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Inspection on 02/02/06 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 2nd February 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 well cared for at the home and staff treat service users with respect. Service users and visitors spoken with were pleased with the care provision at the home, and there is a homely atmosphere throughout. The activities provision is good, with regular events taking place. The food provision continues to a good standard, with service users being offered choices, which are respected. Staffing is maintained to appropriate levels, and the recruitment procedures are overall robust. There is evidence of ongoing staff training, to include induction, foundation and NVQ in care training programmes. Quality assurance systems are in place to include regular auditing. Systems are in place for maintenance and servicing, and health and safety is being well managed in the home. There are ongoing plans and improvements to provide single, en suite facilities for the service users.

What has improved since the last inspection?

There has been an improvement in the formulation of the service user plans, with some work still to be progressed, specifically with the formulation of service user plans for new service users, plus the need to expand the bedrail risk assessments to ensure the information is comprehensive. Staff have had additional training in adult protection (POVA) management.

What the care home could do better:

Ongoing shortfalls in the management of medications are of a concern, and action must be taken to address the shortfalls identified and thereafter to maintain robust procedures for medication management. Two environmental shortfalls, the fitting of closures on the laundry room doors and the reviewing of the ill-fitting glass doors, are 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 Unannounced Inspection 2nd February 2006 10:00 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.V270641.R01.S.doc Version 5.0 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.V270641.R01.S.doc Version 5.0 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 40 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.V270641.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include 40 service users over the age of 40 years. Date of last inspection 8th August 2005 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. A decked area has been created outside one of the communal rooms and this affords another attractive seating area for service users and their visitors. The home provides nursing care for 40 ex-service personnel. The accommodation consists of 32 single rooms, two with en suite facilities, and four double rooms. Work is taking place to provide four more single rooms with en suite facilities, and thereafter all bedrooms will be single. There are spacious communal sitting and dining rooms and a designated smoking area. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 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 11 hours was spent on the inspection process. The Inspector carried out a tour of the home, and inspected service user plans, staff records, maintenance and servicing records. 7 service users, 7 staff, 1 volunteer and 2 visitors were spoken with as part of the inspection process. The purpose of this inspection was to follow up the requirements and recommendations from the last inspection, and to view some additional standards. The majority of key standards were viewed at the last inspection and it is recommended that this report be read in conjunction with the last report to gain full inspection information for the home. What the service does well: What has improved since the last inspection? What they could do better: Ongoing shortfalls in the management of medications are of a concern, and action must be taken to address the shortfalls identified and thereafter to maintain robust procedures for medication management. Two environmental shortfalls, the fitting of closures on the laundry room doors and the reviewing of the ill-fitting glass doors, are to be addressed. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 6 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.V270641.R01.S.doc Version 5.0 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.V270641.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. The home does not currently provide intermediate care. Service users and their representatives are provided with information about the home. Service users are assessed prior to admission to ensure the home can meet their needs. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. The Service User Guide is available in the reception area. The supplying of a copy of the Statement of Purpose in the reception area was discussed. The documents provide current information about the home. The Registered Manager said that with the registration of the new 7 bedded intermediate care unit a new Statement of Purpose and Service User Guide will be produced and the format of the Statement of Purpose will be reviewed to ensure it is clear and readerfriendly. The home has very comprehensive pre-admission documentation and examples viewed were well completed. Copies of Social Services and/or Primary Care Trust (PCT) assessments and information from the prospective service users GP are also obtained. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 9 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 and 10 Service user plans were generally well completed and reflected the needs of the service users. Ongoing shortfalls in the medication management could place service users at risk. Staff are courteous to service users and care is provided in such a way as to respect the service users privacy and dignity. EVIDENCE: The Inspector viewed three service user plans. Generally these were well completed and gave a good picture of the service user. In one instance, for a service users quite recently admitted to the home, documentation was not fully completed. The need to ensure that service user plans are completed promptly after admission was discussed. Monthly reviews had been carried out, and there was evidence that care plans had been formulated for newly identified needs. Risk assessments for falls were in place and these are updated following any falls. The home does admit service users for short and long term respite care. The possibility of formulating a simplified service user plan for service users who are on short-term respite, which contains the required information, was discussed. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 10 Documentation for wound care was in place. Pressure relieving equipment is identified in the service user plan and was seen in use in the bedrooms. Information regarding infection control and wounds is clearly recorded, and there was evidence of input from the Tissue Viability and the Infection Control Nurses. Assessments for continence, moving & handling and nutrition were in place. Where a need had been identified in any of these areas, care plans to address them had been formulated. Written consents for the use of bedrails had been obtained. The bedrail risk assessments still required some expanding to clearly identify the reason for their use and to comprehensively assess all areas of risk associated with bedrails to ascertain if the use of bedrails is appropriate in each individual case. This was discussed with the Deputy Manager. There was evidence of input from Healthcare Professionals. The CSCI Pharmacist Inspector carried out a full medications inspection on 02/02/06 and a separate inspection report is available. The requirements and recommendations resulting from that inspection have been incorporated into this report. The abbreviation ‘MAR’ stands for Medication Administration Record. Ongoing shortfalls with the management of medications gave the Inspectors cause for concern and action must be taken to address this area robustly and effectively. Staff were seen caring for service users in a gentle and respectful manner. Service users spoken with said that they are well cared for by the staff at the home. Staff speak with service users using their preferred term of address. Service users were well dressed and care is taken with service users clothing. Some of the bedrooms are quite personalised, and this is the choice of each individual. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 11 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): Aspects 12 and 15 Information regarding service users hobbies and interests is available and activities are provided to meet the service users needs. Dietary needs of service users are well catered for with food choices provided and food available that meets service users preferences. EVIDENCE: Care plans for social and leisure interests are in place, and ‘interest’ charts are also completed to ascertain individual interests details. Some of the outings arranged are at the weekends, and once the new intermediate care unit is completed and registered, more weekend activities are to be incorporated. There was evidence of activities taking place. Service users were seen enjoying their lunchtime meal. Service users and visitors spoken with were complimentary about the food provision, and service users individual food choices are recorded and respected. It was clear from the mealtime viewed that as well as the options on the menu for the day, if service users wish to have something different then this will be provided. The standard of food provision remains high. The chef and kitchen staff are involved in the serving of the food and is present at mealtimes. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Systems are in place for the protection of vulnerable adults so as to protect them from possible risk of harm or abuse. EVIDENCE: Standard 16 was viewed at the last inspection and the standard was met. No complaints have been received since the last inspection. There have been no adult protection (POVA) issues since the last inspection. Staff spoken with were clear of POVA procedures and the Registered Manager carried out additional training in this area following the last inspection. This standard was viewed in depth at the last inspection. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 13 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): Aspects of 19, 25 and 26 Overall the home is maintained to a high standard, providing service users with a homely environment. Minor shortfalls identified should be easy to address. Procedures for infection control are good, thus safeguarding service users. EVIDENCE: The home continues to be maintained to a high standard. The décor is in good order throughout. Redecoration and refurbishment had taken place on the first floor, both on the landing area and in the bedrooms. One ground floor area is being converted into four single rooms with en suite facilities, after which all service users will be accommodated in single rooms. There is still a substantial amount of communal space within the home. On the day of inspection the weather was cold, and the corridor that runs alongside the dining room was very cold. It was noted that the two sets of glass doors that are at either end of this section have gaps under them, allowing for a significant draught to blow through. The Registered Manager said that this would be addressed. Door closures had not yet been installed on the entrance doors to the laundry. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 14 Again, this is to be addressed. The findings were discussed with the Registered Manager. No infection control issues were identified at the time of inspection. The home was clean and smelled fresh throughout. This standard was examined in depth at the last inspection. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 15 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 and 30 The home is appropriately staffed to meet the needs of the service users. Staff undergo training to provide them with the skills to meet the needs of the service users. The systems for the recruitment of staff are robust and safeguarded service users. EVIDENCE: The home is appropriately staffed to meet the assessed needs of the service users. There was evidence that due to increased dependency, an additional member of care staff was being rostered for each afternoon shift. Appropriate numbers of administration, maintenance, catering and domestic staff are also employed to meet the needs of the service users and to maintain the home to a good standard throughout. The home has induction and foundation programmes based on the Skills for Care (formerly TOPSS) core standards. Copies of staff induction programmes were viewed. 9 of the care staff have attained the NVQ in care to level 2 or 3, or have an equivalent qualification. Three are completing NVQ in care training. The Inspector viewed two sets of staff employment records for recently employed staff. These contained all the required information. The application form for the home did not request a reason for leaving previous places of employment. This information had been voluntarily supplied in the records viewed, and the need to update the application form to include a request for this information was discussed. Confirmation has since been received that the application has been updated. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 16 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38 Auditing procedures ensure that the home is well maintained and the views of service users and their representatives listened to. The health and safety management in the home is robust and safeguards service users, staff and visitors. EVIDENCE: The home has a comprehensive Operating Plan for quality assurance. Surveys for service users and relatives had recently been carried out and the introduction of a survey for stakeholders was discussed. Service user, relative and staff meetings are held, and minutes are taken and copies are made available. Policies and procedures are reviewed annually and are also updated when any changes necessitate this. Staff training records evidenced that staff have attended mandatory training to include fire safety, manual handling, infection control, and food hygiene. The home has 5 qualified first aiders. Risk assessments had been carried out for all St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 18 equipment and safe working practices. All rooms had been risk assessed. These are updated annually and whenever relevant changes occur. The Registered Manager said that he ensures compliance with all relevant legislation. Samples of servicing and maintenance records were viewed and were up to date. Good systems for the maintenance of the home are in place. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 17 Requirement The service user plan must accurately reflect the condition of the individual and must be kept up to date. (previous timescale of 19/09/05 not met). Service user plans for new admissions must be completed promptly. Bedrail assessments must clearly identify the appropriateness of the use of bedrails in each individual instance. (previous timescale of 19/09/05 not met) Medicines must be accurately endorsed when administered. All prescription medicines must be locked up in the clinical room. Oxygen must be stored securely. All nurses administering medicines must be fully aware of the homes policies and procedures for safely handling medication. Systems must not be changed without full discussion with other senior nurses and training. Medicines must be administered as prescribed. DS0000010956.V270641.R01.S.doc Timescale for action 01/03/06 2. OP8 13(4) 01/03/06 3. 4. 5. OP9 OP9 OP9 13(2) 13(2) 13(2) 03/02/06 03/02/06 14/02/06 6. OP9 13(2) 03/02/06 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.0 Page 21 7. OP9 13(2) 8. 9. 10. 11. OP9 OP9 OP19 OP25 13(2) 13(2) 23(4) 23(2)(b) (p) Medicines and the MAR must be thoroughly checked when received into the home. If discontinued then this must be clearly written on the MAR. The home must use a finger pricking device for professional use. Communication must improve in the home so that dates for blood tests are not missed. Door closures in line with fire safety must be in place on the laundry room doors. The glass doors must be reviewed to ensure that they fit properly and to address all draughts. The heating in this section of the home must be satisfactory. 03/02/06 01/03/06 01/03/06 01/03/06 01/04/06 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. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V270641.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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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