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Inspection on 28/06/06 for Stonecross Nursing Home

Also see our care home review for Stonecross Nursing Home for more information

This inspection was carried out on 28th June 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

The service has recently improved a lot, and these improvements are detailed in the next section. What the service now does well is listen to residents. The new manager has spent a lot of time talking with residents and families, on an individual basis, to find out what residents want. Residents had been consulted widely on menus, and were pleased to have had their preferences included. Residents had also been enabled to make clear their preferences on care matters and choices such as getting up and going to bed times. The atmosphere in the home was calm and friendly, with staff going about their duties in a cheerful manner.

What has improved since the last inspection?

Since the new manager came into post in February 2006, many improvements had been made at Stonecross. The planning and delivery of care had improved through the introduction of detailed care records and through discussion with residents about their care choices. Staff training had commenced with sessions having taken place for fire, moving and handling, infection control and adult protection (abuse). All grades of staff had been included in this training. The general standard of hygiene and upkeep of the building had improved, and full redecoration was underway. Staffing levels had increased through recruitment of new staff, and better deployment of those staff on duty through revised working practices. There had been a decrease in staff absence, and a positive change in the attitude of the staff group.

What the care home could do better:

There were still areas in which the home could improve. Requirements are made on the following items. Whilst the standard of care planning had improved greatly, there were pockets of inconsistent practice, which need to be improved. Again, although the management of medicines had improved greatly, there was further work to be done. The provision of activities and occupation for residents was limited and could be improved. The manager needs to apply for registration with the commission, and formal staff supervision needs to be completed. Good practice recommendations are made on the following. Further staff training is needed, particularly in food hygiene and NVQ. The home should appoint a member of staff to act as fire warden and attend the appropriate training course.

CARE HOMES FOR OLDER PEOPLE Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH Lead Inspector Jenny Donnelly Unannounced Inspection 28th June 2006 08:30 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 Stonecross Nursing Home DS0000006156.V299160.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. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonecross Nursing Home Address Milnthorpe Road Kendal Cumbria LA9 5HH 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) 01539 721673 01539 730752 Stonecross Care Limited Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 Brief Description of the Service: Stonecross is registered to offer general nursing care for up to 42 older people, although the home has reduced its bed numbers to 38, by changing double bedrooms into singles. Stonecross Care Ltd operate the home, and Mrs Sue Williams is the manager. The building is a three storey Victorian town house, set in the outskirts of Kendal. It has been adapted for its current use by the installation of a passenger lift, grab rails, and an extension to the rear. The home now has 34 single, and 2 double bedrooms. There is a large lawned garden to the rear of the home, but as this has a steep gradient, it is not easily accessible to service users, but is pleasant to look at. There are patio areas with seating and sunshades where service users can sit out. The weekly fees at the time of this site visit ranged from £425.00 to £525.00, plus any registered nursing care contribution entitlement from the primary care trust. The home had information for prospective residents and their families, in the form of a statement of purpose, service user guide and CSCI inspection reports. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspectors, Jenny Donnelly and Liz Kelley carried out an unannounced site visit on 28th June 2006, between 08.30 and 16.00 hours. The pharmacist inspector, Angela Branch, visited unannounced on 6th July 2006, and a brief overview of her findings is included in this report. The inspection comprised of a tour of the building, discussions with residents, visitors, staff and the manager. Meals and activities were observed, as was the general running of the day. Staff and residents’ files were inspected, along with maintenance and safety records. CSCI comment cards had been completed by some residents and visitors, and the manager had produced written information for the inspectors. The last full inspection took place in March 2006. Since then a random inspection to follow up on particular issues was carried out on 6th June 2006. What the service does well: What has improved since the last inspection? Since the new manager came into post in February 2006, many improvements had been made at Stonecross. The planning and delivery of care had improved through the introduction of detailed care records and through discussion with residents about their care choices. Staff training had commenced with sessions having taken place for fire, moving and handling, infection control and adult protection (abuse). All grades of staff had been included in this training. The general standard of hygiene and upkeep of the building had improved, and full redecoration was underway. Staffing levels had increased through recruitment of new staff, and better deployment of those staff on duty through revised working practices. There had been a decrease in staff absence, and a positive change in the attitude of the staff group. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 6 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. Stonecross Nursing Home DS0000006156.V299160.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 Stonecross Nursing Home DS0000006156.V299160.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): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. The home had good assessment procedures for ensuring the needs of newly admitted residents could be met. There was good information available for prospective residents and their families, detailing the services offered at Stonecross. EVIDENCE: The service had developed a statement of purpose, which sets out the aims and objectives of the home, and includes a resident guide, which provides basic information about the service. The guide was made available to residents in a standard format. The files of two residents new to the home were inspected. These showed that new residents had a full assessment carried out by one of the homes’ nurses, prior to being offered a place. Copies of social services assessments were also on file where relevant. Prospective residents were welcome to visit Stonecross for a look around, if they were able to. For many people admitted from hospital this was not always possible. Following this needs assessment the manager confirmed whether the home could meet the needs of the individual. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 9 Each resident was provided with a statement of terms and conditions prior to moving to the home. These set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. Stonecross Nursing Home DS0000006156.V299160.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 and 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The home on the whole provides a good standard of personal and health care for residents. This improvement has been due to recent changes in practice, which have yet to become fully embedded. The manager had focussed on medicines handling since the previous pharmacy inspection and there was much improvement in the quality of the service. EVIDENCE: Since the appointment of the new manager in February 2006, much work had been done to improve the planning and delivery of personal and healthcare needs. Each registered nurse had taken a specific area of interest and responsibility within the home. These included continence care, management of medicines, wound care, and respiratory disease. A new care planning system had been devised, and each resident had been allocated a “named nurse” and “key worker”. Several care plans were examined in detail. The assessments and care plans were of a good quality and contained concise and clear instructions for staff to deliver consistent care and monitoring of healthcare needs. The plans were divided into short-term Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 11 and long-term needs, and there were good details on life history, lifestyle and interests. Risk assessments were in place for safe moving and handling, skin integrity, risk of falls and nutritional needs. There were separate night time assessments, with good detail of sleep patterns and instructions for staff on night care needs, and preferences for when to get up and go to bed. The records on the management of wound care were much improved from previous visits. Staff were able to demonstrate that specialist advice had been sought and followed where necessary, to promote wound healing. In one file the assessments had not been completed in full, and information was missing. Consequently some of this person’s care and health needs were not being met. For example there were no instructions or provision about mouth care, and the persons’ mouth was very dry. There was a water jug in the bedroom, even though this person could not take anything orally. When interviewed care staff didn’t know about any plans for mouth care. While the majority of care plans have improved with evidence of monitoring by qualified staff and the manager, some pockets of inconsistent practice remained. The manager was aware that further work was needed to improve the planning and delivery of care. Staff were aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranged for residents to enjoy the privacy of their own rooms. Residents were happy with the way that staff delivered their care and respected their dignity. The manager had focussed on medicines handling since the previous pharmacy inspection and there was much improvement in the quality of the service. Storage was much improved with less stock-piling of medicines. Recording of receipt, administration and disposal was improved although some improvement is still required. The system for ordering of medicines must be improved to ensure that medicines do not run out so that residents have the medicines they need at the time they need them. The pharmacist inspector made a number of requirements on the management of medicines. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The home provided some in house acitivtes each week, although there were limited opportunites to go out. There were good links with the local community and visiting by friends and family was encouraged. The provision of meals was very good, and residents had recently contributed to planning new menus. Residents’ preferences about their daily routines were taken into account by staff. EVIDENCE: Further to a previous requirement, there was more evidence during this visit that residents were making choices in areas such as meals, activities and times of getting up. Breakfast was seen being served from 08.30 onwards, with residents each having the breakfast items they had requested. The manager had introduced a new routine for the morning, which gave care staff and nurses clear areas of responsibility. This was working well and the morning routine was judged to be more structured and efficient than on previous visits. The atmosphere was much calmer and residents’ needs were being well met. A relative and resident spoken to in private said they thought the carers were very good, the resident said she was given free reign to do as she pleases and this was her home, staff frequently popped in to keep her Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 13 company. She had been allowed to choose between a number of bedrooms that were available. The home employed an Activities Organiser for 15 hours per week, and a structured in house programme was arranged. The manager was aware of the necessity to make activities more individual and to consult more with residents. Residents and visitors commented that the lack of a mini bus for outings restricted the social activities programme. Residents said they had been enjoying a programme of summer concerts with outside singers and entertainers coming into the home. One afternoon per week was set aside for a film, and visitors and relatives were invited to join in. The design of the home provided seating areas within the communal areas of the home where residents could entertain their visitors, in addition to the privacy of their own room. It was clear that the home encouraged individuals and groups from the community to visit. Family and friends felt welcome and knew they could visit at any time. The chef had been asked by the manager to help in drawing up new menus, and all residents had been consulted about this. The new menu coming in at the beginning of next month will include two proper options of main meal at lunchtime. Residents had asked for fewer stews and more other types of meat such as chops, and the new menus reflected this. The main meal on the day was hotpot and this looked nutritious and appetising. It was served with four types of vegetables. Two different puddings were available, lemon meringue pie or strawberries and ice cream. Meal times were orderly and staff were giving appropriate help to residents in a dignified and friendly manner. Care staff were sensitive to the needs of those people who needed assistance with feeding. Residents enjoyed the flexibility of meal arrangements and enjoyed being able to eat in their own room if they wished. Regular drinks were available and staff would always make a cup of tea at any time when asked. Staff supported residents who needed help in financial matters, and worked to a clear robust policy that protected the residents from financial abuse and clearly directed staff in their practice. The home had a robust system of invoicing residents for any additional cost such as hairdressing and the head office of the organisation handled this, with printed receipts given. The home was able to offer residents information and telephone numbers for contacting independent people who will act as advocates on their behalf. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents and visitors understood how to make complaints about the service, and those complaints made, had been fully investigated and responded to in a timely and satisfactory manner. The process for ensuring residents were protected from any form of abuse, had improved greatly through recent staff training and closer supervision of care practices. EVIDENCE: The home had a complaints procedure on display. Since the new manager came into post, three complaints had been made. The complaint records showed that all three had been investigated and responded to by the manager in timely and appropriate manner. Some of the issues raised had taken place prior to the manager coming into post, and there was evidence that resident satisfaction had increased significantly since then. The residents and visitors spoken to said, they were aware of how to make complaints, and felt the manager would address any concerns they might have. Further to previous requirements, staff training on the protection of vulnerable adults (abuse) had begun. The training consisted of watching two DVD’s, discussing their content and completing written questionnaires. Eleven staff had attended this session, and another three sessions were planned, to include all staff members. The home had policies and procedures for staff on whistle blowing, managing aggression by residents, and what to do in the event of a suspected abuse. These documents were clear and included the local multiagency good practice guidance. Staff confirmed their attendance at the Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 15 training session, saying the DVD’s had been disturbing to watch and had provoked much staff discussion on their day-to-day care practices. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 16 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, 24 and 26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents were living in a well maintained and clean home, which was being decorated. The infection control procedures had improved following recent staff training. The standard of overall hygiene was good. EVIDENCE: There was evidence of significant investment in the fabric of the building and in providing new equipment. The dining room had been completely refurbished, with new flooring, furniture and decoration. A second dining area had been created in the conservatory, and residents were very pleased with both areas. Also on the ground floor, three bedrooms, and one bathroom had been fully refurbished to a high standard. This work was set to progress throughout the entire building. One bedroom at a time was being worked on, and residents were being asked to move out of their room while this work was undertaken. No resident had objected to this so far, and they had been consulted on colours and fabrics for their room. Some new equipment had been purchased including a bedpan washer for the sluice room. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 17 The home was generally well-maintained and provided aids and equipment to meet the care needs of the residents. It was a very pleasant, safe place to live with rooms that met or exceeded the minimum space requirements. Some bedrooms had en-suite facilities. The home was well lit, clean, tidy and fresh smelling all day, even at 08.30 when residents were getting up and beds were being stripped. The management had a good infection control policy. They sought advice from external infection control specialists, and encouraged staff to work to the homes’ policy to reduce the risk of infection. There were good procedures for the management of laundry. Two new commercial washing machines were purchased last year, and the laundry had sufficient hanging space for ironed clothes and labelled boxes for residents’ smaller items. The laundry and domestic staff had attended infection control training along with the care staff. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents were supported by a committed and caring staff group. Staffing levels were stable and enabled the home to provide consistent care to residents. Recruitment procedures were sound, and served to protect residents from having unsuitable staff working in the home. Staff training had started to take place, and made a positive impact on residents daily lives, although there were areas yet to be covered. EVIDENCE: On arriving at Stonecross at 08.30 hours, there were 7 care staff and 2 nurses on duty. This reduced to 5 carers in the afternoon and 3 at night, with one registered nurse. Recent changes in staff deployment had led to more efficient and timely care being given to residents’. The atmosphere was calmer as a result of this, and residents benefited from staff being less frantic. The introduction of planned staff break times also helped this. Staff reported that the staffing levels were better, sick leave had reduced and they were less exhausted at the end of shifts. Several said, “It was a pleasure to come to work now with the new manager and the changes she had brought in”. The homes’ recruitment practice was examined. For those staff recruited by the new manager, the information was to a good standard, with records kept of identity, application forms and two references. The manager also asked for copies of any relevant training and certificates. Enhanced Criminal Records Bureau disclosures had been requested on all staff including cooks and Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 19 domestic staff. These are all good practices and ensure that a carefully selected and vetted staff team supports residents’. The manger was able to confirm that nursing staff had active registrations with the Nursing and Midwifery Council. The new manager had improved training opportunities for staff. She had identified 3 staff to be put forward for an NVQ, as levels of NVQ trained staff were low in the home. Only 12 of care staff had an NVQ, against the 50 recommended. Training courses attended recently included safe use and handling of chemicals, fire safety, fire drills, protection of vulnerable adults (abuse), infection control and safe moving and handling. Good practice in this area was identified through the manager’s inclusion of ancillary staff on all the above training. There was a need to update food hygiene training for kitchen staff, which had become out of date. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 20 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The management arrangements in the home were good, and the friendly open approach encouraged residents, visitors and staff to contribute to the improvement process. Staff training and better risk monitoring had improved the level of health and safety protection for residents and staff. The manager was undertaking quality assurance work with residents, although this had not been formalised. EVIDENCE: The manager had been in post since February and had the necessary forms to apply for registration with the commission. This application needs to be completed. The owner and registered provider of Stonecross had made an unannounced visit over weekend, and staff, residents and visitors were spoken to and asked their experience of Stonecross. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 21 The home did not manage any residents’ finances. All fees and any additional costs were invoiced by the homes’ head office. There was a secure safe for the storage of items of value if needed. Health and safety matters were up to date, although the home had no trained fire warden; the manager had been discussing the need for this role with staff. Risk assessments were in place for water temperatures, legionella, surface temperatures and kitchen equipment. The fire log was up to date, showing regular checks on extinguishers, alarms, emergency lighting, and fire drills. There was no formal quality assurance system in place, although the manager had continued to communicate daily with residents and visitors, and to take on board their comments and suggestions. Staff meetings had been held monthly, and an open meeting for residents and relatives took place in April, with another one planned for July. The quality assurance system needs to be formalised. No formal staff supervision had taken place recently. Staff confirmed that the previous deputy manager had carried out some supervision sessions, but had taken these records away with him. The new manager has operated a very “hands on” style of management since being appointed, and she gives direct supervision to staff as they carry out their care duties. This now needs to be formalised into written one to one supervision. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 22 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 23 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 Each resident must have a care plan that details their health and social care needs and this should be updated as required and reviewed on a regular basis. (This was to have been met by 31/04/06) The home must consult with residents to ensure a varied and suitable programme of activities and events is provided. The home must employ a suitable qualified and competent manager, who is registered with CSCI. An effective quality assurance and monitoring system must be implemented. (This was not to have been met until 30/09/09) Care staff must receive regular formal supervision. Records The registered person must ensure that medicine DS0000006156.V299160.R01.S.doc Timescale for action 30/09/06 2. OP12 16 30/09/06 3. OP31 9 30/09/06 4. OP33 24 30/09/06 5. 6. OP36 OP9 18 13(2) 30/09/06 14/08/06 Stonecross Nursing Home Version 5.2 Page 24 administration records are Complete for all administration signatures Complete for reasons for nonadministration that must be documented Signed, checked and dated where these are hand-written (This was to have been met by 30/06/06) 7. OP9 13(2) Administration Ordering procedures must be reviewed to prevent excess stock, to ensure that there is a continuous supply of medications and to prevent out-of-date medicines. (This was to have been met by 01/08/05 and again by 30/06/06) Storage Medicines with limited expiry after opening must be marked with the date of opening. (This was to have been met by 01/08/05 and again at 30/06/06) Administration Medicines prescribed for one person must not be administered to other residents. (This was to have been met by 01/08/05 and again at 30/06/06) Storage The registered person must ensure that medicines are not left unattended if they cannot be secured. Records The registered person must ensure that all medicines leaving the service are recorded. DS0000006156.V299160.R01.S.doc 14/08/06 8. OP9 13(2) 14/08/06 9. OP9 13(2) 14/08/06 10. OP9 13(2) 14/08/06 11. OP9 13(2) 14/08/06 Stonecross Nursing Home Version 5.2 Page 25 12. OP9 15(2)(b); 13(1)(b) Administration The registered person must ensure that care plans are detailed and up-to-date for the management of medicines administration through stomach tubes, and the management of low and high blood sugar levels. Medicines must be made available if prescribed and usage must be detailed in the care plan. 14/08/06 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. 2. 3. Refer to Standard OP28 OP30 OP38 Good Practice Recommendations The home should work towards 50 of care staff having an NVQ in care. Kitchen staff should have up to date food hygiene certificates. The home should have a suitably trained fire warden on the staff group. Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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. Extracts may not be used or reproduced without the express permission of CSCI Stonecross Nursing Home DS0000006156.V299160.R01.S.doc Version 5.2 Page 27 - 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. 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