearly ascertain that all service users are being provided with an appropriate, varied and nutritional diet. EVIDENCE: Discussions with three residents and the activity co-ordinator showed that they are happy with the activities provided. The schedule on display in the reception area showed a variety of both mental and physical stimulation and church involvement. Residents spoke of regular entertainment and occasional outings. Where residents are unable to make a positive choice to be involved in group activities, the activity co-ordinator provides alternative one to one stimulation through discussions or reading newspapers etc. Contact with family and friends is also important and the inspector observed visitors in the home. One visitor spoken to was visiting for the first time and told the inspector that she was made welcome by staff and provided with refreshments without any prompting or request.
Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 13 The GP was visiting at the time of the inspection and stated how pleased she was to see that service users were given opportunities to participate in activities both in and out side the home. Discussion took place with the cook and menu were examined, their is a six week rotating menu plan, the cook was unable to recall the frequency of reviews to the plan however, stated to her knowledge the current plan had been in operation for more than a year. Although the menu indicated a varied diet is provided with a choice offered at lunch and teatime, there was no variation in choice of fruit and vegetables to reflect the time of year. On the day of the inspection an alternative lunch had been provided to that which was written on the menu, however the menu had not been amended to accurately reflect the food provided to service users. On occasions it is necessary for service users requiring a soft diet to have an alternative meal than that provided to the majority of service users due to the consistency of the food. There was no record of the alternative meal provided for these people. No record is being maintained relating to meals provided at breakfast time or for the evening meal. It is necessary for a detailed record of food provided to service users to be maintained to provide written evidence that all service users are being provided with a varied nutritional diet. Records seen indicated that a nutritional assessment is undertaken at the time a service user is admitted to the home, service users weight is routinely monitored and the GP and community dietician are involved in any issues which may be detrimental to the service users health. The three service users spoken to stated the quality of food was generally very good; there is ample provided with an either/or menu at lunch times. All service users had chosen the lamb curry on the day of the inspection. The one criticism raised by 2 of the 3, was the toughness of the meat. They were unable to chew it. Breakfast is taken in the bedroom which was welcome by all. Lunch is taken in the main dining room and supper can be taken either in the dining room or in the individual bedroom. Refreshments and snacks are available throughout the day. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 14 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): 18, Staff have received appropriate training regarding the homes vulnerable adults procedure to ensure a proper response is made to any suspicion or allegation of abuse. EVIDENCE: A nurse and two care assistant were spoken with, all stated they were aware of the term whistle blowing and stated if they had any concerns regarding the practice of colleagues they would discuss the matter with the manager. The manager stated the home liaises with Bromley Social Services department and staff are able to attend adult protection training on a regular basis. Staff stated they had also attended adult protection training courses arranged inhouse by the company. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 15 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, Although all areas of the home users by service users are clean, comfortable and well maintained, the kitchen requires redecoration and refurbishment to facilitate effective cleaning. EVIDENCE: As discussed following pervious inspections, the kitchen is in need of attention. On the day of the inspection grease and dirt had build up around the cooker, hood and walls. The flooring was also torn in front of the cooker preventing effective cleaning of the area. The cook stated the home does not have a contact with a cleaning company to provide a deep clean. This task is carried out by hand by herself and the assistant cook as and when time permits or alternatively she stated, she came in when off duty to undertake the task.
Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 16 These matters must be addressed as a priority. A recommendation was made following the previous inspection that all bedroom doors should be fitted with locks. This would enable service users the choice to lock their rooms should they so wish. This recommendation has not been followed. The manager stated however that locks are fitted on the request of individual service users. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 17 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): 28,29 Suitably qualified and competent staff are employed to meet the needs of service users. Procedures in place regarding recruitment of staff need to be developed further to safeguard and protect service users. EVIDENCE: The manager is suitably qualified to manage the home on a day-to-day basis. In addition qualified nursing staff working in the home, have also attained the registered managers qualification. Care staff spoken with had either an NVQ 2 or 3 in care. Three staff files were viewed. Two of the three staff recently recruited, were recruited by an agency on the home’s behalf. The files contained proof of identity and the Criminal Records Bureau Check, however this check had not been completed until after the start date. Other checks, including fully completed application forms; exploration of gaps in the application forms and verification of references and previous employment in care, were less robust and need improvement. The home also uses agency staff. The Manager and Administrator were not aware of checks made on those agency staff used, as required under Regulation 19 of the Care Standards Act 2000. Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 18 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): 33, 35 There are relevant policies and procedures in place to safeguard service users and staff working in the home. Quality assurance mechanisms must be developed to include a copy of the owners monthly audit being forwarded to the CSCI and the publication of questionnaires completed by staff, service users and their representatives regarding the satisfaction of the service provided. EVIDENCE: Discussion took place in relation to quality assurance mechanisms in the home. The administrator stated she randomly sends four questionnaires to service users, relatives and members of staff each month to ascertain their views in relation to the caring service provided. This information is then forwarded to a member of the companys management team, however the manager and care
Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 19 staff working in the home stated they do not routinely receive feedback regarding the outcome of the information. Quality assurance mechanisms need to be developed further, the results of the service users surveys need to be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. The manager stated that a member of the companys management team visits the home monthly to undertake an audit on their behalf to comply with regulation 26 of the Care Standards Act 2000, however to date these have not been forwarded to the CSCI, in order to fully comply with this requirement a copy of their findings must be submitted following each inspection. Discussion took place with the manager regarding regulation 24 of the Care Standards Act 2000, and her requirement as the person in charge of the home on a day-to-day basis to develop her own audit mechanism with a view to monitoring and improving the quality of service and nursing care provided in the home. Discussion took place regarding safe working practices in the home, staff spoken with stated they had attended manual handling courses and good practise was seen during the course of the inspection in relation to this. Members of staff spoken with hold current first-aid qualifications or are due to commence a course in the near future. Staff spoken with have completed infection control courses and good practice was observed through the course of the inspection in relation to this issue. The homes current practice regarding money is that it pays for service users hairdressing, chiropody and newspapers etc in advance. These purchases are paid for through the petty cash system. The home records the purchases and sends the receipts to the head office who then invoice the service users’ representatives. Whilst it is possible to see where purchases are made there are no receipts kept in the home and therefore records cannot be crossreferenced. A minority of service users choose to have small amounts of money held by the home for safekeeping. In these instances the home collects money from relatives which is placed in a sealed marked envelope in the safe. No receipts are currently provided however both the relative depositing money and two members of staff sign the envelope. Discussion took place regarding the need for receipts to be given and the administrator stated this would be addressed Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 20 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 2 x x x x x x x STAFFING Standard No Score 27 x 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 2 x 2 x x 3 Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 21 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 OP15 Regulation 16(2)(i) Sch 4 .13 Requirement Timescale for action 30/01/06 2 OP19 3 4 OP33 OP33 5 OP29 Records of the food provided to service users is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise and of any special diets prepared for individual service users. 23(2)(b) The registered person must (d) ensure the premises are kept in a good state of repair. The action plan regarding the kitchen refurbishment must be provided to the commission. The previous timescales 31.03.05 and 30.08.05 not met. 26.5 A copy of the providers monthly audit is sent to the CSCI. 24.1(a)(b) The registered person must 2&3 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home, including the quality of nursing when nursing is provided at the care home. 19 Recruitment procedures must be developed so as to be robust and
DS0000010141.V275248.R01.S.doc 30/04/06 30/01/06 30/04/06 30/01/06 Sloane House Nursing Home Version 5.1 Page 22 comply with Regulation 19 of the CSA 2000 6 OP9 13(2) An accurate record of all medication administered to Service users must be kept. 30/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP24 OP33 Good Practice Recommendations Doors to service users private accommodation need to be fitted with locks suited to service users capabilities and accessible to staff in emergencies. 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. Hand transcriptions to medication record require the signatures of two members of staff. Written receipts are given to relatives depositing money for safekeeping. 3 4 OP9 OP35 Sloane House Nursing Home DS0000010141.V275248.R01.S.doc Version 5.1 Page 23 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
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