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Inspection on 19/10/06 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 19th October 2006.

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

Service users are comprehensively assessed prior to admission to the home to ensure that the home can meet their needs. Staff care for service users in a gentle, courteous and professional manner, respecting their privacy and dignity. End of life care is well managed at the home. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made very welcome at the home. There are robust systems in place for the management of complaints and POVA. There is evidence of ongoing redecoration, refurbishment and upgrading of the premises to provide a high standard of accommodation. The bedrooms and communal areas are spacious, plus work has taken place to make the grounds throughout easily accessible to service users and a pleasant environment to frequent. The home is appropriately staffed to meet the needs of the service users and of the home in general. Service users personal monies are being well managed, with systems being reviewed to ensure good management in this area is maintained.

What has improved since the last inspection?

Door closures have been fitted to the laundry room doors. The heating in the corridor area by the dining room has been reviewed to ensure this area is pleasantly warm and draughts have also been addressed.

What the care home could do better:

Whilst it is acknowledged that the environment in the intermediate care unit has been built to a high standard, additional staff training, a review of the documentation in use plus recruitment of an occupational therapist need to take place in order to provide effective and ongoing rehabilitation for each service user accommodated therein. Repeated delays in the formulation of service user plans, lack of updates in some areas, lack of information being included in the service user plan and repeated issues with bedrail assessments not being appropriately completed give cause for concern. Action must betaken to ensure the systems in place for the formulation and review of service user plans, to include input from the service users. Shortfalls in the management of medications continue to be found, and again, this needs to be robustly addressed and effectively managed thereafter. The home has an activities co-ordinator who works hard to meet the service users interests, however there needs to be in place individual activities programmes for each unit with the staff available to ensure these programmes are effectively carried out. Information regarding advocacy services was not freely available to service users and their visitors, and this is to be addressed. Some bathroom areas were being used for storage. Systems for ensuring the kitchenette fridges are regularly checked, cleaned and defrosted had broken down. Shortfalls in the staff employment records viewed were found, and there have been previous shortfalls identified in this area. The system being used to ensure all required documentation is in place prior to employing a new member of staff must be adhered to, and reviewed if found not to be fully effective. The Registered Manager has been very involved with the building works, both for the intermediate care unit and also the new 18 bedded unit in the process of construction. It is clear from the shortfalls identified at this inspection that the home has not been being fully audited and managed, and this needs to be addressed as a priority. Although overall systems for the management of health & safety in the home are good, shortfalls in staff training and fire drills for night staff need to be addressed.

CARE HOMES FOR OLDER PEOPLE St David`s Nursing Home For Disabled Exservicemen and Women Castlebar Hill Ealing London W5 1TE Lead Inspector Mrs Clare Henderson Roe Key Unannounced Inspection 19th October 2006 10:30 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.V313977.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.V313977.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 47 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.V313977.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. 2nd February 2006 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 service users and their visitors can sit. Work has been done to create a patio area outside the activities room and also a pathway around the garden with a summerhouse, affording attractive areas for service users and their visitors. The home provides nursing care for ex-service personnel, plus there is now 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 £1,100 per week, dependent on service user need. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.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 17 hours was spent on the inspection process. The Inspector carried out a tour of the home, and service user plans, medication records, staff records, financial records, management records, administration records, maintenance and servicing records were viewed. 9 service users, 5 visitors, 10 staff and 1 healthcare professional were spoken with as part of the inspection process. The pre-inspection questionnaire, given to the home at the time of inspection, has also been used to inform this report. What the service does well: What has improved since the last inspection? What they could do better: Whilst it is acknowledged that the environment in the intermediate care unit has been built to a high standard, additional staff training, a review of the documentation in use plus recruitment of an occupational therapist need to take place in order to provide effective and ongoing rehabilitation for each service user accommodated therein. Repeated delays in the formulation of service user plans, lack of updates in some areas, lack of information being included in the service user plan and repeated issues with bedrail assessments not being appropriately completed give cause for concern. Action must be St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 6 taken to ensure the systems in place for the formulation and review of service user plans, to include input from the service users. Shortfalls in the management of medications continue to be found, and again, this needs to be robustly addressed and effectively managed thereafter. The home has an activities co-ordinator who works hard to meet the service users interests, however there needs to be in place individual activities programmes for each unit with the staff available to ensure these programmes are effectively carried out. Information regarding advocacy services was not freely available to service users and their visitors, and this is to be addressed. Some bathroom areas were being used for storage. Systems for ensuring the kitchenette fridges are regularly checked, cleaned and defrosted had broken down. Shortfalls in the staff employment records viewed were found, and there have been previous shortfalls identified in this area. The system being used to ensure all required documentation is in place prior to employing a new member of staff must be adhered to, and reviewed if found not to be fully effective. The Registered Manager has been very involved with the building works, both for the intermediate care unit and also the new 18 bedded unit in the process of construction. It is clear from the shortfalls identified at this inspection that the home has not been being fully audited and managed, and this needs to be addressed as a priority. Although overall systems for the management of health & safety in the home are good, shortfalls in staff training and fire drills for night staff need to be addressed. 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 David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 7 DETAILS OF Inspector FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. The lack of staff training in respect of the provision of intermediate care means that the unit is not being effectively managed. EVIDENCE: The Inspector viewed 4 sets of pre-admission assessment documentation. These were comprehensive and identified the service users needs. The home has an intermediate care unit. There are 7 flats, and each service user has their own flat. 3 of the rooms have overhead tracking from over the bed through to the shower room, so that service users with profound moving & handling needs can be accommodated. The flats are spacious and well appointed. The home has a physiotherapist who works 10 hours per week. When the unit first opened there was a volunteer occupational therapist in place that has since left the home. The service user plan documentation was St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 9 for the same format as that used in the general nursing unit, and not appropriate for intermediate care. The staff must formulate clear service user plans for rehabilitation, to include treatment and recovery programmes with goals for service users to re-establish community living. Staff had not attended any specific training in the management and running of an intermediate care unit, and this needs to be addressed as a priority. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service user plans were not always promptly completed, kept up to date and did not accurately reflect the condition and needs of the service user, thus placing service users at risk of not having their needs met. Shortfalls in the medication management could place service users at risk. Staff are courteous to service users and personal support is provided in such a way as to promote and protect the service users privacy and dignity. Management of service users needs during their final days is good, thus respecting service users wishes with sensitivity and respect. EVIDENCE: The Inspector viewed 3 service user plans in the general nursing unit and 2 service user plans on the intermediate care unit. In one instance on the intermediate care unit the majority of the service user plan documentation had not been completed for 2 months following admission. One of the service user plans on the general nursing unit had not been reviewed since July 2006, despite two hospital admissions for the service user in the interim period. The St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 11 care plan documentation in use is for long term care, and documentation specific to the needs of intermediate care, to clearly identify goals for rehabilitation and the full care needs and specialist treatment to be provided to achieve these, needs to be introduced on this unit. Much of the care plan documentation viewed on both units was very general and not personalised to the individual. Daily records had been completed, however not all information had been included. For example, for one service user who was experiencing problems that required healthcare input, no record had been made of the healthcare professionals visit or the fact that the service user had soon after asked for a further visit as the situation was not resolved. Risk assessments for falls were in place, and there was evidence that these had been updated following any falls. With the exception of signed consents there was no evidence of input from the service users and/or their representatives in completion and review of the service user plans. Documentation for wound care was viewed. Some of the documentation had not been updated, to include some pressure risk assessments. Photographs of wounds had been taken. Wound progress records were in place, although some were not clearly marked to identify the wound to which they referred. For one service user the information in the service user plan in respect of the specialist mattress in use for the service user was very out of date. Referrals to the Tissue Viability Nurse Specialist had been made. Nutritional information was not always complete and some of the information in respect of conditions that affect nutritional need was not clear. For one service user whose nutritional needs had changed significantly there had been a marked delay in completing appropriate documentation to address this. Moving & handling assessments were in place, but did not always identify the number of staff and/or specific equipment required to meet each service users needs. Continence assessments viewed were not always complete. Risk assessment documentation for the use of bedrails was in place, however a full assessment to identify the appropriateness of their use and how any risks are to be minimised had not been carried out. Consents for the use of bedrails had been obtained. There was evidence of input from the GP and other healthcare professionals. The major shortfalls identified with the completion, review and overall standard of the service user plans, plus the fact that those on the intermediate care unit are not appropriate to robustly plan the rehabilitation process for the service users, gave the Inspector cause for serious concern. A full audit and review of the service user plan provision in the home needs to be carried out as a matter of priority. Systems then need to be put in place to ensure that the service user plans are maintained accurate and up to date in the future. The CSCI Pharmacist Inspector carried out an inspection on 11/10/06 and a separate report is available. The requirements and recommendations resulting from that inspection have been incorporated into this report. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 12 Staff were seen caring for service users in a gentle, courteous and professional manner, respecting their privacy and dignity. Service users were appropriately dressed and clothing was labelled for each individual. Service users can have their own telephones, either landline or mobile. Service users can bring in personal possessions in line with fire safety. The home has policies and procedures in place for the care of the dying. The Inspector met with one of the GPs for the home. The management of service users wishes in their last days was a topic recently discussed at a joint meeting with the home. A formal system is being put in place for a meeting between each new service user, their family, the GP and senior registered nurse, to discuss the service users wishes in respect of end of life care so this can be planned for in accordance with their wishes. This information could of course be reviewed with the service user and their family at any time. The home has had an informal system in place in the past, however this will ensure service users wishes in respect of their final days are understood from the outset. The home manages end of life care in a caring and sensitive manner. Input is available from the Macmillan Nurses and from the local Hospice. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.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 adequate. This judgement has been made using available evidence including a visit to this service. The activity input for the home is good, providing a variety of activities, outings and entertainments to meet the service users needs. The home has an open visiting policy, thus encouraging service users to maintain contact with family and friends. Information regarding advocacy services needs to be freely available to ensure the service users right to independent representation is respected. The food provision in the home is good, offering variety and choice, with service users choices being respected. EVIDENCE: The home has a full time activities co-ordinator, plus the Facilities Manager, who is a trained First Aider, also drives the homes bus for outings and has some involvement in activity provision. The information in the service user plans in respect of social and leisure activities was overall very general and did not clearly identify each service users individual interests. The activities coordinator is working with the general nursing and intermediate care units. On the day of inspection some of the service users on the intermediate care unit had been involved in cooking lunch for everyone on the unit, using the activities room, which has a cooker and a hob, as well as other kitchen equipment in place. It was noted that the hob height is not adjustable, so St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 14 service users cannot easily use it. Some of the service users from the intermediate care unit do their own laundry in the domestic facilities provided in the activities room, thus maintaining a level of independence. There was evidence of in-house activities, outside entertainment being brought to the home, plus various outings for service users. The activities co-ordinator said that she is aware of the changing needs of the service users on the general nursing care unit, and would like to learn more to meet the rehabilitation needs of service users in respect of social and leisure interests for the intermediate care unit. Service users are encouraged to get involved with aspects of gardening, and it was reported that service users grew fruit & vegetables and planted the hanging baskets. An aviary is being built in the garden and the activities co-ordinator explained that the service users who are interested will be involved in the selection of the birds to be kept therein. The Summer House in the garden has facilities for serving tea. Lists of activities were seen for each service user on the intermediate care unit, reflecting their abilities. An individual activities programme for both units needs to be available, addressing the different needs of the service users. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and staff are very helpful and supportive. Service users can choose to receive visitors in their bedrooms or in one of the communal areas. The Registered Manager said that if there are any issues regarding visits, then these are recorded and the service users wishes respected. The Registered Manager said that details of an advocacy service have been obtained, but this has not been cascaded to service users and their representatives. The need for this information to be freely available to service users and their representatives was discussed. The Inspector viewed the kitchen. This was clean and tidy and up to date cleaning, fridge & freezer temperatures were being maintained. Good food stocks were available in the home. A new storage room had been part completed, but a change of use to a walk-in refrigeration and storage area was now being planned. The chef said that presently the majority of vegetables used are frozen, with some fresh vegetables also. All items in the fridges and freezers are dated when opened. Samples of the meals are kept each day in line with Environmental Health guidelines. The staff changing area for kitchen staff is now situated near to the kitchen. There is direct access to the dining room. The lunchtime meal was observed. Menus were available on each table and service users chose their meal at that time. A choice of 3 options is available, however if anyone wants an alternative this is provided. The food is very well presented, to include a wide choice from a ‘salad bar’. The food is of good quality and service users spoken with were satisfied with the meal provision. An attendance list for mealtimes was being completed, however this did not evidence the meal partaken by each service user. The need to review St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 15 the list and formulate one that records each service users choice at each mealtime was discussed with the chef and the Registered Manager. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.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 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. The home has clear complaints procedures in place to address any concerns raised by service users and their visitors. There is a robust system in place for the safeguarding of service users from abuse. EVIDENCE: The home has a clear complaints procedure with timescales for action. The home had received one complaint and this had been fully investigated and documented. Due to the nature of the concern the documentation was not being held in the complaints file, and the Registered Manager said that he would ensure a copy was transferred to the complaints file. The home has policies and procedures for adult protection, and these dovetail with the Ealing Safeguarding Adults documentation. There have been no POVA issues since the last inspection. Staff spoken with said that they would report any concerns, and were also clear on Whistle Blowing procedures. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in the home continue, thus providing a smart, clean and homely environment for service users to live in. Communal rooms are available, providing the service users with a choice of places to socialise. Equipment in the home is available throughout the home, thus providing for the service users needs. Clear infection control procedures are in place and followed in most instances, however shortfalls could place service users at risk. EVIDENCE: The Inspector carried out a tour of the home. The home has recently completed a new section of single rooms with en suite facilities and all service users now have single bedrooms. A new 18 bedded unit is in the process of being built. The Registered Manager said that work is planned to install en suite facilities in some of the rooms that currently do not have them. It is clear that work is ongoing to provide a high standard of accommodation provided at the home. Some of the carpet in corridor areas of the intermediate care unit was already frayed and damaged and the Responsible Individual said this was being replaced the following week. Several of the bedroom doors had signs on St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 18 them with instructions for the ‘Dorguard’ door closures. These have been removed since the doors were put onto the integrated fire alarm system, and this signage needed to be removed, to avoid any confusion. The home has several communal rooms, which are spacious. On the intermediate care unit each flat has its own sitting/dining area. There is a large sitting room with a separate area for smokers to sit in. The dining room is well laid out and appropriate to accommodate service users in wheelchairs or sitting chairs. There is a central courtyard, which is well maintained and is a pleasant area for service users and their visitors to sit out in. Some of the rooms open onto the courtyard. Work has also been done in the rear garden to provide a path for service users, an attractive patio area with outdoor furniture, and a Summer House for service users and their visitors to use. There is a good improvement in the outdoor provision of space at the home. Several of the bedrooms have en suite facilities, some to include assisted showers. There is a good provision of assisted bath and shower facilities available throughout the home. Toilets are available near to the communal rooms. The corridors in the home are wide and rails are in place. The home is accessible to service users with disabilities. The home has two passenger lifts, one for each unit. The home is well equipped with moving & handling equipment to meet the needs of service users on both units. Doorways are wide and suitable for service users needing wheelchair access. One bathroom was identified as not in use and was being used for some storage. Call bell systems are in place throughout the home, with separate systems for each unit. There is a well-equipped physiotherapy room in the intermediate care unit. All the bedrooms are single and several viewed were very personalised. The beds are all adjustable and the rooms are well furnished. All bedroom doors have suitable locks and keys are available to service users if they wish and are able to manage one. Separate call bell systems are in place on each unit, and calls were heard to be being answered promptly. The home was pleasantly warm throughout. The lighting was satisfactory. It was noted that the water temperatures for one boiler had been recorded at 45˚ centigrade since March 2006. The storage temperature must be a minimum of 60˚ centigrade and the distribution temperature a minimum of 50˚ centigrade. This needs to be addressed, and a system put in place to ensure such issues are addressed promptly in the future. The home was clean throughout and smelled fresh. In one kitchenette several very out of date items were found in the fridge. This was brought to the attention of staff at the time and addressed. The small freezer compartment was completely frozen up and staff spoken with said they had been unable to St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 19 access the electricity supply in order to defrost it. Several soap dispensers were damaged and bottles of liquid soap had been provided in the areas concerned. The laundry room was clean and tidy. Individual containers are available for each service users clothing. All the washing machines have a sluice programme. Infection control policies and procedures are available and the laundry personnel were clear on the routines to be used for the laundering of any infected laundry. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.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 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to meet the needs of the service users. Staff have received appropriate training to provide them with the skills and knowledge needed to meet the needs of the service users, thus maintaining good standards of care. The standard of vetting and recruitment practices is poor with appropriate checks not being carried out, potentially leaving service users at risk. EVIDENCE: The home was being appropriately staffed at the time of inspection. Rosters viewed show that the staffing is in place for each shift, and occasionally agency staff are used to cover staff shortages. Service users spoken with expressed their satisfaction with the care provision at the home. The home was clean and sufficient numbers of ancillary staff are employed. The kitchen has one vacancy and the chef explained that this is being covered until a new person is recruited. The Inspector viewed some of the training records. Two kitchen staff are undertaking NVQ level 2 in catering. The Deputy Matron explained that the home has accessed a new training company for NVQ training, and this will commence in January 2007. On the nursing unit 50 of the care staff are qualified to NVQ level 2 or the equivalent, with more staff commencing in January 2007. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 21 Three sets of staff employment records were viewed. Application forms had been completed, but in some instances a full employment history, the reason for leaving previous employment and/or dates of employment had not been completed. In one instance no references were seen and a Criminal Records Bureau check was not available. POVA list checks had been carried out in all three cases. Photographs were not available on all the files viewed. No dates of employment were available. The Deputy Manager explained that all staff are employed on a ‘bank’ basis and this is reviewed after 3 months. The major shortfall identified under this standard gave the Inspector cause for concern, and the home has been identified as having shortfalls in this area in the past. Prompt and robust action must be taken to ensure all employment checks and information is gained prior to employing a new member of staff. The home uses an induction and foundation programme that meets the Skills for Care common standards. Staff spoken with said that they had undergone induction and foundation training. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the qualifications to manage the home, however the home is not being fully effectively managed overall, thus shortfalls are not being promptly identified and addressed. Systems for quality assurance are in place, thus providing an ongoing process of system and practice review. Service users monies are well managed, thus safeguarding service users interests. Systems for the management of health and safety are generally good, thus safeguarding service users, staff and visitors. Updates in staff training in some areas of health & safety are required to ensure they have the appropriate skills and knowledge to maintain this. EVIDENCE: The Registered Manager is a is a first level registered nurse with qualifications in general and mental health nursing. He also has a degree in Healthcare Management. The Registered Manager said that he is aware of the need to St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 23 undertake periodic updates to keep his knowledge up to date, however some of his health & safety training needed updating also. It was apparent from the inspection that some parts of the care have not been being effectively managed, especially the service user plans and the medication management. The Registered Manager said that his role has expanded with the overseeing of the development of the new units and the additional work this entails. He said that he had identified the need for more effective management in certain areas and had discussed this with the Responsible Individual. This needs to be addressed in order to ensure all areas are being robustly managed. The home has an Annual Operations Plan that is kept up to date. Regulation 26 visits are carried out monthly and a copy of the reports forwarded to CSCI. Annual satisfaction surveys are done at the end of each year. Staff meetings are held every 2 months for all staff. The Registered Manager said he meets with all the heads of department on a 1:1 basis at supervision sessions. A service user and relatives meeting was due to be held. The Registered Manager said that representatives from service users, relatives and staff had attended the project meetings for the developments taking place. It was clear that areas of care to include service user plans, medications and staff records had not been subject to regular auditing, and this was evident by the shortfalls identified. The need to ensure systems are in place for the effective auditing and management of the home was discussed with the Registered Manager. Samples of the records of service users monies were viewed. Some service users have bank accounts, and a record of all monies held in the ‘patients account’ is maintained. Some of the service users with bank accounts had built up significant sums of money in the ‘patients account’ and the Inspector recommended that action be taken to arrange transfers of funds. Receipts are given for all income and expenditure and clear records of all monies received and given out are maintained. The Registered Manager explained that the system is being reviewed to ensure that robust procedures for the management of service users personal monies are maintained. The Inspector sampled maintenance and servicing records and those viewed were up to date. Records of hot and cold water temperature checks evidenced where any adjustments had been necessary. The fire risk assessment had been updated in August 2006. The fire log recorded all events in relation to the fire system, including servicing. Fire drills had been carried out every 3 months for day staff, but the last night fire drill was recorded as October 2005. This needs to be addressed. The general training records did not evidence that all staff have received training and annual updates in all health & safety topics. Risk assessments for equipment and safe working practices were in place and there was evidence of recent updating. Those for the garden areas and associated works were still to be updated, but it was clear that work was being done to update all the risk assessment documentation. Overall health & safety is being well managed at the home. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 24 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 3 X X 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 2 X 3 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 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.V313977.R01.S.doc Version 5.2 Page 25 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 OP6 Regulation 18 Requirement 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 service users assessed rehabilitation needs. Input from physiotherapy and occupational therapy services must be appropriate to provide effective and ongoing rehabilitation for each service user on the intermediate care unit. The service user plan documentation must be appropriate to the service users on the intermediate care unit, to include treatment and recovery programmes with goals for service users to re-establish community living. The service user plan must accurately reflect the condition of the individual and must be kept up to date. Previous timescales of 19/09/05 & 01/03/06 not met. Service user plans for new DS0000010956.V313977.R01.S.doc Timescale for action 01/01/07 2. OP6 18 01/01/07 3. OP6 15, 17 01/01/07 4. OP7 15, 17 01/12/06 5. OP7 15, 17 01/12/06 Page 26 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 6. OP7 15, 17 7. OP7 15 8. 9. OP8 OP8 15, 17 15, 17 10. OP8 13(4) 11. OP9 13(2) 12. OP9 13(2) 13. OP9 13(2) 14. 15. OP9 OP9 13(2) 13(2) admissions must be completed promptly. Previous timescale of 01/03/06 not met. All information to include input from healthcare professionals must be clearly recorded in the service user plan. Input from the service user 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. All documentation relating to wound care must be up to date and accurate. All assessments and related documentation must be complete, up to date and identify any specific equipment required to meet the service users needs. Bedrail assessments must clearly identify the appropriateness of the use of bedrails in each individual instance. Previous timescale of 19/09/05 & 01/03/06 not met. Medicines must be accurately endorsed when administered. Previous timescale of ½/06 not met. Attention must be given to clarity in the instructions of variable doses. Controlled drugs must be stored in a cupboard meeting the requirements of the Misuse of Drugs Act. Controlled drugs must be recorded in the Controlled drugs register when received, administered or disposed of. Entries must be signed and witnessed. The pulse should be recorded for all residents prescribed digoxin. The home must use a finger pricking device for professional DS0000010956.V313977.R01.S.doc 01/12/06 01/12/06 17/11/06 01/12/06 01/12/06 23/10/06 23/10/06 19/10/06 19/10/06 19/10/06 Page 27 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 16. 17. 18. OP9 OP9 OP12 13(2) 13(2) 16(m)(n) 19. OP12 15 20. 21. 22. OP14 OP22 OP26 12 23(2)(l)& (m) 13(2) 23. OP29 17 24. 25. OP31 10, 12 10(3) OP31 26. OP33 24 use. Previous timescale of 01/03/06 not met. Individual use finger pricking devices must be clearly labelled with the service users name. Medicines must not be shared between residents unless a bulk prescription is available Nursing staff must have an update in controlled drugs legislation There must be in place separate activities programmes to meet the assessed needs of the service users on each unit. Individual information for each service user must be recorded to identify their social and leisure interests. Information regarding advocacy services must be freely available to service users. There must be adequate storage available within the home. A system for defrosting and cleaning out the fridges in the kitchenettes must be in place and be followed. Staff records must include all the information required under Schedule 2 of the Care Homes Regulations 2001. Staff must not be employed until all required information has been obtained. The Registered Manager must ensure that the home is being managed effectively at all times. The Registered Manager must undertake periodic training to ensure that his knowledge and skills are kept up to date. A training plan to address this must be in place. Effective systems for auditing must be in place and prompt action taken to address any shortfalls identified. DS0000010956.V313977.R01.S.doc 23/10/06 01/11/06 01/12/06 01/12/06 17/11/06 01/01/07 10/11/06 10/11/06 20/10/06 01/12/06 01/12/06 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 Page 28 27. OP38 28. OP38 13, 18, 23 All staff must undergo health & safety training and updates at the required intervals. An action plan to address this must be drawn up. 23(4) Fire drills must take place every 3 months for all night staff. An action plan to address this must be drawn up. 01/12/06 10/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations That the pharmacist updates the MAR removing all discontinued items. The home must work with the pharmacist to identify those items requiring deletion. This is a repeat recommendation The home should keep fit charts to monitor seizures in residents with epilepsy It is strongly recommended that a record of each service users meal choice is maintained for each meal. It is strongly recommended that the out of date signage on some of the bedroom doors be removed. It is strongly recommended that where service users have significant funds being held in the ‘patients account’ action should be taken to transfer funds to the service users individual account with interest being paid. 2. 3. 4. 5. OP9 OP14 OP19 OP35 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V313977.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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