CARE HOMES FOR OLDER PEOPLE
St Anne`s Nursing Home 60 Durham Road London N7 7DL Lead Inspector
Edi O`Farrell Unannounced Inspection 9th August 2006 09:40 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 St Anne`s Nursing Home DS0000010329.V288045.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. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Anne`s Nursing Home Address 60 Durham Road London N7 7DL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7272 4141 020 7263 0952 nelia.nabeebaccus@anchor.org.uk Anchor Trust Ms Nelia Nabeebaccus Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. For the Provision of General Nursing care for up to 40 Frail Elderly People aged 60 years and over. The Staffing Notice For the provision of personal care for up to 20 frail elderly people Date of last inspection 22/11/05 Brief Description of the Service: St Anne’s is a residential care home with nursing. The home provides long term care for up to 50 frail people over the age of 60. There are currently 37 places for people who require nursing care and 13 for people who require personal care only. The residential beds include two for respite care. The home can use up to ten beds flexibly for either personal or nursing care and still operate within their registered categories. This is particularly useful as it means that people in the residential beds can stay at the home when their needs increase. The home is situated in Islington and is accessible by both bus and tube networks. The home was purpose built in 1997 and is accessible to wheelchair users. The property is over three floors, with service user accommodation being on the first and second floor. All bedrooms are en-suite and meet statutory requirements for space and size. Residents have their own letterbox and doorbell. The home provides 24 hour staffing covered by registered nursing staff and trained support workers. The home is owned by Anchor Homes an established national, not for profit, provider of housing and support for older people. Camden and Islington Primary Care Trust (PCT) and the London Borough of Islington jointly commission the service. The full cost of the service is from £598.13 to £632.98 per week, and social services individually access each service user to decide their fee. PCT staff assess each person for eligibility to receive a NHS contribution to their nursing care. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The, unannounced, site visit for this inspection was carried out on a weekday from 09:40 to 16:40. Prior to the visit the information that the commission already had about the service was reviewed. This included pre-inspection forms that the manager had completed. It also included summarising incident and monthly reports, and requesting up to date documents, such as the Statement of Purpose. Postal questionnaires were circulated to visiting professionals and some relatives. Three completed cards were returned. During the visit the building was toured, initially with the manager, and then several time unaccompanied. Service users and staff were spoken to during both, and lunch was observed being served during one of the unaccompanied tours. Staff were observed interacting with service users, and attending to their needs, such as assisting with meals. The medicine trolleys on the second floor and the administration charts were checked. Seven care plans were examined and compared to the care being provided. In each case the service users were asked for their views, though some were unable to give them due to their level of disability. The care plans were also cross-referenced with other records, such as complaints and accident and incident reports. Most service users were spoken to during the day. In some cases this was a simple ‘hello, how are you’. In others a more detailed discussion was held in their room or in the lounges/dinning rooms. Some staff were asked about aspects of care, and of their experience of working at the home. Staff recruitment, supervision, and training records were examined. A robust health and safety audit had been carried out by the organisation the day prior to the site visit. The report and action plan was seen and spot checked. All who contributed to the site visit are thanked. A questionnaire was sent to the manager the day following the visit so that she could let the commission know how she thought the visit went. What the service does well:
The home provides a safe, warm, and welcoming environment for service users to live in. It is well maintained and furnished and decorated in a homely fashion. All bedrooms are of a good size allowing personal possessions to be accommodated. Each room has an ensuite toilet, shower and wash hand basin. There are also communal, assisted, baths on both floors for people who St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 6 prefer a bath. The design of the building, separating the services into four units, gives a feeling of living in a small home. Service users said that staff ‘look after you’, and are ‘good’. They made varying comments about the food, from ‘good’ through to ‘terrible’. Those making negative comments acknowledged that if they did not like anything on the main menu there were always lots of other choices. Menus used to assist service users choosing their meals include pictures. This helps where service users’ memories are impaired. The home has full disabled access, which is important as many of the service users can only get around in wheelchairs, or use walking aids, such as frames. There is a robust recruitment process, comprehensive induction, and a training programme that is job-focused. This means that staff are able to meet the needs of service users. The staff team come from a variety of racial and cultural background, as do the service users. This includes both groups having people who can speak a variety of languages. This is important as even where a service users speaks fluent English as a second language, it can feel comforting to speak in one’s original language. The assessment and care planning system includes the use of stickers highlighting important areas of risk and care. The stickers have basic symbols, for example that the service user smokes and uses oxygen. Others show how equipment must be used. This is excellent as in reading the care plans the eye is immediately drawn to the stickers. This type of information is more likely to stick in staffs’ minds, and is also accessible to anyone that may have difficulty reading written English. Complaints are responded to promptly and fully investigated. What has improved since the last inspection? What they could do better:
One omission in both the old and the new assessment system is that they do not identify service users’ racial origins. One care plan did not note that the service user was born outside England and speaks that country’s language fluently. This was identified in the social services review form, which was at
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 7 the back of the file. In another file there was no mention that the service user was African Caribbean, though in practice specific skin and hair care needs were being met. Knowing about service users’ backgrounds and origins is important information. Staff will have to use if they are going to fully complete the new assessment and care planning system. A very good element of the new system is that it includes a life history section. This is best practice in providing health and social care to older people. They can often be seen simply as ‘the service user’, or ‘patient’, rather than an individual who has lead a full and interesting life. The written information about the service is to a high standard. Prospective service users of this home will often not be able to visit prior to admission. It may be their relatives, or social services, that are making decisions on their behalf. Making a visual and/or an audio version of the information, such as video, DVD, audio tape and picture book, would make it much more accessible. It also has the advantage of being able to be looked at, or listened to, repeatedly. This can greatly assist prospective service users, and their relatives, in making difficult choices. 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. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective service users, and their representatives, have the information they need to make an informed choice about moving into the home. They know that the home will meet their needs. The provision of information in a range of formats would increase accessibility to those service users who cannot visit the home prior to admission. EVIDENCE: The Statement of Purpose held in the commission’s file was out of date. An up to date copy was requested prior to the site visit. This accurately describes the current service, as does the service user guide. Examination of three files of admissions since the last inspection demonstrated that full assessment takes place. Discussion, by phone, prior to the site visit, with the manager, and the local authority commissioner, demonstrated that the home only accepts people whose needs they can meet. This tends to be where social workers refer people with dementia, who have challenging behaviour. The home is registered to provide services to people aged 60 and
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 10 over that are frail. Many use wheel chairs or walking aids. Where managers, or RNs, identify that a prospective service users known behaviour may place current service users at risk, then the referral is not accepted. This protects current service users. In discussion during the site visit the manager was very clear that people with challenging behaviour could only be admitted if one of the units became specialist. The Commission discussed this aspect of care with the local authority prior to the site visit. The written information about the service is of a high standard. It is informative and accurately describes the service provided. In the files looked at during the site visit one person had been assessed at the home. Their recorded view was that it was ‘lovely’. Another service user already knew the home because they had received respite care. Not all prospective service users are able to visit the home. In some cases it will be relatives, or social services, making decisions on their behalf. The home should consider making the information available in other formats. This could be video, DVD, audiotapes and picture books. These formats have the added advantage that they can be looked at/listened to repeatedly. This helps when older people, and their relatives, have to make difficult decisions. This is Recommendation 1 St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. Service users’ health and personal care needs are met. Staff follow correct medication procedures, which protects service users. EVIDENCE: Seven case files were looked at and the service users spoken to. The service being provided was compared with the written records, and staff were observed providing care, such as assistance with meals. Care records were cross-referenced with records held by the commission, such as monthly and incident reports. Some aspects of care were discussed with service users and with staff. The findings were discussed with the manager during the site visit. A sample medication audit was carried out on the second floor. A new assessment and care planning system has been piloted since February 2006, through to the end of July. Some amendments are being made and once competed the new system will be introduced for all service users. The files seen included both people on the pilot project and those still on the old system. Generally assessments were comprehensive, identifying wishes and preferences. Care plans stated how needs should be met, again including preferences.
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 12 The seven care plans were chosen because they represented a range of needs, including diversity in terms of disability, racial origin, gender, and health needs. In relation to disability, gender and health needs, the assessments and care plans followed through, and included risk assessment. The use of stickers to highlight specific care or risk issues is excellent. They draw the reader’s eye to the issue, and are more likely to be understood and remembered by carers. This is particularly important where English may not be the first language, or where literary skills are limited. It means that people, such as those with dyslexia, are not automatically disbarred from working in care services. One omission from both the old and the new system is that racial origin is not included in the initial assessment. There is a section in the new system for cultural needs, but in one case, where the service user was African Caribbean, this information was not included. In another file the fact that the service user had been born out side of England, and enjoyed talking to care staff in that language of her birth was only noted in the social services review forms. These were at the back of the files. The new system includes a section on life history, which had not been completed in the files seen. This is a very important part of care planning for older people, and racial and cultural identity is a key element. Without full, and accurate, information about peoples’ histories they can often simply be viewed as ‘service users’, or ‘patients’ by staff. This is Requirement 1. In practice health and personal care needs are being met. Service users stated that staff ‘care well for us’, and ‘see to my needs’. This included the African Caribbean service user, whose skin and hair cares needs are well attended to. Staff were observed assisting service users. It was noticeable that they did not automatically step in and help. They waited and asked the service users what help they wanted. This shows a commitment to maximising service users’ independence. Risk assessment for such things as nutrition and fluid intake, blood sugar levels, pressure areas, and risk of falls were all in place. There was clear instruction for carers to report any problems to the nurses. There was then follow through by the nurses, where necessary, in reporting problems to the GP, or specialist community nurses, such as tissue viability. Assessments of the potential risks to older people of the recent hot weather had been carried out. Care plans had been reviewed to take account of the need for service users to drink more fluids. As stated in the previous section of this report the use of stickers to denote specific risk or care issues is excellent. In several of the files seen the stickers showed exactly what equipment should be use, and how to assist service users with mobility problems. The commission looks forward to seeing how the new care planning system improves the quality of life of the service users. This will be looked at during future site visits. St Anne`s Nursing Home DS0000010329.V288045.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’ needs and wishes regarding their daily life and social activities are met. They are offered a varied and balanced diet, with alternatives to the main menu. EVIDENCE: The manager supplied the activity programme with the pre-inspection information. Service users were asked about their daily routine, and care plans were examined. The activity co-ordinator was on leave the week of the site visit, so could not be interviewed. The programme is very varied. It includes reminiscence groups, memory games, films, hymns, history and sing alongs. Service users spoke about enjoying bingo and the BBQs. Many enjoy watching television, and several like being seated close to windows so they can see people going by. Some service users spoke about going to the local day centre, and how much they enjoyed it. Preferences in terms of lifestyle are noted in the care plans seen. Discussions with these service users confirmed that their preferences, such as time getting up and going to bed, are respected. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 14 Some day trips have been organised, both in London, and to seaside resorts. Relatives and friends are invited on these outings. The minutes of a recent relative meeting were seen by the signing in book. The attendance at these meetings is very low and the manager is currently looking at how relative input can be increased. This is important as friends and relatives have a key role in ensuring that service users’ quality of life is maintained once they move into a home. One of the tours of the home was carried out during lunchtime. It was good to note that food is served in tureens at the tables, rather than simply being ‘plated’. Service users gave varying views on the food. This ranged from ‘good’ to ‘terrible’. There is a very varied menu, with both a meat and vegetarian choice at each meal. Where service users do not like either of the main menu choices then they have the option of salads, jacket potatoes, sandwiches, and other snacks. The service users who were negative about the food acknowledged that they always had these choices. Greek and African Caribbean service users stated that they liked the food, and that if they wanted it they could have culturally specific food. St Anne`s Nursing Home DS0000010329.V288045.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 can be confident that their complaints are listened to and acted upon. They are protected from abuse, when correct procedure is followed. EVIDENCE: Complaint records were examined and discussed with the manager. Service users were asked about their life in the home, including how staff responded if they raised concerns. The home has to inform the commission of any significant incidents, including any allegation of abuse. These records were analysed prior to the site visit. The incident and accident records were examined during the site visit, and cross-referenced with care plans, reports to the commission, and complaint records. Service users reported that when they raise concerns they are responded to. The records seen supported these views. Complaints are fully recorded, investigated, and remedial action put in place where necessary. The only concern is that in addressing complaints so promptly the manager is sometimes bypassing the local authority adult protection procedures. A recent complaint, which had been fully investigated, was not referred to the local authority or the commission. A relative then raised issues with the local authority, which could not be fully checked because of the time delay. In order that service users are fully protected the manager must at all times follow the local authority policy and procedure on the protection of vulnerable adults. This is Requirement 2.
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Service users live in a safe and well-maintained environment. This home is clean, pleasant and hygienic. EVIDENCE: The home was toured on several occasions during the site visit. This included being accompanied on the original tour and then several wanders around the home later in the day. Both types of tour included going into service users’ bedrooms, with permission. The cleaning staff are to be congratulated in doing an extremely good job. All parts of the home were clean, tidy, and free from any odours. Care plans included when service users rooms should be cleaned. They also included when and how service users preferred their surroundings and possessions to be cleaned. The home is purpose built, and has full disabled access. This is important as many of the people living there use wheelchairs or other mobility aids, such as frames. All bedrooms have ensuite toilet, shower and washbasin. There are communal, assisted, bathrooms on both floors, for people who prefer a bath.
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff are trained and competent to do their jobs, ensuring that service users’ needs are met. Access to email and the Internet for all members of staff would assist in further service improvement, EVIDENCE: Staff were observed carrying out their duties, and interacting with service users. Service users were asked their views. Recruitment, induction, supervision, and training records were examined. Some staff were asked about aspects of care and whether the level of staff was sufficient for them to carry out their duties well. Service users reported that staff were ‘good’, and ‘they care for us’. Overall most service users agreed with these statements. One positive thing observed during the site visit was that staff did not automatically jump in to assist service users. Instead they asked what help the service users wanted, and then gave it. This is an empowering approach, which care staff are to be congratulated upon. Formal supervision is carried out in both individual and group sessions. These are recorded, and any agreed action is followed up. Recruitment is robust and follows an equal opportunities framework. This includes a job description, person specification, standard interview questions and test, and written record of interviews.
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 18 Induction is based on the Skills for Care framework, with a high quality workbook and record, which is cross-referenced to the National Vocational Qualification (NVQ) framework. Access to email and Internet in the home is restricted to management and administrative staff. Extending access to all staff could assist in service development. The Internet can be a valuable tool in supporting staff to acquire new knowledge, and therefore improve the care provided within the home. This is Recommendation 2. There was ample evidence in the incident reports sent to the commission and from the complain log that the manager, and the organisation, take staff mistakes seriously. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 19 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 home is run in the best interests of service users. Necessary health and safety records and checks are in place. Staff are appropriately supervised. Service users’ financial interests are safeguarded. EVIDENCE: Information held at the commission’s office was reviewed prior to the site visit. This included the monthly reports that the organisation providing the service has to send in. It also included reports that the manager has to send when accidents/incidents occur. Staff and service users were asked about the running of the home. The manager, and other management staff were observed during the visit. Judgements and evidence from the previous sections of this report have also been used to come to the above judgement. The home has a very clear management hierarchy. There is a registered manager, deputy, registered nurses, and shift leaders. Job descriptions are
St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 20 clear about roles and responsibilities. Staff reported that they found the home good to work in, and service users stated that they felt it was well managed. A health and safety audit had been carried out the day prior to the site visit. Anchor carry out these checks on a regular basis, and the report, including the action plan, was seen during the site visit. As this is a robust system a spot check only was carried out. All records seen were in order. A comprehensive quality assurance system is in place. This includes gathering the views of service users. The last report is dated August 2005, so another survey is now due. As the organisation has this in hand no requirement has been set, though the commission will monitor this aspect of care. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 21 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 X 3 3 3 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 4 St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12 (4) (b) Requirement Timescale for action 30/09/06 2 OP18 13 (6) The Registered Persons must ensure that care plans include information about the racial origins, and cultural and linguistic backgrounds, of service users. The care plans must include details of how staff are to meet any specific racial or cultural needs. The Registered Manager must 31/08/06 ensure that they always follow the local authority policy and procedure on the protection of vulnerable adults. This must include informing the local authority and the commission of all allegations of potential abuse. 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 OP1 Good Practice Recommendations The Registered Persons should consider making
DS0000010329.V288045.R01.S.doc Version 5.2 Page 23 St Anne`s Nursing Home 2 OP30 information about life within the available in a variety of formats. This could include video, audiotapes and picture books. This would increase accessibility and assist people in making decisions about moving into the home. The Registered Persons should consider all staff having Internet access at work. This could contribute to each staff member’s professional development, and ultimately to service improvement. St Anne`s Nursing Home DS0000010329.V288045.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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