This inspection was carried out on 9th July 2009.
CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: St David`s Nursing Home For Disabled Ex-servicemen and Women Castlebar Hill Ealing London W5 1TE one star adequate service 03/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Rekha Bhardwa Date: 0 9 0 7 2 0 0 9 Information about the care home
Name of care home: Address: St David`s Nursing Home For Disabled Exservicemen and Women Castlebar Hill Ealing London W5 1TE 02089975121 02089972447 stdavids.office@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St David`s Nursing Home for the Disabled Ex-Servicemen and Women Name of registered manager (if applicable) Ms Jane Mcauley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Conditions of registration: The maximum number of service users who can be accommodated is: 68 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 Physical Disability - Code PD The seven beds in the John Poland Rehabilitation Unit are to be used for service users requiring intermediate care, and not for permanenet placement.
Care Homes for Older People Page 2 of 10 care home 68 Over 65 68 0 0 68 Date of last inspection Brief description of the care home 0 3 0 3 2 0 0 9 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. The fees range from £741 to £1,200 per week. Care Homes for Older People Page 3 of 10 What we found:
We inspected the safe handling of medication in Lord Mark unit, to check progress made following concerns raised at an inspection in March 2009. We looked at the recording of receipts,administration and disposal and audited several samples against the stock held. We checked the controlled drugs and noted that they were stored securely and balances of stock were correct. We noticed that warfarin was managed safely in Lord Mark Unit with blood results kept with the MAR (Medication Administration Records) for reference. Anticoagulant guidance was kept in the clinical room and when we counted the tablets and checked the recording we noted that it was being given accurately. We looked at all the residents MAR. We noticed that there was one too many capsules of an antibiotic left for one resident which indicated that one dose had not been given but signed as given.There was a heart tablet left in the monitored dosage system for a resident and it was signed as given. For another resident one dose of a steroid was not recorded as administered but signed as such. We noticed gaps on the MAR for anticonvulsant, antibiotic and antidepressant liquids and did not know whether the doses had been administered. There were gaps for calcium but the tablet had been given.There were two other discrepancies in audit and inconsistencies in recording accurately when medicines were not given. Other audits was accurate and receipts and disposal were all well recorded. We looked at the fridge and noted that it needed defrosting and the maximum temperature was very high.The manager had a new thermometer on order as the current one was too complex to use.There were protocols in place to manage residents being fed by tube and for those who sometimes experienced seizures. Care plans for the former were not always updated when regimens changed and we were concerned why a feeding tube recently became blocked. We looked at the in house audits of medication which were requested to be carried out regularly following the inspection in March 2009.There was one thorough audit in March and very simplistic checks in April and May. No audits were available for inspection in June. We also asked to see the audits for the other units and there was not one available for the main unit either. We were shown the records for administration of warfarin to 2 residents in the main unit. One resident was due a prescribed dose of 1.5mg on Saturday 20th June and was only given 1mg. Because of the repeated lack of evidence of robust auditing and the error in administration of warfarin we identified, we issued a code B notice for referral to the regional enforcement team for further action to improve the safe handling of medication. The Commission is consequently taking enforcement action to secure compliance and achieve better outcomes for service users. A Statutory Enforcement Notice is being sent that provides greater details of the medication shortfalls. We inspected a sample of staff records at the home, to check progress made following concerns raised at an inspection in March 2009. We sampled three sets of staff employment records. Overall with the exception of one photograph the required information was available. We viewed this file and it was clear that the administrator had
Care Homes for Older People Page 4 of 10 identified this shortfall and was addressing this with the staff member concerned. We recommended some changes to the application form to enable staff to provide details and dates of their work history. We noted that for one member of staff a copy of their Nursing and Midwifery Council registration card was available on the file. It was not clear whether their registration had been verified by the home. We spoke with the Manager and she said that she would check this. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 3 14 All residents must have a full 27/03/2009 pre-admission assessment undertaken prior to moving into the home. To ensure that the home is able to meet the residents assessed needs. 2 7 17 The care planning system in 27/03/2009 place must be reviewed to ensure a care plan has been completed for each identified need. Care plans must be reviewed regularly and following any changes to a residents condition. In order that each persons needs are clearly identified and being met. 3 8 13 Prior to bedrails being used, a full assessment of suitability must be carried out and written consent for their use must be obtained. To ensure the safety of the resident. 27/03/2009 4 8 17 All assessments to include moving and handling, nutrition, pressure sore, risk of falls and continence must be complete and up to date. 27/03/2009 Care Homes for Older People Page 6 of 10 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action To accurately reflect each residents current condition. 5 11 12 The wishes of residents and 03/04/2009 their representatives must be clearly recorded in respect of their care during their final days. This information must be updated should their wishes change. This is in order to ensure their wishes are respected and adhered to. 6 33 24 Systems for quality 31/03/2009 assurance must be further developed to ensure that shortfalls are promptly identified and addressed.This must include having a robust system for auditing all aspects of the home. To protect the residents living at the home. 7 37 17 All records required under 31/03/2009 Schedule 17 of the Care Homes Regulations 2001 must contain clear, up to date and accurate information and there must be in place effective systems for review and updating so that the information is always current. This is to ensure that residents, staff and visitors are safeguarded. Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 To make arrangements to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. This is a Statutory Requirement Notice. 03/08/2009 2 9 13 To make sure there are robust auditing processes in place, to ensure the safe handling of medication and that they are available for inspection. This is a Statutory Requirement Notice. 03/08/2009 3 9 13 To make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is a Statutory Requirement Notice. 03/08/2009 4 9 13 To make arrangements to 03/08/2009
Page 8 of 10 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record; and that the person administering the medication completes the Medication Administration Record in respect of each individual service user at the time of administration. This is a Statutory Requirement Notice. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
