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 October 2005 11:30 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 Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 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 Mrs Maureen Elizabeth Powis 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.V257793.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1. Registration is for 50 places on condition that: a) Alterations to the 4-bedded room to create 2 en-suite twin rooms will be commenced within 3 months of registration b) In the meantime no new service users will be accommodated in the room c) The room will be taken out of use when no longer occupied pending commencement of the upgrading. 2. The registration categories for the Home will be transferred as existing on the conditions that Stretton Care Ltd conducts a full review of the service and the statement of purpose in respect of the Home (and hence the necessary categories of registration) within 4 months of registration. 3. During the 4 month review period referred to in Conditions 2 above, service users with care needs associated with dementia illnesses may only be admitted to the Home where these are secondary to the person`s physical care needs. 4. The Responsible Individual will arrange training for himself in respect of local procedures for the protection of vulnerable adults within 3 months of registration. (It is recommended that this be done through the local POVA co-ordinator). 5. Stretton Care Ltd will make arrangements for the Manager to have supervision at least six times a year by someone suitably qualified and trained. These sessions must result in a report to the Provider on the quality of clinical nursing practices in the Home. 6. Stretton Care Ltd will arrange a review of the skills, training and experience of the registered nurses and care assistants employed at the Home. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commission for Social Care Inspection within 3 months of the date of registration. 7. Stretton Care Ltd will review the staffing arrangements to assess their adequacy to meet the needs of the service users. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commission for Social Care Inspection within 3 months of the date of registration.
Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 5 8. Stretton Care Ltd will review progress on requirements detailed in the inspection report from the inspection carried out during September and October 2004. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commission for Social Care Inspection within 3 months of the date of registration. 9. Stretton Care Ltd will carry out a review of the premises (including fire safety arrangements), adaptations and equipment at Stretton Nursing Home. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commission for Social Care Inspection within 3 months of the date of registration. 10. Stretton Care Ltd will carry out a review of the heating, surface temperatures of radiatiors and pipes, water temperature controls and Legionella precautions at Stretton Nursing Home. The review, together with an action plan to rectify any deficits identified, will be sumitted to the Commission for Social Care Inspection within 3 months of the date of registration. 11. The Responsible Individual for Stretton Care Ltd will be present on site at Stretton Nursing Home for the equivalent of 4 working days a week for a minimum of one month from the date of registration in order to establish a working relationship with the Manager and the staff team. Date of last inspection 30th June 2005 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. 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. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place between the hours of 11.30 – 17.00 hrs on 11th October 2005. Information has been obtained through observation of parts of the premises, meals, care practice and practice of ancillary staff. Information was also gathered from looking at residents and staff records, and other records in the Home. A number of staff including the manager, residents and relatives were spoken with. The Commission has received four complaints since the last inspection at the end of June 2005. The complaints are about poor care practice, staffing levels, quality and lack of choice of food and recruitment practice. One complaint was referred to the Provider to investigate and respond to the complainant. The Commission has investigated the complaint about poor recruitment practice. One part of the complaint was upheld and the second part was not upheld. The Commission received the complaint following a recent unannounced inspection, which had already highlighted the poor recruitment practice referred to in the complaint. Letters requiring the Provider and Manager to take immediate action were issued as part of those inspection findings. A visit from the Commission took place at the beginning of September 2005 in response to a report that the staffing levels had fallen so low as to make it impossible for the care needs of residents to be safely met. A letter was sent to the Home requiring them to take steps to ensure appropriate staffing levels are maintained. One complaint concerning poor care practice and quality and choice of food is currently under investigation by the Commission. The Provider and Manager continue to be very co-operative in assisting the Commission in investigating concerns. Due to the findings of this inspection, an urgent meeting has been arranged by the Commission to meet with the Provider and Manager of the Home. Failure of the Home to meet the requirements of this inspection may lead to enforcement action being taken by the Commission. What the service does well:
The Home is located in its own extensive grounds in a peaceful rural area. It is a single storey building, which makes its accessibility good for residents using wheelchairs. The manager and staff make visitors welcome in the Home. The staff were seen to maintain resident’s privacy and dignity at all times by knocking on doors before entering the room and making sure that the door is closed when helping the resident with personal care such as washing, dressing and going to the toilet. Residents seen appeared comfortable, appropriately dressed for the current climate, and the staff had nicely shaved the men who needed assistance. The resident’s clothes were nicely laundered. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 7 Staff were observed assisting residents to eat their lunch in a discreet and unhurried manner. Plenty of adapted crockery for serving meals to physically disabled residents was in use. Relatives spoken with during the inspection expressed their satisfaction with the care provided by the Home. Residents told the Inspector that the staff ‘are very kind’. A letter from a relative says ‘the staff are all very kind and helpful but also very busy’. What has improved since the last inspection? What they could do better:
The Statement of Purpose must be reviewed, as it does not contain the information that is required for prospective residents. Care planning must be improved so that staff know what to do for each resident and they provide an accurate record of the care given by the staff.
Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 8 The individual care plans must to be reviewed more often and changed when the residents care needs change. Activities and interests for residents must be provided by the Home. Staff must find out what each individual resident likes to do or about any hobbies they may wish to carry on with whilst living at the Home. This information must be written down to ensure that all staff know what residents enjoy and when they wish to engage in their interests. The meals provided at lunchtime and suppertimes must be reviewed. Residents must be asked the type of food that they enjoy and must be offered a choice of meal at each mealtime that is suitable, wholesome and nutritious. An identified toilet must be properly cleaned. The Home must ensure that there is sufficient staff on duty at all times. Staff must be employed correctly to protect the residents at the Home. The owner and manager must establish a system to gather views of the residents, staff, relatives, visitors, visiting professionals and other stakeholders of the community. This information must be used as part of their review of the quality of the service. Unannounced monthly visits must be done by the owner and a written report sent to the Commission. The fire risk assessment for the building must be reviewed to ensure that it addresses the safety implications of holding doors open with wedges. Foots rests must not be taken off wheelchairs and must be used at all times when using the wheelchair to transport residents. Staff must not leave trailing wires across corridors when cleaning the Home and must use notices to tell people that they are working in that area. Hot and cold water storage temperatures must be monitored and recorded as part of the Home’s control and management of Legionella. Records of any maintenance on wheelchairs need to be recorded. 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.V257793.R01.S.doc Version 5.0 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.V257793.R01.S.doc Version 5.0 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 The Statement of Purpose and Service User guide is inadequate and does not provide sufficient information for prospective residents so that they can be clear about all aspects of the services the Home provides, including terms and conditions of residence. EVIDENCE: A revised Statement of Purpose has been sent to the Commission since the last inspection. The manager confirmed that this document is a combined Statement of Purpose and Service User guide. A copy of this document is on display at the entrance to the Home and has been put into all of the bedrooms. This document needs further review as it does not include information about arrangements for respecting the privacy and dignity of resident’s, a sample contract outlining the terms and conditions of stay including the payment of the ‘Free Nursing Care’ contributions and needs to include a minimum of the summary page from the last inspection report. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 11 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. There is a care planning system in place, but the information contained in the care plans does not provide staff with clear and consistent information to enable them to meet the resident’s needs. The Home has failed to improve their standard of record keeping, and not all of the healthcare needs of residents are being met, which potentially places residents at risk. Aspects of the Homes management of medicines need improving to ensure medicines are securely stored, resident’s medication needs are met, and to reduce the risk of potential harm. EVIDENCE: Two identified residents care records were seen during this visit. Care plans are not being updated to reflect their current care needs when the residents care needs change. They are not being reviewed each month. Continence assessments are not being reviewed regularly. There was no information recorded following a referral made by the Home in May 2005 to the General Practitioner requesting a specific test for a resident. A care plan for a specific dressing for a wound gave good, clear instructions about the frequency and type of dressings to be used, but the wound had not been fully reviewed since July 2005, there were no photographs or measurements of the wound and it was not being treated daily as ordered in the care plan. Individual risk assessments for walking, moving and handling needs and for the use of
Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 12 bedrails are not being reviewed monthly. Care staff are now recording information about personal care in the care plans. This is good practice. The medicine chart for an identified resident contained gaps where there was no information to show that the prescribed medicine had been given by the trained nurse. The medicine fridge in one part of the Home was unlocked. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 13 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): 15 The Home has failed to improve the quality and choice of food. A varied menu is not provided at lunch or suppertime to enable residents to exercise choice and control over what they eat. EVIDENCE: The menus are on display in the dining room on the corridor wing. The Inspector was unable to identify the menu of the day without asking the chef. On the day of the inspection the lunch was Chicken & Mushroom pie, chips & sweetcorn, followed by a dessert of Bakewell Tart & cream. There was no alternative choice of menu on display, except a note saying that individual diets are catered for. Residents when asked were not aware of what was for lunch and did not know that they could ask for an alternative choice of meal. The meals were described, as “like boarding school food, the same food, it is satisfactory”. Written comments have been received from visitors to the Home about the lack of choice of food and that the food served is not appropriate for the residents living at the Home. The menus have not been reviewed since the last inspection. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 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): 18 The Home is failing to protect residents from potential harm. EVIDENCE: Since the last inspection on 30th June 2005, 4 complaints have been received by the Commission about the Home. A complaint was received about poor recruitment practice. One part of the complaint was upheld and the second part was not upheld. The Commission received the complaint following a recent unannounced inspection, which had already highlighted the poor recruitment practice referred to in the complaint. Letters requiring the Provider and Manager to take immediate action were issued as part of those inspection findings. One of the complaints was referred to the Provider to investigate. The complaints expressed concern about poor care practice, the adequacy of the staffing levels provided by the Home and the quality and lack of choice of food. Robust recruitment procedures are not in place for the protection of the residents living at the Home. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 15 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 & 26 The location and layout of the Home is suitable for the residents living at the Home. In order to maintain a safe environment for residents, staff and visitors to the Home, the Home needs to review some areas of current practice and procedures. Considerable improvements have been made to ensure that a pleasant and hygienic environment is provided. EVIDENCE: The Home is a single storey building set in extensive grounds, which are accessible to the residents. The conversion of the five-bedded room into two double rooms is still in progress. Trailing hoover leads were seen across the corridor and from the corridor by the front entrance across the dining room. The standard of hygiene in an identified toilet needs attention. Upgrading work is taking place in the one unit of the Home. Bedrooms are being upgraded with new carpets and curtains and some furniture is being replaced. Work has been done on the outside of part of the building by replacing guttering and drainage.
Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 16 The laundry floor has been upgraded and replaced with an impervious, non-slip surface. A Condition of Registration agreed by the new Provider was that within 3 months of registration they would carry out a review of the heating, surface temperatures of radiators and pipes, water temperature controls and Legionella precautions. The review and any action plan are to be submitted to the Commission. Despite correspondence with the Provider, there is no information available to indicate that this has been done. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 17 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 & 29 Sufficient staff are not being provided at all times to ensure that the health and social care needs of the residents are being met. The procedures for the recruitment of staff are not robust and do not offer protection to residents living at the Home. EVIDENCE: Concerns have been raised with the Commission since the last inspection regarding the adequacy of staffing levels in the Home. This inspection is the second visit to the Home since the last inspection. A visit from the Commission took place at the beginning of September 2005 in response to a report that the staffing levels had fallen so low as to make it impossible for the care needs of residents to be safely met. A letter was sent to the Home requiring them to take steps to ensure appropriate staffing levels are maintained. The Manager continues to notify the Commission through notifications when the staffing levels have fallen below the required numbers and the reason for not being able to provide the staff. The Commission have received a copy of proposed staffing levels to be provided by the Home according to the numbers of people in residence. These proposals will be discussed with the Provider and Manager. On the day of the inspection there were satisfactory numbers of nursing and care staff on duty for the number of people in residence. Agency staff are currently being used to supplement the staff numbers, although concern was raised by a number of staff about the future provision of agency staff to supplement the staff numbers. This concern is being brought to the attention of the Provider. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 18 Two staff files show that recruitment practice is still poor. The Home has not been able to provide any evidence that Criminal Records Bureau or Nursing & Midwifery Council Personal Identification Number (PIN) checks have been carried out for these two trained staff. Only testimonial style references had been accepted for both of these staff. There was no information to show that the authenticity of these ‘To whom it may concern’ testimonials had been checked and there was no information to show the Home had verified the reason why they had left there previous employment. The information written on the interview form was very brief and there was no evidence that a gap in a curriculum vita had been explored during the interview. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 38 The systems for consultation with residents, relatives, visiting professionals and stakeholders of the community are not satisfactory with little evidence that indicates that residents and others parties views are sought and acted upon. Improvements have been made in the Home in order to promote and safeguard the health, safety and welfare of the residents using the service, although there are still areas of health & safety practice that require attention. EVIDENCE: As part of the Home’s quality review a suggestions box has been placed at the entrance of the Home for relatives, residents, staff and visitors to the Home. Comment cards provided by the Commission are also available to be completed and forwarded to CSCI in pre-paid envelopes. Monthly written reports from the Responsible individual are not being carried out and a copy forwarded to the Commission. No report has been received by the Commission in respect of any quality review carried out by the Home. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 20 A lock has been put on the laundry door to ensure that the chemicals are stored securely when the room is not in use and safety data sheets are displayed on the notice board in case of any spillage or accident. The maintenance file contains forms for service and inspection of the wheelchairs, but none were completed. Four wheelchairs in one identified unit had either one or no footrests attached. There is no information available showing that the storage temperatures of hot and cold water are being monitored for the prevention and control of Legionella. A copy of some guidance produced by the Health & Safety Executive was given to the Manager. Individual and generic risk assessments for the use of door wedges had been reviewed and updated since the last inspection. The fire risk assessment for the building was not available for inspection. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 21 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 x 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 x 29 1 30 X X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X 1 Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? 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, 5 Requirement Timescale for action 30/11/05 2 OP7 3 OP7 4 OP12 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 Regualtions 2001 and Regulation 5a (Care Homes (Amendment No. 2) Regulations 2003. Brought forward amended as timescale of 30/06/05 has not been fully met. 12, 15 Care plans must be established 30/11/05 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 30/09/05 not met 12, 13, 15 The care plan for each person 30/11/05 must be reviewed to ensure that all information is up to date. Timescale of 30/09/05 not met. 12, 16 Activities must be provided in 31/10/05 the Home on a group and individual basis. Residents must be consulted about the type of activities they would like and this
DS0000062332.V257793.R01.S.doc Version 5.0 Stretton Nursing Home Page 23 5 OP15 12, 16 6 7 OP26 OP38 23 13 8 OP27 18 9 OP29 19 10 OP29 19 11 OP29 19 must be recorded in their individual care plans. Brought forward with same timescale, not assessed. Menus must be provided that are suitable, wholesome and nutritious and a choice of food must be available for residents each mealtime. Timescale of 30/09/05 not met. The standard of cleanliness in an identified toilet must be improved. Electric wires must not be trailed across corridors and doorways. Hazard warning signs must be provided and used by staff when cleaning is in progress. Timescale of immediate & ongoing The Home must ensure that sufficient staffing levels are maintained at all times. The numbers of trained and care staff must not fall below the guidance set by the originating health authority. The registered Provider must ensure that recruitment practice at the Home fully complies with statutory requirements with regard to references, Criminal Record Bureau checks and Protection of Vulnerable Adult checks. Timescale of immediate & ongoing not met. Staff must not be employed to start work in the Home unless all documents required under Regulation 19 & Schedule 2 have been obtained. Timescale of 30/06/05 not met. Staff must not commence employment until a minimum of a Protection of Vulnerable Adult first clearance has been obtained alongside all other elements of
DS0000062332.V257793.R01.S.doc 30/11/05 31/10/05 21/10/05 21/10/05 21/10/05 21/10/05 21/10/05 Stretton Nursing Home Version 5.0 Page 24 12 OP33 13 OP33 14 OP38 15 OP38 16 OP38 Regulation 19 & Schedule 2. The identified staff must be supervised at all times until receip of Protection of Vulnerable Adult first clearance. Timescale of 30/06/05 not met 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 31/05/05 not met 26 Unannounced monthly visits must be carried out by the Provider in accordance with Regulation 26 and a written report submitted to the Commission. 13, 23 The registered Provider must ensure that the fire risk assessment for the building addresses the safety implications of holding doors open with wooden wedges. Timescale of 31/08/05 not met. 13 Both footrests must be fitted to all wheelchairs and be used when transporting residents at all times. Timescale of 31/07/05 not met 13 Hot and cold water storage temperatures must be monitored and recorded as part of the control and management of Legionella. Timescale of 31/07/05 not met 31/01/06 31/10/05 31/10/05 31/10/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000062332.V257793.R01.S.doc Version 5.0 Page 25 Stretton Nursing Home 1 Standard 38 A maintenance programme should be set up for cleaning, and checking the safety of the wheelchairs in use. Stretton Nursing Home DS0000062332.V257793.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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