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Inspection on 06/05/08 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

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

Prospective residents are fully assessed prior to admission to ensure the home can meet their needs. Staff were observed to interact with the residents in a caring and professional manner. Residents and representatives` wishes in respect of end of life care are being recorded. The home has a visiting policy and visiting is encouraged. Relatives and visitors spoken with during the course of the inspection commented that they are always made to feel welcome. Information regarding advocacy services is freely available. The meal provision in the home is good and residents are offered choices to meet individual preferences. Complaints are well managed. The home was clean and fresh. Systems are in place for the management of infection control. The home is well staffed to meet the needs of the residents. The home has an ongoing programme of training for staff to meet the needs of the residents. Over 50% of care staff have attained their NVQ level 2 training or equivalent. Residents monies are well managed with all documentation in place.

What has improved since the last inspection?

Since the last inspection a full time physiotherapist has been employed to work on the intermediate care unit. The hours worked by the occupational therapist have also increased. Several residents have been successfully rehabilitated to move onto independent or supported living. The admission criteria for the intermediate care unit has been agreed and is used for any prospective residents that are referred. Staff working on the intermediate care unit have undertaking training in the area of rehabilitation. Risk assessments for falls, continence, moving and handling, nutrition and pressure sores were up to date. All Requirements in relation to medication management issued at the last inspection had been addressed however further shortfalls were identified at this inspection. Regulation 26 visits were being carried out and were unannounced. Staff had received training in fire safety. Risk assessments were available in relation to the building works being undertaken in the home.

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 Key Unannounced Inspection 10:15 6 , 7th & 13th May 2008 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.V362083.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.V362083.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 59 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (59) of places St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. 3. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 59 The seven beds in the John Poland Rehabilitation Unit are to be used for service users requiring intermediate care, and not for permanent placement. 16th April 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 and there are currently 2 units for this, 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 £741 to £1,200 per week. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection carried out as part of the regulatory process. A total of 20 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, medication records, management records, training matrix, staff employment records, administration records, maintenance and servicing records were viewed. 16 residents, 20 staff, 4 visitors and 1 healthcare professional were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus CSCI surveys received from residents, representatives/visitors and staff have also been used to inform this report. What the service does well: What has improved since the last inspection? Since the last inspection a full time physiotherapist has been employed to work on the intermediate care unit. The hours worked by the occupational therapist have also increased. Several residents have been successfully rehabilitated to move onto independent or supported living. The admission criteria for the intermediate care unit has been agreed and is used for any prospective residents that are referred. Staff working on the intermediate care unit have St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 6 undertaking training in the area of rehabilitation. Risk assessments for falls, continence, moving and handling, nutrition and pressure sores were up to date. All Requirements in relation to medication management issued at the last inspection had been addressed however further shortfalls were identified at this inspection. Regulation 26 visits were being carried out and were unannounced. Staff had received training in fire safety. Risk assessments were available in relation to the building works being undertaken in the home. What they could do better: 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.V362083.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.V362083.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. The home has an effective intermediate care unit, where residents are helped to maximise their independence and return home. EVIDENCE: The home has an extensive pre-admission assessment pack, and the Manager Designate had also introduced a new, simpler document. Pre-admission assessments seen had been completed, although some information was not comprehensive. However, copies of the Social Service assessments were available. The Manager Designate was receptive to ensuring the homes documentation is also completed in full in future. The intermediate care unit is purpose built and consists of 7 individual flats. There is dedicated space for occupational health and physiotherapy. The home St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 9 employs one full time physiotherapist, one part time physiotherapist and one part time occupational therapy assistant. The service user plan documentation available for use does provide appropriate assessments for service users accommodated for intermediate care. The registered nurse in charge of the unit has several years experience in intermediate care and overall the whole unit has benefited from the employing of healthcare staff who have a good understanding of intermediate care. The Manager Designate has also ensured that the residents being admitted to the unit have been fully assessed and are appropriate for the rehabilitation programme the home can provide. There has been an improvement in staff training, which has had positive outcomes for the residents living there. There is a multi-disciplinary team meeting every week to discuss the progress and goal setting for each individual. On the intermediate care unit 3 service user plans were viewed. These were up to date and clearly recorded the needs of each individual and how these needs are to be met. There was evidence of involvement and input from each resident and the multi-disciplinary healthcare team. The service user plans had been reviewed monthly and whenever a significant change had occurred. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.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. 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. Service user plans are not always promptly updated, and do not always accurately reflect the condition and needs of the resident, thus placing residents at risk of not having their needs met. Although generally well managed, shortfalls in the medication management could place residents at risk. Whilst overall staff are courteous to residents, shortfalls were identified that could compromise respect for residents and their dignity. Information regarding the end of life care wishes of residents is ascertained, so that their wishes can be recorded and respected. EVIDENCE: 4 care plans were viewed on the general nursing units. Care plans were in place for identified needs and there was evidence of monthly reviews. However, for a resident who had been in hospital the service user plan had not been updated promptly following readmission to the home, and in one instance where the persons condition had changed this was not reflected in the review for that particular care plan. Risk assessments for falls and other identified St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 11 risks were in place. It was not always clear if residents had been involved in the formulation and review of their service user plan. Documentation for wound care was viewed. Pressure sore risk assessments were in place. For one resident the care plan for pressure sores did not identify a sore, although one was present. The wound assessment and action plan document did identify a wound and the dressing regime to be followed. However the records did not reflect the stated frequency with which the wound was to be dressed. For one resident with two wounds, only one wound assessment and dressing action plan was available, although the wound dressing record showed that 2 separate wounds had been being redressed on a regular basis. For another resident clear wound care documentation was available for each wound and the progress of the wound had been fully documented. The need to ensure that all wounds are fully identified, assessed, have the full wound care documentation in place and that wounds are redressed at the stated frequency was discussed with the Manager Designate and the registered nurse on duty. It is acknowledged that the wounds are improving, however clear documentation must be in place to support this finding. Assessments for moving & handling, continence and nutrition were in place. 3 documents are in use for nutritional assessments and the Manager Designate is aiming to streamline the assessment process. Where it has been identified that a residents needs have significantly changed and the home is no longer able to meet their needs then this is appropriately addressed, to include involvement of Social Services and healthcare professionals to review those concerned and, where necessary, identify an alternative placement. There was evidence of input from healthcare professionals to include GP, tissue viability nurse, dietician, physiotherapist and chiropodist. We carried out a specialist inspection of medication in all three units of the home. The recording of receipts, administration and disposal was checked and medication audited against the stock held. Throughout the home medicines were being checked when received into the home. There were however inconsistent practices of recording the date of receipts of medication and balances carried forward, and it was therefore not possible to always reconcile the stock held. In the main nursing unit fybogel was not available for 4 days for one resident in the middle of the cycle. Nurses need to be able to ensure that medication does not run out. Accurate recording and audits are necessary to maintain stock levels and provide evidence that residents are receiving their medication as prescribed. In the main nursing unit it was disappointing to find that the accurate recording of administration was not better. There were several gaps on the Medication Administration Records (MAR) E.g. for one resident there were gaps for tamsulosin, viscotears on 25/4 and sofradex on 3/5.For another resident trazodone at night on 6/5 was not signed for. And for another tolteridone was not signed for at night on 6/5.Warfarin 1mg was not signed as administered on St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 12 22/5. Unless medication is recorded there is no evidence that it has been administered. There was generally good recording when residents went into hospital and with one exception when dosages changed. Antibiotic liquids must be stored in the fridge and not left on the trolley. Chloramphenicol eye drops also need to be stored in the fridge. One bottle was past its expiry date and not refrigerated. This poor practice could lead to a further eye infection in this resident. The home was good at recording dates of opening on liquid medicines but this practice was not always extended to eye drops, which have a short expiry dates and must be used within a short period to prevent infection. There was great concern throughout the home that the instructions and recording of warfarin were not always clear, particularly when different doses are prescribed on different days. In the new unit a dose of 1mg of warfarin was not recorded as given on 6/5 in addition to the 3mg tablet to make up the total required dose for that day. Nurses must make sure that the MAR is clearly marked with the prescribed doses and the evidence of the current dose kept with the MAR for confirmation. If the dose is changed it is good practice to rewrite the entry. Controlled drugs were checked in the home and balances were correct. On 6/5 a dose of temazepam remained in the blister and there was no endorsement on the MAR in the new unit. This means that the tablet was not given and no reason was stated. CD cupboards must be designated cupboards and not used to store other items such as keys and phones. Storage in the main clinical room and the new unit was spacious and well organised. There was no evidence of excess stock. Several residents were prescribed feeds for enteral nutrition. These were well managed according to individual protocols in the care plans and residents rooms. They were regularly reviewed by the dietician. In order to maintain the MAR as a current list of prescriptions, they should also be listed on the MAR. One resident had diabetes and there was evidence in the care plan of what to do in the event of a hypo or hyper glycaemic episode. Insulin was stored in a fridge used to store food items. This is currently being addressed by the manager. Recording of both the minimum and maximum temperature of the fridge must be recorded throughout the home. In the new unit the room temperature should be monitored, as the room was very warm. Medicines need to be stored below 25 degrees to maintain their potency. Staff were seen caring for residents in a gentle, courteous and professional manner, and there was a good atmosphere on each unit. Residents clothing was individually labelled and residents were well dressed to reflect individuality and culture. Residents can have their own telephones, either landline or St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 13 mobile. Some comments were received regarding staff speaking over residents in a language that could not be understood by the resident, and the residents felt that they were not being treated as a person, more as an object. This was discussed with the Manager Designate who said that this problem had been identified and staff had been spoken with about this poor practice. We spoke with some of the staff also regarding this matter, reiterating the importance of good communication with every resident and treating each in a respectful manner. In the dining room there was some ‘banter’ by a member of staff that was somewhat loud and including words that some residents may not wish to hear. Whilst friendly discussion to enhance the residents’ lives is important, loud, unnecessary comment that could cause offence should not take place. A short questionnaire regarding each residents’ wishes in respect of end of life care was in place and these had been completed. If a resident does not yet wish to discuss this sensitive topic then this is also recorded. Training in end of life care has been booked for some of the registered nurses. The home has access to the Macmillan nurses and to palliative care input. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.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): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an activities co-ordinator, however more work is needed to ensure activities are provided on an ongoing basis to meet the needs and interests of all the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring residents right to independent representation is respected. The food provision in the home is good, offering variety and choice, however staff need to ensure mealtimes are appropriately spaced to enhance the residents’ day. EVIDENCE: The home has a part time occupational therapist, a full-time activities coordinator and also employs a driver who assists with activities. On the intermediate care unit there are therapy programmes to enhance each persons rehabilitation process. Residents are also encouraged to join in with group activities. On the nursing units the care plans for activities are very general and do not reflect peoples individual interests. This is a repeat finding. We spoke with the occupational therapist who was able to explain how she puts together activity sessions to encourage discussion and reminiscence so that residents communicate well and share their memories. Residents commented St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 15 that they enjoy these sessions as they are very interesting. There is a wellequipped reminiscence room. An activities programme has been devised and lists the activities for each day. The activities co-ordinator works mainly with the residents on the nursing units. A group of residents are taken out quite regularly on trips and also have afternoon tea sessions in the garden or other communal areas, depending on the weather. This would appear to involve a similar group of people on each occasion. Some comment was received regarding the lack of activities for residents who are unable to come out of their rooms. The importance of identifying each persons needs in relation to social and leisure activities was discussed with the activities co-ordinator. From the information gained the activities programme can be further advanced to include outings and activities to suit all the residents, and thus more residents may join in. The activities co-ordinator has undertaken training specific to providing activities for those living in a care home environment. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and offered refreshments. Residents can choose to receive visitors in their own rooms or in one of the communal areas, depending on their wishes. Information regarding advocacy services was on display in the home on several of the notice boards and also in the reception area. We viewed the kitchen and the area was clean and tidy and records were up to date. The lunchtime meal was sampled on both days of inspection and was well presented and tasty. Residents are offered a choice at the time of each meal and their choices are recorded. Menus are available on the tables. Residents spoken with said that they enjoy the food and are offered a choice. On the second day of inspection in was noted that on the main nursing unit the supper mealtime was starting at 4.35pm, with residents being served their evening meal before others had come into the dining room. The lunchtime meal had ended at 1.30pm. Staff spoken with asked us what time the meal should begin. We went and spoke with the Manager Designate who came back to the dining room and was clear that supper should be at 5.30pm. We did ascertain that snacks are available throughout the night, however the need to ensure that meals are arranged in a timely fashion so that they are spread out throughout the day was discussed. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure that is followed, thus enabling residents and representatives to express concerns and have them addressed appropriately. The home has procedures in place for safeguarding adults, however lack of knowledge by some staff could place residents at risk. EVIDENCE: The home has a clear complaints procedure and complaints are recorded and investigated, with documentation being available to show what action has been taken. Residents and relatives spoken with said that they feel they are able to raise concerns and that these are addressed. The home has a policy for safeguarding adults in place, and this dovetails with the Ealing Safeguarding Adults documentation and procedures. Several of the staff spoken with were clear to report any concerns and understood the Whistle Blowing policy and procedure. Some staff were not clear about the procedures to be followed and had not all read the homes policies and procedures for POVA. The importance of ensuring all concerns are reported promptly was discussed. The homes training matrix was viewed and it was evident that not all staff had received POVA training. The Manager Designate stated that this had been planned and all staff would receive the training within 1 month. At the visit made on 13/05/08 one training session had already taken place and a second one for the rest of the staff had been scheduled. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well built, thus providing a safe, clean and homely environment for residents to live in. A redecoration and refurbishment programme would evidence that the environment is being maintained. Clear infection control procedures are in place and being adhered to, thus safeguarding residents. EVIDENCE: The home is built in 3 sections – the main nursing home unit, the intermediate Care unit and the new 18 bedded nursing unit, which has 9 beds commissioned therein. The home does not have a maintenance man, however maintenance work is carried out as and when needed on a contract basis. One member of staff does carry out the routine checks, for example, water temperature testing. Overall the environment is of a good standard. In some areas the carpets have frayed and need attention to ensure they do not pose a health & safety hazard, and this had been identified by the Manager. It is strongly recommended that an ongoing redecoration and refurbishment programme be St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 18 drawn up, thus evidencing the fact that work is being done to maintain a good environment throughout. The new nursing unit has been built to a high standard with en suite shower rooms for each bedroom. The bedrooms are spacious, as are the communal areas throughout. The home has a wellmaintained garden that residents enjoy sitting out in. There are also some decked areas for residents use. The home was clean and tidy and smelled fresh throughout. We viewed the laundry room and the washing and drying machines are industrial and meet the homes needs in this area. The laundry person has been in post for several years and the laundry is being well managed. Residents’ individual clothing is appropriately cared for and items viewed were labelled. Protective clothing to include gloves and aprons was available. Staff were seen in the corridors with gloves on and when asked said that they were going to assist residents. The importance of using gloves only when necessary and being discreet about this was discussed. It is acknowledged that infection control was not being compromised. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to ensure that the needs of the residents can be met at all times. Systems for vetting and recruitment practices are in place, however shortfalls identified could place residents at risk. There is a training programme in place to provide staff with the skills and knowledge to care effectively for the residents. EVIDENCE: At the time of inspection the home was well staffed to meet the needs of the residents. Work is being done to improve the integration between the nursing and care staff so that everyone works together for the overall good of each resident. There were appropriate numbers of domestic and catering staff to meet the homes needs. The Manager Designate said that they were advertising for a maintenance person. The home is very well provided for with administration staff. The home has NVQ in care training for staff and the AQAA records that the majority of permanent care staff have attained NVQ level 2 or 3 in care. 5 sets of staff employment records were viewed. In 3 instances all the required documentation was in place. In 2 instances a second reference was not available to view. In 1 instance no CRB confirmation was available and in another no photograph was seen. At a further visit on 13/05/08 one reference St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 20 had been found and the other re-applied for. The CRB clearance had not yet been received and the Manager Designate said that the person was working under supervision. Should exceptional circumstances make it necessary to commence new staff prior to receipt of the CRB clearance then they must be chaperoned by a member of staff with CRB clearance, and the Manager Designate was clear on this. The Manager Designate said that she is reviewing the job descriptions to ensure that all staff have clear information regarding their roles and responsibilities. The home has an induction programme that meets the Skills for Care common induction standards. Staff spoken with said that they had received a full induction and had worked on a supernumerary basis for a week. There was evidence of training in other topics relevant to the diagnoses of the residents. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 21 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. The Manager Designate has the experience to manage the home, and is open and approachable. Systems for quality assurance must be put in place, in order to provide an ongoing process of management and practice review. Resident’s monies are being managed and securely stored. Shortfalls identified in the management of health & safety at the home could place residents living at the home, visitors and staff at risk. EVIDENCE: The Manager Designate is a registered nurse with several years experience of managing care homes for older people. She has completed the Registered Managers Award and in addition holds a Teaching and Assessing qualification and the NVQ Assessors Award. The Manager Designate said that she is up to date with all mandatory training and is also a moving & handling instructor. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 22 Staff spoken with commented that the Manager Designate was approachable and spends time working alongside staff to observe and improve practice by example. It was clear from speaking with the Manager Designate that she has a good knowledge of the work needed to bring the home up to a good standard throughout. The home does not have an annual development plan for quality assurance. A residents survey had been carried out and the results collated and displayed. Regulation 26 visits are carried out and these are now unannounced, to comply with the Regulation. Some audits to include care plans and medication are carried out, plus a full auditing system is to be introduced. Regular residents and relatives meetings take place and minutes are recorded. Staff meetings take place regularly and again minutes are recorded. We sampled records for residents’ personal monies held on their behalf by the home. The financial records viewed were being well maintained with receipts and records for income and expenditure available and up to date. Monies are securely stored. The majority of residents 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 residents with larger amounts of money have individual bank accounts that accrue interest. Maintenance and servicing records were sampled and those viewed were up to date. The Manager Designate stated that risk assessments for equipment and safe working practices were available and these are in the process of being reviewed and updated. The fire risk assessment had been updated for each unit in January 2008. Regular fire drills and tests were being undertaken. We viewed the staff training matrix and it was evident from this that not all staff had received training in health and safety topics to include moving and handling. The Manager Designate said that she was aware of this and training in these areas was being arranged. One member of staff was seen pushing a resident in a wheelchair with no footplates on, and the chair had been tipped up and the residents’ legs were dangling down. We intervened as a matter of health & safety and also lack of respect for the resident. Footplates were then found to use on the chair, however these were of different heights. It was noted that on other wheelchairs the footplates did not always appear to match, and action must be taken to ensure all footplates are suitable for the wheelchair and adjusted to suit the needs of the resident. The smoking arrangements for any residents that smoke is that their own individual bedrooms are used, or they go outside. The designated smoking rooms must be clearly identified and residents must only smoke in these areas. There is signage on some of the entrances stating ‘no smoking’ and the Manager Designate said that a made to measure notice has been ordered for the main entrance. St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 24 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 15 Requirement Input from the people living at 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 & 01/06/07 partially met Service user plans must be reviewed promptly following any changes and the information contained therein must be up to date and accurately reflect the needs of each individual and how these are to be met. Wound care documentation must be complete and up to date to accurately reflect the progress of each wound. Medicines must be recorded accurately when administered. If not administered the correct endorsement must be used. There must be a tightening up of recording dates when medicines are received into the home and when balances are carried forward from one cycle to the DS0000010956.V362083.R01.S.doc Timescale for action 01/08/08 2. OP7 15, 17 01/06/08 3. OP8 15, 17 01/06/08 4. OP9 13(2) 01/06/08 5. OP9 13(2) 01/06/08 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 Page 25 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13 (2) 9. OP10 12 10. OP12 16(m)(n) 11. OP18 13(6) 12. OP29 19(1) Schedule 2 24 13. OP33 next. This is to ensure that medicines do not run out and also provide evidence of accurate administration. The safe administration of warfarin must be reviewed in the home to ensure that warfarin is administered as instructed. Eye drops must have the date of opening written on the container and must not be used beyond the expiry date in order to prevent infection. Chloramphenicol eye drops must be kept in the fridge. The minimum and maximum temperature of all drug fridges must be recorded daily and the room temperature in the new unit. Staff must at all times behave in a manner that ensures that all residents are fully respected and treated in a dignified manner. All residents must be consulted regarding their social and leisure interests. This information must be recorded and used to inform the programme of activities. The activities programme must reflect each persons needs and be inclusive of all residents. All staff must have good knowledge and understanding of POVA procedures and be able to put these into practice to ensure that residents are safeguarded at all times. All required staff employment checks and records must be in place before staff work at the home in order to safeguard the residents. Effective systems for quality assurance must be in place so that shortfalls are identified promptly and action taken to address them, in order to protect DS0000010956.V362083.R01.S.doc 01/06/08 01/06/08 01/06/08 14/05/08 01/07/08 01/06/08 01/06/08 01/06/08 St David`s Nursing Home For Disabled Exservicemen and Women Version 5.2 Page 26 14. OP38 13(5), 18 15. OP38 23(2)c 16. OP38 13(4) residents. All staff must receive training in health & safety topics to include moving & handling at the required intervals to ensure residents are handled safely. Wheelchairs must have the correct footplates in place. Wheelchairs must be appropriate to meet the needs of each individual. The designated smoking areas in the home must be clearly identified and smoking must only take place in these areas in order to protect the health of residents, staff and visitors. 01/08/08 01/06/08 01/06/08 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 OP3 Good Practice Recommendations That the homes pre-admission assessment document be completed in full, regardless of the fact a copy of the Social Services assessment is available, to evidence that the home has carried out their own thorough assessment. That enteral feeds are included on the MAR That nurses are reminded to store liquid antibiotics according to the manufacturers instructions at all times. That the mealtimes be adhered to so that there are appropriate intervals between meals. It is strongly recommended that a redecoration and refurbishment programme be available to evidence the ongoing work that is taking place to maintain a good environmental standard. Gloves should not be worn by care and nursing staff except when needed during the carrying out of personal care. 2. 3. 4. 5. OP9 OP9 OP15 OP19 5. OP26 St David`s Nursing Home For Disabled Exservicemen and Women DS0000010956.V362083.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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