Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 16/04/07 for St David`s Nursing Home For Disabled Ex-servicemen and Women

Also see our care home review for St David`s Nursing Home For Disabled Ex-servicemen and Women for more information

This inspection was carried out on 16th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living at the home are cared for in a gentle and professional manner, thus respecting their privacy and dignity. On the general nursing unit preadmission assessments are thorough and clearly reflect the needs of people wishing to live at the home. End of life care is planned in accordance with the wishes of each individual. Individuals` religious and cultural needs are catered for by the home. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home. The food provision is good, offering variety and choice. Policies and procedures are in place for the management of complaints and safeguarding adults, and these are adhered to. People spoken with said that any concerns raised are promptly addressed and representatives are kept up to date with any issues. The accommodation provision on both units is of a good standard, with the adaptations and equipment necessary to meet peoples individual needs. Bedrooms are bright and airy and personalised. The home was clean and tidy and smelled fresh throughout. Although some issues arose with the laundry facilities on the first day of inspection, these were promptly addressed and the laundry provision is appropriate for the size of the home, with personal items of laundry being well cared for. Any monies being held on behalf of people living at the home are well managed and securely stored.

What has improved since the last inspection?

There had been an improvement in several areas since the last inspection. Progress has been made with the intermediate care unit to manage the individual rehabilitation programme for each person more effectively. Work is continuing in this area. Some progress has been made to access training or experiential learning for staff working on the intermediate care unit, plus increasing the hours for healthcare professionals working on the unit. More work is still needed in these areas to provide a full, informed, proactive service. There has been an overall improvement in the service user plans, which were up to date and overall contained the information required. Shortfalls in this area should be easy to address. Progress has been made with the ascertaining of peoples individual social and leisure interest information, with more work to be done to ensure the care plans reflect these individual interests. Also, thought has been given to the different types of activity provision required for the each unit. The Registered Manager has made headway regarding obtaining advocacy services information. An up to date redecoration and refurbishment plan is in place, and the home was tidier with no issues regarding storage noted. The staffing provision has been reviewed since the last inspection in line with the needs of the people living at the home, and this is to be kept under review. There has been an improvement in the level of completed and planned training for staff, and more work is required to ensure all staff are kept up to date with the knowledge and skills to provide an ongoing high standard of care. There had been an improvement in the overall management of the home, with a substantial number of management supernumerary hours being provided, the result of which is a steady improvement in areas where shortfalls were identified at the last inspection. Work is ongoing and robust systems must be followed so that once the home has improved further, the quality is then maintained. There has been an improvement in the implementation of monitoring systems for quality assurance such as auditing processes, and as a result, with the exception of medications, a noticeable improvement has been made in the areas being audited.

What the care home could do better:

The pre-admission assessments viewed were thorough and gave a good picture of each persons needs. However for one person on the intermediate care unit the homes assessment could not be located and the Social Services assessment was out of date. The home must ensure they have up to date information and store records securely. Some progress has been made to gain comment from the people living at the home and their representatives about the care provision, and more work is required in respect of involving them in the formulation and review of the service user plans. Despite regular auditing there continues to be concerning shortfalls in the management of medications and the registered nurses must take responsibility for ensuring they complete documentation fully and are up to date with medication policy and guidance. An issue was identified with subcontractors carrying out building works at the home and having unsupervised access to areas where people at the home live. Appropriate action must be taken promptly to address this and prevent further occurrence. The Registered Manager needs to undertake current training in topics relevant to his management role, so that his knowledge and skills are kept up to date. Regulation 26 visits on behalf of the Registered Person to monitor the home have recently been announced visits, and although the reasoning for this is understandable, in that it allows people to plan to meet with and speak with the person carrying out the visits and express their views,the Care Home Regulations 2001 require that these visits are unannounced, so a plan to address this is needed. Some fire safety training issues were identified and the need to ensure everyone undergoes fire safety training as part of their induction was discussed. Lack of assessment and minimising of any risks in an area where work is being carried out gave the Inspectors cause for concern. This has since been addressed, however the shortfalls should have been identified promptly by the home, and not left for an Inspector to identify. Proactive processes to prevent further occurrences of this nature must be put in place.

CARE HOMES FOR OLDER PEOPLE St David`s Nursing Home For Disabled Exservicemen and Women Castlebar Hill Ealing London W5 1TE Lead Inspector Mrs Rekha Bhardwa Unannounced Inspection 10:00 16 & 18th April 2007 th 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 David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.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 David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St David`s Nursing Home For Disabled Exservicemen and Women Castlebar Hill Ealing London W5 1TE Address 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 8997 5121 020 8997 2447 stdavids.office@virgin.net St David’s Nursing Home for the Disabled ExServicemen and Women Mr Barrie Taylor Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The seven beds in the John Poland Rehabilitation unit are to be used for service users requiring intermediate care, and not for permanent placement. 31st January 2007 Date of last inspection Brief Description of the Service: St Davids Nursing Home is situated in spacious grounds in a residential area of Ealing. The home is accessible by bus and the nearest underground and mainline station is Ealing Broadway. The home has a central courtyard that provides a pleasant area in which people living at the home and their visitors can sit. There is a patio area outside the activities room and also a pathway around the garden with a summerhouse, affording attractive areas for people to sit out in. The home provides nursing care for ex-service personnel, plus there is an intermediate care unit consisting of 7 flats, used for rehabilitation. All the bedrooms are single. There are spacious communal sitting and dining rooms and a designated smoking area. The fees range from £561 to £1,450 per week. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 31 hours was spent on the inspection process. Two CSCI Regulation Inspectors and a Pharmacist Inspector carried out the inspection. A tour of the home was carried out, and service user plans, management records, training records, staff employment records, administration records, maintenance and servicing records were viewed. The pre-inspection questionnaire has also been used to inform this report. The CSCI pharmacist Inspector carried out a medication inspection on 16/04/07 and a separate report is available. The requirements and recommendations from the pharmacist inspection have been incorporated in this report. 12 people living at the home, 8 visitors and 14 staff and a visiting professional were spoken with as part of the inspection process. The term ‘service user’ refers to a person living at the home. What the service does well: What has improved since the last inspection? There had been an improvement in several areas since the last inspection. Progress has been made with the intermediate care unit to manage the individual rehabilitation programme for each person more effectively. Work is continuing in this area. Some progress has been made to access training or experiential learning for staff working on the intermediate care unit, plus St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 6 increasing the hours for healthcare professionals working on the unit. More work is still needed in these areas to provide a full, informed, proactive service. There has been an overall improvement in the service user plans, which were up to date and overall contained the information required. Shortfalls in this area should be easy to address. Progress has been made with the ascertaining of peoples individual social and leisure interest information, with more work to be done to ensure the care plans reflect these individual interests. Also, thought has been given to the different types of activity provision required for the each unit. The Registered Manager has made headway regarding obtaining advocacy services information. An up to date redecoration and refurbishment plan is in place, and the home was tidier with no issues regarding storage noted. The staffing provision has been reviewed since the last inspection in line with the needs of the people living at the home, and this is to be kept under review. There has been an improvement in the level of completed and planned training for staff, and more work is required to ensure all staff are kept up to date with the knowledge and skills to provide an ongoing high standard of care. There had been an improvement in the overall management of the home, with a substantial number of management supernumerary hours being provided, the result of which is a steady improvement in areas where shortfalls were identified at the last inspection. Work is ongoing and robust systems must be followed so that once the home has improved further, the quality is then maintained. There has been an improvement in the implementation of monitoring systems for quality assurance such as auditing processes, and as a result, with the exception of medications, a noticeable improvement has been made in the areas being audited. What they could do better: The pre-admission assessments viewed were thorough and gave a good picture of each persons needs. However for one person on the intermediate care unit the homes assessment could not be located and the Social Services assessment was out of date. The home must ensure they have up to date information and store records securely. Some progress has been made to gain comment from the people living at the home and their representatives about the care provision, and more work is required in respect of involving them in the formulation and review of the service user plans. Despite regular auditing there continues to be concerning shortfalls in the management of medications and the registered nurses must take responsibility for ensuring they complete documentation fully and are up to date with medication policy and guidance. An issue was identified with subcontractors carrying out building works at the home and having unsupervised access to areas where people at the home live. Appropriate action must be taken promptly to address this and prevent further occurrence. The Registered Manager needs to undertake current training in topics relevant to his management role, so that his knowledge and skills are kept up to date. Regulation 26 visits on behalf of the Registered Person to monitor the home have recently been announced visits, and although the reasoning for this is understandable, in that it allows people to plan to meet with and speak with the person carrying out the visits and express their views, St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 7 the Care Home Regulations 2001 require that these visits are unannounced, so a plan to address this is needed. Some fire safety training issues were identified and the need to ensure everyone undergoes fire safety training as part of their induction was discussed. Lack of assessment and minimising of any risks in an area where work is being carried out gave the Inspectors cause for concern. This has since been addressed, however the shortfalls should have been identified promptly by the home, and not left for an Inspector to identify. Proactive processes to prevent further occurrences of this nature must be put in place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.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 David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wishing to live at the home are assessed prior to admission, to ascertain that the home is able to meet their needs. One omission was identified on the intermediate care unit and documentation must be securely stored. Although more work is required, progress had been made with the intermediate care unit to manage the individual rehabilitation programme for each person, thus more effectively working towards maximising their independence. EVIDENCE: One Inspector viewed pre-admission assessment documentation for the general nursing unit. This was comprehensive and gave a good picture of the needs of the person wishing to live at the home. For one person living on the intermediate care unit the pre-admission assessment could not be found. The registered nurses spoken with said that an assessment had been carried out. The Social Services documentation available was not an assessment and was a St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 10 copy of a review that had taken place 6 months before the person was admitted to the home, and the information was therefore not up to date. There is no specific admission criteria document for the intermediate care unit. The need for a criteria document to be compiled in order to ensure that people referred to the unit are appropriate for rehabilitation was discussed with the Registered Manager and Assistant Matrons. The home has an intermediate care unit, which can accommodate 7 people. At the time of inspection the unit was full. At the last inspection the Inspectors noted that 2 people had been accommodated for more than the 6 months agreed under the homes conditions of registration. Progress has been made in this area and the Inspector was informed that reviews have been undertaken and alternative suitable placements are being sought. This will be reviewed at the next inspection. Some progress had been made in obtaining staff training specific to the intermediate care unit. The Assistant Matrons were both very aware of the need to access training or experiential learning placements relevant to rehabilitation. The occupational therapist is planning to provide some training relevant to ‘life skills’. Since the last inspection a part-time occupational therapist has been employed to work 15 hours per week. The physiotherapist for the unit works 10 hours per week. The management are aware of the need for more occupational therapy and physiotherapy hours to ensure all those living in this unit receive maximum input with their rehabilitation processes. Service user plans have been developed in line with peoples rehabilitation needs. These include input from the people living at the home so they can express their wishes for their ongoing care and the outcomes they want to achieve. The occupational therapist and physiotherapist carry out their own assessments on the people living in the unit in order to establish the treatment programme required for each individual rehabilitation programme. The Inspectors spoke with the occupational therapist and the physiotherapist during the course of the inspection. Both commented that there is better multi-disciplinary teamwork within the unit, to include all aspects of healthcare input required. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made in the formulation and review of service user plans, thus a better picture of the needs of people living at the home and how these are to be met is available. Shortfalls should be easy to address. There continue to be shortfalls identified with the medication management, thus placing people living at the home at risk. Staff care for people living at the home in a caring and professional manner, thus respecting their privacy and dignity. End of life care is planned in accordance with the person living at the home and their family, thus listening to and respecting their wishes. EVIDENCE: Since the last inspection there had been an improvement in the formulation and review of the service user plans on both units. On the general nursing unit there was some evidence of input from people living at the home and their representatives in the service user plan documentation, and the need to involve them in the actual formulation and review of the service user plans was again discussed. The Registered Manager said that as new people are admitted to the home this practice is being introduced. There is now a ‘resident/relative St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 12 comment sheet’ in each bedroom where any issues can be discussed. Risk assessments for falls are in place and there was evidence of these being updated following any falls. Other risks had been identified and an assessment carried out with interventions to minimise any risk being recorded. There was evidence of monthly reviews being carried out. In some of the daily records, daily entries had not always been made, thus there was no written evidence that care had been carried out. The need to ensure entries for day and night care are made was discussed with the home management. Wound care documentation was in place, with some information to be transferred from the tissue viability nurse assessment to the care plan for the wound. Overall the records for wound care were much improved and the progress of each wound could be followed, with evidence of wound healing. Pressure sore risk assessments had been completed and were up to date. Pressure relieving equipment was in use and had been identified in the service user plan. Pain assessments had been carried out and appropriate pain relief prescribed and administered. Nutritional assessments had been carried out and monthly weights are recorded. Food likes and dislikes plus dietary information is included in the service user plan. Moving & handling assessments had been carried out and some information missing on the first day of inspection had been completed on the second day. Specific equipment to be used for moving & handling had been identified. Continence assessments were not completed in all the service user plans viewed and this was discussed. Care plans for continence care needs were in place. A new, more comprehensive document for bedrail risk assessments had been introduced and these had been completed. Written consents for their use had not always been obtained and this had been addressed by the second day of inspection. There was evidence of input from the GP and other healthcare professionals, and people are referred to the GP if any concerns are identified. The CSCI Pharmacist Inspector carried out an inspection on 16/04/07 and a separate report is available. The ongoing shortfalls identified at the medications inspection gave cause for concern. The requirements and recommendations resulting from that inspection have been incorporated into this report. The abbreviation ‘MAR’ stands for medication administration record. Staff were seen to care for people living in the home in a gentle, caring and professional manner, respecting their privacy and dignity. People living at the home spoken to expressed their satisfaction with the care they receive at the home. Personal clothing viewed was labelled with their name and people were appropriately dressed to show individuality. The religious and cultural needs of service users are identified and planned for. People can bring in personal belongings to the home, in line with fire safety. The home has introduced documentation in respect of end of life care. These are in the process of being completed for each person living at the home, so St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 13 that his or her wishes can be recorded and respected. Care plans for religious needs are also being completed. Policies and procedures for care of the dying and care after death are in place. Training in ‘end of life issues’ had been provided in March 2007. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been progress made with the activities provision in order to better meet the individual needs of the people who live at the home. The home has an open visiting policy, thus encouraging people to maintain contact with family and friends. The Registered Manager is progressing accessing advocacy services for the people who live at the home, to ensure their right to independent representation is respected. The food provision in the home is good, offering variety and choice, thus meeting peoples’ individual needs. EVIDENCE: One Inspector spoke with the activities co-ordinator. Work has been being done to speak with people living at the home to ascertain their individual interests and this work is ongoing. The Deputy Manager does ascertain some information regarding individual interests as part of the pre-admission assessment, plus representatives had also provided some information on a document entitled ‘personal profile’, however this information had not always been transferred to the care plan for social activities. As a result the information on the care plans for activities is still very general and needs personalising. For the general nursing unit an activities programme is produced each week and a copy is given to each person living in the unit. Outings St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 15 continue to be arranged and the activities co-ordinator said that people living at the home are asked where they would like to visit. For the intermediate care unit, work is being done to introduce activities relevant to the rehabilitation theme, for example, shopping, budgeting and meal preparation. It was also discussed that leisure activities, for example, going out for a meal, would be undertaken at the weekends. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home. People can choose whether to receive visitors in their own rooms or in one of the communal areas, as they so wish. The Registered Manager reported that he has been making enquiries about advocacy services, and evidence of this was available. Funding issues had apparently affected the provision of some services, and the Registered Manager is seeking alternative advocacy provision. The CSCI must be kept up to date with progress on this. One Inspector viewed the kitchen, which was clean and tidy and records were up to date. There is a walk-in area to include cold storage, and fresh, dried, tinned and frozen foodstuffs were being appropriately stored with evidence of stock rotation. A cooked breakfast is available and menus were seen on each table in the dining room. People choose their meal at the time of the meal, and records are kept of each person’s choices. The home provides good quality meals, with a wide variety of options. The chef has a good knowledge of individual dietary needs, to include likes, dislikes and any medical or cultural dietary needs. Food is presented in an attractive manner and overall people spoken with said that they enjoyed the food at the home, although comment was received regarding the inclusion of a ‘traditional’ meal option on the menu each day, examples given being liver and bacon or beef stew. On the day of inspection the lunchtime choices were lasagne, mushroom stroganoff or Chinese pork ribs. A salad option plus any other simple alternatives such as an omelette were also available. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place for the management of complaints and adult protection issues, and these are followed, thus safeguarding the people who live there. EVIDENCE: The home has a clear complaints procedure with timescales for completion. There have been no complaints since the last inspection. Staff have received training in the protection of vulnerable adults (POVA). One incident has been reported to the Ealing Safeguarding Adults Team since the last inspection and appropriate reporting procedures were followed. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24 &16. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the environment is of a good standard and action has been taken to identify areas for redecoration and refurbishment, thus working to provide all people living at the home with a clean, well-maintained and homely environment with adaptations and equipment available to meet their individual needs. EVIDENCE: One Inspector carried out a tour of the intermediate care unit and the other a tour of the general nursing unit. Since the last inspection an environmental audit has been carried out and the rooms identified for full refurbishment have been added to the redecoration and refurbishment plan, with timescales for completion. The adding of any areas of more minor works identified, for example, the painting of a marked wall, was discussed during the inspection and the Registered Manager and Administrator said that they would address this. The gardens are extensive and well maintained, with walkways and St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 18 seating areas. There is also an enclosed courtyard that several of the ground floor bedrooms have access out onto. With the exception of the area where work is currently taking place, which has been separated off, the external grounds are well maintained and provide pleasant, peaceful areas for people to sit out in. The home has appropriate numbers of assisted bath and shower facilities, plus toilets situated throughout the home to meet the needs of the people living at the home. The areas viewed were clean and tidy and uncluttered. COSHH products were being securely stored. Living areas of the home were tidy and no issues with storage were noted. The corridors are wide and there are handrails in place, which service users were seen making use of to assist with their mobility. The home has a variety of hoists to meet the moving & handling needs of the people living at the home. The majority of beds are electronic profiling beds, and for the few people who have chosen not to have these beds, the Registered Manager stated that these are available should people wish to have them in the future. There is a call bell system in place for each unit. Some comment was received regarding occasional delays in answering of bells at busy times of day, but overall people spoken with were satisfied that usually bells are answered promptly. Call bells being answered promptly at the time of inspection. There are two passenger lifts in the home. The home and garden are accessible to wheelchair users. The home has adequate storage areas throughout. Several bedrooms were viewed during the tours of the units. These were bright and airy and had been personalised. The rooms were appropriately furnished to meet the needs of the people living in them. Each room has a lockable space for valuables etc and all doors have suitable locks to allow staff access in an emergency. The people living at the home are all offered a key to their room. The home was clean and tidy and smelled fresh throughout. One Inspector viewed the laundry room. There are two small and two industrial washing machines in use and two industrial tumble dryers. Ironing facilities are also available and care is taken with the process of washing and ironing clothing belonging to the people living at the home, to ensure clothing is well presented. On the first day of inspection there was water on the floor of the laundry room and on questioning it was identified that one of the washing machines was out of order, and the Inspector was informed that this was a regular occurrence. The alarm was sounding on another machine and the reason for this was unclear. A plumber working on the premises attended the laundry room to assist. The maintenance man said that the faulty machine had been reported to the engineers. A recurrence had been found on the second day of inspection and a further call to the engineers had been made. The Registered Manager reported that the maintenance engineers provide a good and prompt service. It is acknowledged that with 4 washing machines, there is St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 19 provision should one of the machines be out of order for a short time. The importance of ensuring all staff are skilled in all aspects of the equipment they use within their role was discussed with the Registered Manager. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing has been reviewed to provide appropriate levels of staffing for the assessed needs of the people living at the home. There has been an improvement in the training provision, with some areas of training still required to ensure all staff are kept up to date, in order to deliver care based on current good practice. For staff employed directly by the home clear employment procedures are being followed, however processes had not been followed for other people working in the home with access to areas where people live, thus this lack of safeguard could place people living at the home at risk. EVIDENCE: Following the last inspection a review of the dependency level of each person living at the home has been carried out. The Inspectors were informed that there is a supernumerary person on each day for the general nursing unit. In addition to this another carer has been rostered to work the morning shift. In order to allow for staff to attend training, bank and agency staff have been employed to maintain appropriate staffing levels for the home. The duty rosters viewed did not detail the hours worked by the Registered Manager. The home was clean and fresh and ancillary staff are employed in such numbers to meet the needs of the home. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 21 The pre-inspection questionnaire NVQ information was inaccurate. The Registered Manager has provided further information confirming that 7 care staff are qualified to NVQ level 3 in care or the equivalent and this equates to 30 of the full time equivalent care staff numbers. There are 8 staff currently undertaking NVQ level 2 in care training with Thames Valley University. The importance for NVQ in care training to bring the home back to a minimum of 50 of care staff with such a qualification was discussed and the Registered Manager is clear on this. One Inspector viewed three sets of staff employment records. These contained the information required under Schedule 2 of the Care Home Regulations 2001. The subject of issuing job offer letters had been identified in the Trustee Audit Review Plan, a copy of which had been submitted to CSCI. This was discussed with the Registered Manager who stated that this had been commenced. All new staff are employed on a ‘bank’ basis and contracts are issued within 6 months of commencing work at the home. Building works are being undertaken at the home. On the first day of inspection several workmen were seen in the main building and it was confirmed that some of them do carry out work unsupervised in the living areas of the home. This gives them access to areas accommodating the older people living in the home. The Registered Manager did not know if any Criminal Records Bureau checks had been carried out for the workmen. Action must be taken to address this shortfall and confirmation forwarded to CSCI. The home has an induction and foundation training programme that meets the Skills for Care Common Induction Standards. There had been an improvement in the training provision at the home. A training matrix had been formulated to identify training undertaken and also the gaps in training. External training had been accessed for several topics relevant to the diagnoses and needs of the people living at the home. As identified in Standard 26, work is required to ensure staff are fully trained in the use of any equipment relevant to their role. Training for the registered nurses to provide them with up to date knowledge and skills in line with current nursing practices is required, in order to ensure a proactive approach to care provision. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the overall management of the home since the last inspection, and further work in this area is continuing, working towards bringing the home to a good standard of management. Quality assurance processes have improved, thus the home is being better audited and reviewed on an ongoing basis and any shortfalls are being identified swiftly for action. Money held on behalf of people living at the home is robustly managed, thus safeguarding the peoples’ interests. Health & safety is being better managed however shortfalls identified could place people living, working and visiting the home at risk. EVIDENCE: The Registered Manager is a first level registered nurse with qualifications in general and mental health nursing. He also has a degree in Healthcare St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 23 Management. Since the last inspection the Registered Manager has undertaken some training in areas of health & safety, but updates in topics relevant to his management role are also required. The importance of keeping up to date with any changes in legislation and guidance to include changes in inspection processes was discussed with the Registered Manager. There has been an improvement of the overall management processes for the home, following increased input from the Board of Trustees and increased supernumerary hours for the Deputy and Assistant Matrons. There is also a goodly amount of administration support in the home. The home has also engaged the services of a Consultant who is a first level registered nurse with many years of experience in the commissioning and management of care homes, who is advising on current best practice for several areas. With the substantial amount of management support the shortfalls identified in the last report are being steadily addressed, however it is the legal responsibility of the Registered Manager to ensure the home is brought up to a good standard and this standard is maintained thereafter. Comment was received that in some instances staff did not always feel valued and an atmosphere of openness and respect was not always being fostered. Following discussion, the Registered Manager is aware of the importance of valuing staff and of working together to improve the home. The policies and procedures for the home are up to date, and where any gaps in the provision of this documentation have been identified action has been taken to draw up draft procedures. Regulation 26 visits take place, and in recent months these have been announced visits so that people living at the home can have prior notice if they wish to meet with the person carrying out the visit. In line with the Care Home Regulations 2001, Regulation 26 visits must be unannounced and the process must be reviewed to ensure unannounced visits are also carried out. The Registered Manager said that a Heads of Department meeting had taken place to discuss the way forward for the home and to allow open forum for discussion. Staff meetings, resident and relatives meetings take place and minutes are taken. There has been an improvement in the auditing processes for areas of care, for example, medications and service user plans. The Board of Trustees is very aware of the importance of ongoing audit and review for the home and to have a system in place to fully evaluate the home in line with the National Minimum Standards for Older People and all associated legislation, and it is the responsibility of the Registered Manager to formulate an action plan to meet this. One Inspector sampled the records for monies held on behalf of people living at the home. These were up to date and clearly identified all income and expenditure. Receipts are kept for all expenditure. The majority of people have a representative who manages their money. For any expenditure for those for whom money is not held by the home, an invoice is sent to the representative for payment. The home has safe facilities available. Some people with larger amounts of money have individual bank accounts that accrue interest. Smaller amounts are held in the ‘residents account’ and clear records are kept. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 24 The training matrix identified topics of health & safety training and those who are to attend such training as a priority. Some training has been arranged through an external training company and staff have been informed they must attend mandatory training at the required intervals. Moving & handling training is being provided by the physiotherapist trained to do so, and one of the registered nurses has been booked on a moving & handling trainers course. Fire training is provided by an appropriately trained person, however not all staff had received basic fire safety training as part of the induction process. The fire risk assessment had been updated and areas of work required had been highlighted on the document and a copy given to the maintenance man to implement the repairs. At the time of inspection an area of the home near the laundry room was boarded up due to building works. The fire break glass point had been removed from the wall and had been secured to a pipe several feet above the ground, and was inaccessible to staff. No risk assessment of this area had been done and no-one had noticed the break glass point had been moved until one of the Inspectors pointed it out. In addition, the external door leading from the laundry room was unlocked and there was a drop onto rubble the other side. The key would not lock the door properly. Again, this finding did not appear to have been noted by anyone at the home. There must be proper risk management of any areas of work taking place in the home to ensure the safety of people living, working at and visiting the home. The boiler room near the kitchen was unlocked and unattended on the first day of inspection, and on viewing the room it was very cluttered and in need of clearing out. The Registered Manager explained that the boilers had already been de-commissioned. Confirmation has since been received from the home that action has been taken to address this and the door is now being kept locked when the room is not in use. COSHH products are now being securely stored in the home. One Inspector sampled the servicing and maintenance records and those viewed were up to date. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.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 X X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.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 OP3 Regulation 14 Requirement There must be clear admission criteria in place for the intermediate care unit. Copies of the homes pre-admission assessment and/or a copy of the up to date Social Services assessment documentation must be available for each person prior to admission so the home can ascertain if they are able to meet their needs in full. Staff on the intermediate care unit must be appropriately trained to provide them with up to date skills and knowledge for the effective management of the assessed rehabilitation needs of the people living at the home. Previous timescale 01/01/07 not fully met Input from physiotherapy and occupational therapy services must be appropriate to provide effective and ongoing rehabilitation for each person on the intermediate care unit. Previous timescale 01/01/07 not fully met Input from the people living at DS0000010956.V333879.R01.S.doc Timescale for action 01/06/07 2. OP6 18 01/08/07 3. OP6 18 01/08/07 4. OP7 15 01/06/07 Page 27 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 5. 9. 10. OP7 OP8 OP9 15 15, 17 13(2) 11. OP9 13(2) 17(1) 12. OP9 13(2) 13. 14. 15. OP9 OP9 OP9 13(2) 13(2) 13(2) 16. OP12 16(m)(n) the home and/or their representative must be sought for the formulation and review of the service user plans, unless it is impracticable to carry out such consultation. Previous timescale 01/12/06 not fully met There must be evidence of the 24 care given to each individual. All assessments must be complete and up to date. Medicines must be administered as prescribed. Continuous supplies of medication must also be maintained for residents Medicines must be accurately recorded when administered. Previous timescale of 2/2/06, and 23/10/06 and 05/05/07 not met. If not administered the correct endorsement must be used. The reason for code (o) must be given. Medicines must not be shared between residents when individually prescribed. Previous timescale of 23/10/06 and 12/02/07 not fully met. Only homely remedies on the approved list must be administered in the home. That medication is audited at least weekly and the MAR checked daily. That staff continue to have training and regular updates in the safe handling of medication including insulin. Assessments of competency to administer medication safely must be ongoing. Individual social and leisure interest information must be recorded in each service user plan. This information must be used to inform the activities DS0000010956.V333879.R01.S.doc 11/05/07 01/06/07 01/05/07 01/05/07 01/05/07 01/05/07 01/05/07 01/07/07 01/07/07 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 Page 28 17. OP29 19 18. OP31 10(3) 19. OP33 26 20. 21. OP38 OP38 23(4) 13(3) 21. OP38 13(3) programmes. Any persons working unsupervised in the home must have the relevant checks to include a Criminal Records Bureau check carried out. Where such checks have not been carried out the workers cannot work in these areas unless chaperoned by a person for whom such a check has been carried out. The Registered Manager must undertake periodic training in topics relevant to the management of the home. The Regulation 26 visits for the home must be carried out as unannounced visits, as stated in the Regulation. This can be in addition to announced visits which allow people living at the home notice to consider any points they may wish to discuss with the person carrying out the visit. Fire safety training must be carried out as part of the induction process for all staff. Areas not to be accessed by people living at the home must be kept locked and action taken to minimise any risks. Any areas of the home to be affected by building works must be risk assessed and action taken to minimise any risks identified. Clear evidence of this must be available for inspection. 18/04/07 01/08/07 01/06/07 01/05/07 01/05/07 01/05/07 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 29 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 OP15 Good Practice Recommendations Consideration should be given to the inclusion of a ‘traditional’ meal option on the lunchtime menu. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V333879.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!