Inspection on 11/07/06 for Stretton Nursing Home

This inspection was carried out on 11th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Stretton Nursing Home 12/02/07

Stretton Nursing Home 13/12/05

Stretton Nursing Home 11/10/05

Stretton Nursing Home 30/06/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stretton Nursing Home Stretton Nursing Home Manor Fields Burghill Hereford Herefordshire HR4 7RR Lead Inspector Sandra J Bromige Unannounced Inspection 11th July 2006 10:50 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 Stretton Nursing Home DS0000062332.V307212.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. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stretton Nursing Home Address Stretton Nursing Home Manor Fields Burghill Hereford Herefordshire HR4 7RR 01432 761611 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) Stretton Care Ltd Care Home 50 Category(ies) of Dementia (50), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (50), Physical disability (50), Physical disability over 65 years of age (50), Terminally ill (50) Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents` with care needs associated with dementia illnesses may only be admitted to the Home where these are secondary to the person’s care needs. 27th March 2006 Date of last inspection Brief Description of the Service: Stretton Nursing Home provides nursing care to 50 people. A range of registration categories are in place allowing a service to be provided to people with physical care needs, those arising from dementia illnesses and people who have terminal illness. Residents’ whose care needs are associated with a dementia illness are only able to be admitted to the home where the dementia care needs are secondary to any physical disability and care they may require. The accommodation is provided in a single storey building which is situated in a peaceful rural location just outside Hereford. The building is operated as two wings with independent staff teams and separate communal rooms. The accommodation is within shared and single rooms. The home provides a range of equipment for residents’ with physical disabilities. The current scale of fees are from £470.20 - £559.07 per week. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 11th & 20th July 2006 over 12.5 hours. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission, any concerns, complaints or allegations, written feedback from residents & relatives and a visit to the home. During the first visit to the home the Inspector found evidence of significant concerns relating to the management & administration of medication. Due to this the Pharmacy Inspector was asked to carry out an in-depth inspection of the arrangements. On the 20th July 2006, the reason for this visit was to carry out an inspection by a CSCI pharmacist inspector of the arrangements for handling of medicines (Standard 9 of The National Minimum Standards – Care Homes for Older People). This forms part of the key inspection of the home and was at the request of the lead inspector following concerns about medicines at a recent earlier visit. Medicine stocks and storage arrangements, Medication Administration Record (MAR) charts and other records and procedures relating to medication were looked at. The deputy manager and four other members of staff were spoken to. The inspection took place on a Thursday over a sevenhour period. Issues of serious concern were found at this inspection and were detailed in a letter for urgent action sent to the provider on 24th July 2006. This included requirements for action by 31st July 2006. This information is included in this report together with the rest of the findings. The Deputy Matron wrote to CSCI (received 27th July 2006) indicating the action put in place to address these concerns. The Commission has received two complaints since the last inspection in March 2006. Both of these complaints were referred to the owner for investigation. One of the complaints was relating to the poor provision of health & personal care & management of a resident’s care whilst on respite in the home. It was alleged that the resident developed a bad pressure sore whilst staying at the home. Due to these allegations of neglect a referral was made by the Commission to adult protection. The care of this resident was investigated by the owner with the involvement of the Commission and other multi-agencies who purchase care from the home. The allegation was upheld and the owner was required to provide an action plan to ensure that a reoccurrence of this nature would not be repeated. An action plan was provided and staff have Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 6 undertaken recent training about the prevention and management of pressure sores and the home have purchased more specialist equipment for pressure relief. This visit to the home has identified weaknesses in the provision of healthcare that relate to the concerns raised within the above complaint, such as skin care, pre-admission assessment particularly identification of current prescribed medication and the monitoring and management of elimination. Please refer to ‘choice’ & ‘heath & personal care’ sections of this report. Requirements relating to healthcare of residents that have been made in previous reports have not been met. Failure of the home to meet these requirements may result in enforcement action being taken by the Commission. What the service does well: The home provides written information for prospective residents in the format of a Service User guide so that it can help residents and their relatives to make an informed decision about moving into the home. The manager (designate) visits residents prior to admission either in their home or hospital. Residents are able to visit the home before making a decision to move in. A contract detailing the terms & conditions of the home and a breakdown in fees are issued to residents. Written feedback from 5 visiting professionals to the home has stated that they are satisfied with the overall care provided to the residents in the home. The principles of privacy and respect towards residents are promoted by the staff in the home. A varied programme of activities is offered to provided stimulation and interest for the people living in the home. Visitors to the home are made welcome by the staff. A choice of a varied menu is provided at mealtimes. The meals are nutritious and well balanced. Residents are able to eat their meals in the dining room or in the privacy of their bedroom. The home is situated in a rural setting, in its own extensive grounds and is surrounded by beautiful countryside and wildlife. The building is single storey throughout and accommodation is offered in single and shared bedrooms. A range of equipment is provided by the home for people with physical disabilities. Residents’ rooms are personalised and they are able to bring in some of their own possessions. The gardens are accessible to mobile residents and residents with a physical disability who need to use a wheelchair. The home is clean and generally fresh. Residents’ clothes are nicely laundered. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 7 The staff team come from a multi-cultural background and are a mixture of male & female care staff. Residents are able to have a choice of gender of carer. A programme for induction and training of staff is in place. What has improved since the last inspection? What they could do better: A copy of the revised Statement of Purpose & Service User guide must be sent to the Commission. Care records and the homes management & administration of medication must be improved as this is leading to poor outcomes for some people living in the home and also placing them at risk. Trained staff must have refresher training and assessments of competence for handling medicines. Fresh drinks must be available in residents bedrooms and communal areas every day and staff must ensure that residents who need assistance to drink are given that assistance at all times. Complaints received by the home must be fully recorded in the homes records showing the action that has been taken by the home and the outcome of the complaint. Further training is required for safeguarding adults. The owner must undertake a review of the conditions of the premises & its facilities and submit a report showing the outcome and any action plan of this review to the Commission. Stained and soiled carpets must be cleaned and/or replaced. Residents must have access to a call bells at all times to enable them to call for assistance. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 8 The staffing levels must be reviewed to take into account the dependency of the people living in the home. A copy of the outcome of this review must be sent to the Commission. Prior to staff being employed any gaps in their employment history must be explored for the protection of the people living in the home. The owner must establish a system for measuring and monitoring the quality of the service provided. The owner monthly visits to the home must be unannounced. The owner must not pay money belonging to any of the residents into the business account unless the entirety of the money is for payment for accommodation & services provided by the home. Money managed by the owner on behalf of a resident must be paid into a separate bank account in the resident’s name. Interest on any money that has been held by the home within their accounts should be applied to that money. Two staff should sign all entries for receipt or expenditure of monies for residents held by the home. All care staff must receive formal supervision. Staff must be provided with training in relation to fire and moving & handling. A first aider must be on duty at all times of the day and night in the home. A copy of a current 5 yr electrical installation certificate and gas servicing certificate must be sent to the Commission. All chemicals in use in the home must be locked away when not in use by staff. All accidents to residents’ must be recorded. Individual social care plans should be further developed in consultation with the residents. Further though needs to be given to how stimulation & social contact can be provided on a 1:1 basis for the more frail residents’ at times other than when the staff are giving personal care. Desserts should not be served at the same time as the main course. The home should keep written evidence of staff interviews and these notes should be signed. 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. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 9 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 Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 10 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, & 3 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. People who use this service are given information about the home in order to make an informed decision about whether the service is right for them. Residents are assessed by the home prior to admission to ensure that they are able to meet the residents care needs. The home are not seeking confirmation from the General Practitioner of the residents current prescribed medication prior to or on the day of admission, to ensure that it is being taken as prescribed. EVIDENCE: A monthly visit report by the owner for June 2006 reports that a “new Statement of Purpose & Service User guide is in place”, although a copy has not been received by the Commission. A copy was requested to be sent to the Commission on the day of the inspection, but has not been received. Contracts were available for both residents, although one resident only had a local authority contract on file and no terms & conditions from the home. This had been rectified by the home by the second visit as a contract had been Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 11 issued for that resident. Written information from 13 residents confirmed that they had all received enough information about the home before they moved in. 10 residents said they had contracts, 1 said they were not sure and 1 said they did not have a contract and 1 relative said ”contract received not signed because don’t agree with contents”. The manager (designate) had visited a prospective resident at home and had undertaken a thorough assessment of their care needs with the exception of the resident’s medication. There was no written evidence to show that the manager (designate) had contacted the General Practitioner prior to or upon admission of the resident to the home to seek confirmation of the medication prescribed by the General Practitioner. The resident had visited the home prior to admission. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality outcome in this area is poor. This judgement has been made using available evidence including a visit to the service. The lack of written information within the care plans relating to identifying, planning, delivery & evaluation of the effectiveness of the prescribed care means that all residents cannot be sure that their health & personal care needs will be fully met. Poor outcomes of care have been evidenced during this visit which place residents at risk. The arrangements in place for the handling and recording of medicines are not sufficient so this puts the health and wellbeing of residents at risk. There is poor stock control of medicines and medicine records are not complete leading to poor health outcomes for residents. The principles of respect, privacy & dignity are put into practice. EVIDENCE: 3 care records were looked at in detail. A resident had been admitted to the home who is diabetic, with severe circulatory problems to the extremities and severe pain. The care records showed good evidence of seeking advice from the skin specialist nurse and referral to the diabetic foot chiropodist and Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 13 regular visits from the General Practitioner. The plan of care for the management of the wounds to the toes was good with photographic evidence of the condition to enable them to be reviewed for progress/decline more easily. This is good practice. The plan of care for the management of the resident’s diabetes was poor. There was no mention of any skin or nail care for this resident or how they would be monitoring the resident’s blood sugar levels. The plan of care stated, “give diabetic diet”, but there were no other specific instructions/guidance for staff. The resident suffered with chest pain and there was no plan of care for the management of this condition. The resident had an entry dated 9 days after admission of a “black heel”, this was not recorded on the pre-admission assessment. The manager (designate) was asked to investigate when this developed and to inform the Commission. No information has been received at the time of writing this report, which is 2 weeks after the visit to the home. The wound care plan for the heel states an action of “check alternate days”, there is no evidence in the plan of care of checking this wound alternate days between 5 identified sets of dates ranging of gaps between 4-10 days duration. The resident developed a wound on their arm and a plan of care was written on 27/05/06 stating “observe daily- change dressing alternate days”. There were no further entries in the care plan. A care plan for the management of pain has evidence that the home have run out of stock of a medicine for pain relief on an identified date. The resident had a fall outside and cut their elbow, there is no evidence of an accident form being completed, no wound care plan or any evidence of checking or any further treatment to the wound. The continence assessment was not completed. The plan of care for elimination of bowels had clear instructions that the resident’s bowels should be monitored each day, although there were only 3 entries on the bowel chart, the last entry being the 31st May 2006. There was no evidence to show that the care plan had been discussed with the resident. The care plan showed that the resident had been consulted about their choice of gender of carer. A social & spiritual care plan was in place. The religious beliefs and wishes of the resident had been discussed and actioned. Support for the resident had been requested from the local hospice and McMillan nurses. The second care record had a mobility care plan that had not been reviewed since 29/03/06. The skin risk assessment had been regularly reviewed and showed that the resident was at “very high risk” of developing sore skin due to pressure from sitting or lying. The resident was sitting on a ‘high risk’ pressure-relieving cushion, although the overlay mattress for their bed prescribed by the home was not of a sufficient quality to protect the resident from developing pressure sores. This was brought to the attention of the manager (designate) who replaced the mattress with a ‘high risk’ air mattress. The nutritional risk assessment had not been reviewed since the 01/05/06 and it contained evidence that the resident had lost 4.4 kg since January 2006, but there was no evidence to show that the home had done anything about this weight loss. The continence assessment had not been reviewed since Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 14 25/02/06. The hygiene, elimination & social care plan had not been reviewed since January 2006. The third care record was a resident with Parkinson’s Disease. The specialist nurse for Parkinson’s Disease had recently reviewed the resident at the request of the home. Medication changes had been prescribed and the home had made the appropriate changes to the resident’s Medication Administration Records. A care plan was in place for the management of the Parkinson’s Disease, giving clear instructions to “ensure **** has medication on time”. The Medication Administration Records show 12 gaps between 2nd June – 6th July 2006 and only one entry giving a reason for the medication not being given. The home were also out of stock of the medication one day in March & April 2006. The resident has a wound to their heel and it is not being managed according to the plan of care. There were 2 further wound care plans seen relating to the leg & bottom, but the Inspector was unable to understand the current status of the wounds from the care plans. The trained nurse was asked and stated that the leg wound was now healed and she would have to check the bottom later that evening. The home are recording the resident’s weight each month and a nutritional risk assessment shows that the resident is “very high risk nutritionally”. There is evidence that the resident has lost 4.2 kg over the last 6 months but no evidence that this resident have been referred to a dietician as stated within the homes instructions on their risk assessment record. The continence assessment had not been reviewed since 19/02/05 and the night care plan since 25/04/06. There was information showing that their had been a recent change of pressure relieving mattress and that the home were using ‘thick & easy’ as the resident has swallowing problems and is awaiting further tests. There was a good social history for this resident. The Medication Administration Records for all 3 residents were inspected. Overall they contained evidence of poor management of administration of medication. Medication was not being administered as prescribed by the Doctor in particular for pain management, heart conditions, diabetes, and Parkinson’s Disease for those residents care records seen during this visit. One of these resident’s had recently been admitted to hospital due to chest pain and management of pain and another was being reviewed by a specialist nurse due to their condition deteriorating. The poor management of these residents medication by the home may have contributed to the need for these reviews & admission to hospital. Due to these findings the Pharmacy Inspector was asked to accompany the Lead Inspector on the second day of the visit to conduct a more in-depth Pharmacy Inspection. For one resident records indicate two of three antibiotic courses were previously not given correctly. Unexplained gaps in medicine administration records are consistent findings in the records. Medicine records for a sample of six residents showed a number of gaps so it is not known if they received medicines as the doctor prescribed Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 15 or if the records were not completed accurately. In addition for five of these residents, one or more medicines have not been given, as there has been no stock for periods of up to ten days. All medicines are important for the health and wellbeing of residents but some of these medicines are particularly important. Not having these medicines would have resulted in poor health outcomes. The name of one medicine written on the record of one resident was different to the medicine that was in use in the trolley. Two residents had particular needs for treatment with medicines that were prescribed to use ‘as required’. There were no plans describing how to use the medicines for their benefit. Some counts of medicines in stock agreed with the records of medicines given, but others did not. This could indicate inaccurate records or medicines not given to residents correctly. Two products for a deceased resident were found in a drawer with the name crossed through. Some medicines no longer prescribed were found with the stock medicines. There were a lot of medicines (including controlled drugs) awaiting destruction. Arrangements are in place for correct disposal of medicines following changes last year but a more frequent collection of unwanted medicines is needed. A new unopened bottle of eye drops was not stored in the fridge as it should be. Staff seemed unaware of the correct storage. This was corrected at once. A particular cream was found beyond the ‘use by’ date indicated by the manufacturer once the tubs or tubes are opened to use. Records indicated checks of controlled medicines most days. There was an incorrect stock balance on page 47 in the record book on Woodlands. This is probably due to a missed entry for a dose given. Suitable locked storage is provided for medicines. Temperature records indicate before the recent hot spell the temperatures are often 25-26°C and have been hotter than this during the summer. 25°C is the maximum safe temperature to store most medicines. Some blank prescription forms belonging to a particular doctor were locked in one medicine cupboard. These should not be in the home. Frusemide is still written on medicine charts rather than the new name furosemide. This can be confusing to staff. There is a medicine policy on one trolley but was due for review in May 2006. Only four staff have signed as read. The signature list of staff is not up to date - some staff on duty on the day of the inspection were not included so it is not always possible to identify who has signed the medicine records. On the morning of the inspection the 9am medicine round was completed at 11.45am. One resident received a 9am dose of medicine at 11.30am and the next dose was due at 1pm. Correct dose intervals for this medicine are particularly important for a good control of symptoms. There were two staff short due to illness but staff described a problem with finishing breakfast before giving out the medicines. The pharmacy provides printed information to help with the reordering of medicines and these are kept as part of the home records. In recent months Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 16 there has been a change to a main monthly order rather than weekly as previously. Arrangements are needed so that doctors’ prescriptions (FP10) are checked in the home before they are sent to pharmacy for dispensing. The wrong blood lancing devices are used although each resident who needs such a test does have their own device pen. These still pose a risk of cross contamination. Some skin creams are kept by basins in bedrooms along with other cosmetic products. This needs reviewing to make sure that this is safe for all residents. No resident looks after their own medicines at the moment but staff were aware of proper arrangements if they wanted to. One resident spoken to was happy for staff to look after and give medicines and said they were given when needed. Registered nurses deal with all matters relating to medicines. The training facilitator said he is planning training assessments of nurses for medication. The evidence from this inspection is that refresher training and assessments are needed in all aspects of the handling of medicines so as not to place residents at risk from poor practice. There was no evidence of regular audits of the management of medicines. This would help to identify and correct the sort of issues identified at this inspection. Comments in surveys from 10 residents all report that they “usually” receive the care and support they need. Comments in surveys from 9 relatives report that overall they are satisfied with the care and 3 relatives reported they are “generally”, “usually” and “reasonably” satisfied with the care. Relatives spoken with during the visits said its “pretty good here”; another relative stated that they did not have any concerns regarding the care of the resident. A comment was made that “drinks are left & not given which have been brought to the staffs notice on numerous occasions”. During the visit the Inspector observed that one resident’s tea & beaker of squash had been left out of reach and the tea was nearly cold. This was brought to the attention of the trained nurse at the time of the inspection. Another resident was sat in their room and there was not a drink within reach. Two other residents’ were seen with no water jug in their bedroom. Other residents were seen with jugs of water/squash and a glass within reach. A relative told the Inspector that the water jugs are not replaced every day and that they had mentioned this to the owner of the home. Residents told the Inspector they are “very happy”, “no complaints”, the staff are “gentle” and that they give time for personal care. One resident said they had a shower every week and said this was often enough. They have a choice of male or female carers. Staff were observed to knock on doors prior to entering the room and to close doors when giving personal care. Staff were heard communicating with residents in a polite, respectful and friendly manner. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. A varied programme of activities is offered to provided stimulation and interest for the people living in the home. Further thought needs to be given to how stimulation & social contact can be provided on a 1:1 basis for the more frail residents’ at times other than when the staff are giving personal care. Meals are nutritious and well balanced and offer a choice of a varied diet for residents. EVIDENCE: The home has a member of staff who is designated the responsibility of coordinating an activity programme in the home for groups and on a 1:1 basis. Residents are asked upon admission what social activities they enjoy and what type of activities they would like to join in with in the home. This is all recorded as part of their plan of care and individual diaries are kept of the social activities that residents’ have attended. This is all being done by the Activity Co-ordinator. The residents had arranged the flowers at the entrance to the home. A garden party is due to take place in early August and relatives are asked for ideas of activities that the home could provide. 2 relatives have come forward with suggestions so far. A list of activities was provided by the manager (designate) with the pre-inspection information and lists the following: - personal interests on television, film afternoons, visiting musical, Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 18 music afternoon, various games such as skittles, basketball & quoits which all give the residents the opportunity to exercise. The residents do warm up exercises before they start to play the more energetic games. Themed activities, trips, gardening, beauty sessions, cake decorating and Communion. Multi-denominational religious services are provided as well as 1:1 prayer. Comments in surveys from 8 residents confirm there is ‘always’ or ‘usually’ activities arranged by the home that they can take part in. One resident stated they were unable to take part, as they were bed bound. A resident was observed doing the crossword in the daily paper, and told the Inspector they also play their keyboard occasionally, another resident was watching golf on the television, two residents said they like to watch “the squirrels” and “the wildlife” out of the window. They are “offered activities – plenty for them, like the quiet life”. Other residents were observed on both days sitting in one of the sitting rooms in a semi circle with the television on, but none of them seemed to be watching the programme. A relative told the Inspector that they do not have any residents or relatives meetings. Communion was taking place during the afternoon of the second visit to the home, although no other activities were seen to be taking place on a group or 1:1 basis with staff. The home receives visitors throughout the day and relatives confirm that they are welcomed in the home and are able to visit the resident in private. Relatives also come in and take the resident out for the day. Due to the frailty of the current residents none of them handle their own financial affairs. Care records for an identified resident stated that in March 2006 the Social Worker with consent from the resident had referred them to Citizens Advocacy, although there was no evidence that this had been followed up. This was brought to the attention of the manager (designate) and on the second visit the manager (designate) advised that she had tried to arrange independent advocacy for this resident but it was not available long term. She was given further advice by the advocacy agency that she intended to follow up on behalf of this resident. The pre-inspection information provided by the home reports that four meals are provided each day for residents. Drinks and snacks are served mid morning and afternoon and a choice of fresh fruit smoothies have also been recently introduced for residents each afternoon. A four-week rotational seasonal menu is provided. The menu shows that the residents have a choice of meals. Soups and cakes are homemade. The menu offered is nutritionally balanced, with at least 5 portions of fruit & vegetables available each day. Specialist diets are catered for. Catering staff reported that they do not have any restrictions with regard to a budget for food. The owner is very receptive to requests for new equipment and another hot trolley has recently been ordered. The menus are displayed in both of the dining rooms. Residents told Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 19 the Inspector that the food is “good”, ”food is quite good” and that they are “offered a choice” of meals. Residents are able to eat in the dining room or in the privacy of their own bedrooms. Staff were observed taking the meal to residents in their bedrooms. The food was covered and both main course and dessert were served at the same time. This is not good practice, because if the dessert is a ‘ hot dessert’ it will not be able to maintain its temperature whilst residents are eating their main course and it can be off putting for a resident with a small appetite to be served both courses at once. Staff were observed serving and assisting residents to eat in the dining room. The Inspector observed the serving of supper one day & lunch on the second day. Staff were seen to be assisting residents’ to eat in a discreet and sensitive manner, although staff were also observed standing up over residents’ whilst they assisted them to eat. This is not good practice as it makes this a task rather than it being a social occasion for the resident. Comments in written surveys from 11 residents’ report that 3 residents ‘always’ like the meals, 7 residents’ ‘usually’ like the meals and 1 resident ‘sometimes’ likes the meals. Written comments from relatives include “the food is excellent”, “meals wholesome and well cooked” and relatives also said that the “food is good”, “food is much better”. The Inspector ate lunch at the home on both occasions, a choice was offered and the food was nicely presented and very enjoyable. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality outcome in this area is poor. This judgement has been made using available evidence including a visit to the service. Complaints are not being handled properly to provide residents & relatives with confidence that their concerns will be listened to, taken seriously, and acted upon. Residents are not being safeguarded as there is evidence that staff are not adhering to the action plan from a recent adult protection incident and poor outcomes have been found relating to the healthcare of some residents living in the home. EVIDENCE: A complaints procedure is available in the homes Service User guide. Comments in surveys from residents’ when asked if they know who to speak to if they are unhappy replied; 5 ‘always’, 3 ‘usually’ and 4 ‘ sometimes’. 9 residents’ indicated that they knew how to make a complaint and 1 did not answer the question. Written comments from 9 relatives all indicated that they were aware of the homes complaints procedure 2 relatives were not aware of the homes complaints procedure. The homes complaints record contains information that complaints have been received from 3 people. There was no information to show that these complaints had been investigated or responded to by the home. One care record showed an entry on the 20/06/06 where a visitor had complained about aspects of personal care. There was no information to show that this complaint had been brought to the attention of the manager (designate) and no entry in the homes complaints records. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 21 The Commission has received two complaints since the last inspection in March 2006. Both of these complaints were referred to the owner for investigation. The homes complaints records did not contain any information relating to these complaints and the outcome of the complaints. One of the complaints was relating to the poor provision of health & personal care & management of a resident’s care whilst on respite in the home. It was alleged that the resident developed a bad pressure sore whilst staying at the home. Due to these allegations of neglect a referral was made by the Commission to adult protection. The care of this resident was investigated by the owner with the involvement of the Commission and other multi-agencies who purchase care from the home. The allegation was upheld and the owner was required to provide an action plan to ensure that a reoccurrence of this nature would not be repeated. An action plan was provided and staff have undertaken recent training about the prevention and management of pressure sores and the home have purchased more specialist equipment for pressure relief. This visit to the home has identified weaknesses in the provision of healthcare that relate to the concerns raised within the above complaint, such as skin care, pre-admission assessment particularly identification of current prescribed medication and the monitoring and management of elimination. Please refer to ‘choice’ & ‘heath & personal care’ sections of this report. Discussion with staff and staff records show that all staff have not received training relating to safeguarding adults. The training facilitator advised that a training session has been booked for October 2006. Care staff spoken with were clear of the action they would take to safeguard the residents in the home. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. Some recent investment has improved some of the décor and facilities in the home, although further investment is needed to enhance the facilities and comfort for the people living and visiting the home. Systems are in place for the management & prevention of cross infection, but upgrading of equipment is needed to reduce the potential risks to residents and staff. EVIDENCE: The home was clean. Comments in surveys from 12 residents indicate that the home is ‘always’ or ‘usually’ fresh and clean. Staff spoken with indicated that it is much easier to keep the home clean now that they have 3 staff on duty each day. A bedroom on the Woodlands unit had a very strong smell of stale urine and a bedroom in the corridor had a badly stained carpet. These areas need addressing as a matter of priority. Pre-inspection information provided by the home indicate that the fire officer last visited the home in February 2006, this was in relation to the conversion Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 23 of the 5-bedded ward to 2 double rooms. The Environmental Health Officer visited the home in November 2005 and the catering staff confirmed that the owner is addressing the work highlighted during this visit. The home is single storey and offers accommodation in 28 single bedrooms of which 13 have en-suite facilities. 11 double bedrooms of which 4 have ensuite facilities. The home has 5 sitting rooms. The standard of the décor in the home varies. 2 double bedrooms have recently been converted and upgraded, both with en-suite toilets suitable for people using a wheelchair. The rooms have been furnished with new furniture of a good standard and are bright and cheerful. The divider curtains are not in situ, although the manager (designate) said that they were on order. One room is empty and one resident currently occupies the other. Both rooms did not contain sufficient seating for the residents’ or any seating for visitors. One of the en-suites did not have any grab rails or facilities for a physically disabled person. Other residents rooms were seen, they varied in size & contained personal possessions belonging to the residents. Parts of the home are in need of redecoration and refurbishment; this includes residents’ bedrooms, toilet, sluice & flower arranging areas in the home. All rooms seen contained a call system, although the system was not always accessible to the residents as it did not have a lead & bell push attached to the call point and/or it had not been left within reach of the one or more of the residents. The maintenance person is recording weekly and monthly water temperature checks. Thermometers are available in bathrooms for staff to use to check the temperature of the water prior to use by the resident. The laundry is well organised and systems are in place for the management of cross infection. Plenty of stocks of gloves and aprons are available throughout the home and staff were seen to be using them. Hand washing facilities are also situated throughout the home, with liquid soap and paper hand towels. The Inspector noted that in one bathroom a used glove had been left in the bath and the soap dispenser was broken, paper for drying hands was not in the dispenser and the lid was missing off the soiled continence pad bin, which was situated just inside the sluice door and held ajar by a towel over the top of the door. Hand sluicing facilities are still in use for commode pots and urinals. This can be a potential risk for staff as they may inhale or splash bacteria into their face. The gardens are well maintained and accessible to all residents. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. Current staffing levels for the provision of care are being supplied based on ‘minimal staffing level guidance’ and do not take into account the ‘high’ dependency needs of many of the residents living in the home. Since the last inspection the standard of vetting and recruitment of staff have improved, although a little further improvement is needed to protect the people living in the home. New and existing staff are beginning to receive a structured programme for the induction and ongoing training of staff to ensure that the health, safety & welfare needs of the residents and staff are provided and maintained. EVIDENCE: On the day of the first visit to the home there were 2 trained nurses & 7 care staff on duty for 40 residents. On the day of the second visit to the home there were 2 trained nurses & 6 care staff on duty for 40 residents. The home was 2 care staff short due to sickness and the manager (designate) and training officer who are both trained nurses were assisting with the care of the residents. Staff rotas provided by the home show that the usual staffing levels are 2 trained staff and 6-7 care staff in the morning, 2 trained staff & 5-6 care staff in the afternoon and 2 trained nurse and 2 care staff at night. Rotas show that there are sometimes more trained staff on duty to assist with covering any shortfalls in care staff numbers. The pre-inspection information Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 25 provided by the manager (designate) states that over an 8-week period the home have used bank staff to cover 349.5 hours of care. The manager (designate) is full time and supernumery to these hours. The home also employs a full time training officer who is also a registered nurse. A team of ancillary and catering staff supports the care team. A full time administrator & maintenance person are also employed by the home. Comments in surveys from 10 residents suggested that there is ‘usually’ the staff available when you need them. Comments also included “there is quite a problem on the weekends”, “there is on occasion a shortage of staff to meet the needs of the patients”,” and there are ”not enough staff on duty” you have ”got to find them”. Comments in surveys from relatives showed that 7 were of the opinion that there is always sufficient staff on duty, and 5 were of the opinion that there are not always sufficient staff on duty. “Staff shortage is the biggest worry. Mostly at weekends, when staff fail to turn up.” “I think sometimes they are short staffed but only occasionally”. One resident told the Inspector about staff shortages the previous Saturday. The resident commented that they had requested something and was “refused as not enough staff to look after the residents”. Another resident told the Inspector that they “have been waiting half an hour to go to the toilet as they need two carers”. Trained, care & ancillary staff told the Inspector that “staffing is OK, but difficult at present as there are a lot of new staff”, “much better”, “much better - only short due to sickness at weekends”, “busy, staff are struggling”. Staff indicated that the home was having problems with staff sickness, although they were also aware that this issue was being addressed. Staff also suggested that they had “too much to do” and that they do not have sufficient time when they are not required to give care to write up and review the care plans. The pre-inspection information provided by the home shows that 2 care staff have obtained their NVQ level 2 or above. Two staff recruitment files were seen and these provide evidence to show that the relevant checks are being carried out by the home prior to commencement of employment. One file did not have any information to show that the employee had been interviewed by the home and the second file contained evidence of being interviewed, but the interviewer had not sign the notes. One application form showed a 2-month employment gap, although there was no evidence within the interview form to show that the reason for this gap in employment had been explored. Discussion with one of the staff whose file had been inspected confirmed that they had been interviewed by the owner and the manager (designate) on Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 26 separate occasions, although there was no documentary evidence of this taking place. The home has employed a training officer since the last inspection. The home have 7 further care staff undertaking their NVQ 2 at present. One of the care staff who has already achieved her NVQ 2 is now doing a course to become an NVQ Assessor. 3 care staff are currently undertaking their induction at the home. They are all working supervised. The duration of the induction is a 6week programme and the format that is used by the home is the ‘Skills for Care’ Common Induction Standards for staff that are working in Adult Care. The training officer reported that Foundation Training is not fully in place at present. The pre-inspection information provided by the home reports that training has taken place in the last twelve months on various topics such as fire, syringe drivers, skin care, manual handling, nutrition & feeding. Further training is planned in a variety of topics such as health & fire safety, PEG feeds, Skills for Care, Accountability Awareness, infection control, Protection of Vulnerable Adults, care of the dying, Nursing & Midwifery Council Code of Conduct. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 27 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, 37, & 38 Quality outcome in this area is poor. This judgement has been made using available evidence including a visit to the service. There is no registered manager in post and systems are not in place to measure & monitor the quality of the service provided. This has the potential to puts residents at risk. Residents interests are not safeguarded as evidenced by poor record keeping, this has led in some circumstances to putting residents at risk, for example by poor recording of medication. Systems are not fully in place for the protection of the health & safety of residents living and staff working in the home. EVIDENCE: There has not been a registered manager in post since the end of November 2005. In the meantime the Deputy Manager has been taking the lead for the clinical aspects of the service with the registered provider overseeing and being responsible for all aspects of the service. The owner has kept the Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 28 Commission informed of the progress with regard to advertising and recruitment of a new manager. The current Deputy Manager has made a decision to take on the role of manager of the home and an application is due to be submitted to the Commission. This must be submitted without any further delay. The owner visits the home every Monday and is also available at other times via email or the telephone. The manager (designate) confirmed that the home does not currently have any formal systems in place for measuring and monitoring the quality of the service. The catering staff have carried out a recent food audit with assistance from the training officer. The outcome indicates that the home may not be recognising some of the potential nutritional problems for residents. This is to be addressed through a meeting with the trained staff in the home. The pre-inspection information shows that the owner manages the personal finances of one of the residents. These records were inspected. The records show that the resident has agreed to the owner becoming their appointee. Records show that the resident’s pension is being sent by cheque to the home each week. The cheque is being paid into the business account of the home. The individual record for this resident shows that every 4 weeks an amount of money is allocated to their account as being received by cheque and the amount that the resident has to contribute towards their fees is deducted leaving an amount of personal monies each month. The resident was admitted to the home in February 2005 and a building society account was opened by the home with a small deposit in February 2006 with further more substantial deposits made in March & June 2006 of monies belonging to this resident. The building society account is not in the resident’s name. There is no evidence to show that the resident has received any interest on the money that was held by the home over a 12-month period. Records show 2 amounts of expenditure, although the home were unable to locate a receipt for one item of expenditure for £70. There are no signatures against the entries on the resident’s money sheet held by the home. The training officer confirmed that supervision for staff is not in place at present. They are just commencing appraisals with trained staff and the selfassessment forms for staff to complete have just been issued for completion. The owner has been sending in written reports of his monthly visits to the home. Records relating to the care of residents are not being fully maintained by the home. Please refer to section 2 of this report. The home continues to send in notifications to the Commission of any significant event in the home. Residents’ and staff records are held securely in the home. Records of the two newly recruited staff contain information to show that they have received theory & practical moving & handling training upon employment. Discussion with staff confirmed that they have not all received training for moving & handling, fire, health & safety & COSHH (Control of Substances Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 29 Hazardous to Health). The pre-inspection information provided by the home confirms that they do not have any trained first aiders employed by the home. Pre-inspection information provided by the home show that fire, heating and water systems have been serviced within the last twelve months. No certificates were available for the gas and electrical wiring in the home. Bottles of cleaning chemicals and a bottle of plant food were in the home and accessible to residents. All accidents to residents’ are not being recorded in the accident book. Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 30 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 3 3 2 3 2 3 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 1 1 2 1 Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 31 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 OP1 Regulation 4, 5A Requirement Timescale for action 31/08/06 2 OP7 3 OP7 4 OP7 The Statement of Purpose and Service User guide must include all the information set out in Schedule 1 and Regulation 5 of the Care Homes Regulations 2001 and Regulation 5a (Care Homes (Amendment No. 2) Regulations 2003. Timescale of 30/11/05, 14/12/05 & 30/04/06 only partly met. 12, 15 Care plans must be established as true working documents and used as tools to inform care staff as well as registered nurses about the individual needs of each resident and how these are to be met. Timescale of 30/11/05 & 31/01/06 & 30/04/06 not met 12, 13, 15 The care plan for each person must be reviewed to ensure that all information is up to date. Timescale of 30/04/06 not met 15 Residents and/or their next of kin must be consulted about the content of the care plan. Their agreement to the content of the care plan must be sought and DS0000062332.V307212.R01.S.doc 30/09/06 31/08/06 30/09/06 Stretton Nursing Home Version 5.2 Page 32 5 OP7 13, 15 6 OP8 15, 16 7 OP8 15, 17 8 OP8 12 9 OP9 13, 17 10 OP9 13, 17 11 OP9 13 recorded. Timescale of 31/01/06 & 31/05/06 not met. Moving & handling risk assessments must be reviewed at least monthly as part of the residents care plan. Timescale of 30/04/06 not met. A trained nurse must interpret the outcome of the monthly pressure sore risk assessments and the appropriate equipment must be provided for the individual resident and recorded in the care record. Timescale of 30/04/06 not met. Wounds must be evaluated at the prescribed frequency and recorded in the care records. Timescale of 30/04/06 not met. Fresh fluids must be available in bedrooms & communal areas at all times. Staff must ensure that appropriate fluids are within reach for residents at all times and for those residents who need assistance with drink that it is given. All medicines must always be in stock and given to residents according to the doctors’ directions and with written plans in place for medicines prescribed to use ‘as required’. (Requirement included in letter for urgent action dated 24/07/06.) All medicine records must always be complete and accurate. (Requirement included in letter for urgent action dated 24/07/06.) Implement a system to regularly monitor for safe and effective arrangements for recording, handling, safekeeping, safe administration and disposal of DS0000062332.V307212.R01.S.doc 31/08/06 22/08/06 22/08/06 22/08/06 31/07/06 31/07/06 31/07/06 Stretton Nursing Home Version 5.2 Page 33 12 OP9 13 13 14 OP9 OP16 18 22 15 OP18 13 16 OP19 23 17 18 19 OP22 OP26 OP27 16 13 18 20 OP29 19 medicines received into Stretton Nursing Home and to take appropriate action to correct any deficiencies found. (Requirement included in letter for urgent action dated 24/07/06.) Make safe and effective arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received particularly to address the issues identified in the report. Provide refresher training and assessments of competence for all staff handling medicines. The registered person must ensure that all complaints are recorded & fully investigated. The homes records of complaints must ensure that the outcome of the complaint is documented. All staff must receive training on the Herefordshire procedures for adult protection. Timescale of 28/02/06 & 31/05/06 not met. A review must be undertaken of the condition of the premises & facilities internally and a report showing the outcome and any action plan must be submitted to the Commission. Residents must have access to a call bell at all times. Stained and soiled carpets must be cleaned and/or replaced. The staffing levels must be reviewed to take into account the dependency of the residents in the home. A copy of the outcome and any action plan must be sent to the Commission. A written explanation of any gaps in an employee’s employment history must be obtained by the home. DS0000062332.V307212.R01.S.doc 31/08/06 30/09/06 22/08/06 31/10/06 30/09/06 22/08/06 31/08/06 30/09/06 22/08/06 Stretton Nursing Home Version 5.2 Page 34 21 OP33 22 23 OP33 OP35 24 25 26 27 28 OP36 OP38 OP38 OP38 OP38 29 OP38 30 OP38 12, 21, 24 The registered Provider must establish systems for reviewing the quality of the service provided at the Home including consultation with residents, relatives and staff. Timescale of 31/01/06 not met 26 The owner’s monthly visit must be unannounced. 20 The owner must open a bank/building society account in the name of the resident for whom he is acting as appointee. Monies received by the home belonging to this or any other resident must not be paid into any business account for the home. Records & receipts must be obtained and held for all items of expenditure made on behalf of residents. 18 All care staff must receive forma; supervision at intervals of at least 6 times each year. 13 All staff must receive moving & handling training and this must be repeated at yearly intervals. 23 All staff must receive fire training at regular intervals. 13 A first aider must be on duty at all times. 13 A copy of a current 5 yr electrical installation certificate and gasservicing certificate must be submitted to the Commission. 13 All chemicals must be securely stored at all times. An immediate requirement was made. 17 All accidents must be recorded. 30/09/06 31/08/06 31/08/06 30/09/06 31/08/06 31/08/06 30/09/06 27/08/06 20/07/06 22/08/06 Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 35 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 OP12 Good Practice Recommendations Individual residents social care plans should be further developed in consultation with the residents and/or their family. Further though needs to be given to how stimulation & social contact can be provided on a 1:1 basis for the more frail residents’ at times other than when the staff are giving personal care Desserts should not be served at the same time as the main course for residents eating in their bedrooms. There should be written evidence of staff interviews on all recruitment files and these interview notes should be signed and dated by the interviewer. Two staff should sign all entries for receipt or expenditure of monies for residents held within the home. Interest should be paid to the resident where the money has been held within the business accounts of the home. 2 OP12 3 4 OP15 OP29 5 6 OP35 OP35 Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Stretton Nursing Home DS0000062332.V307212.R01.S.doc Version 5.2 Page 37 - 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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