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Inspection on 30/06/05 for Stretton Nursing Home

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

This inspection was carried out on 30th June 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The 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. A good choice of food is available at breakfast time including cooked breakfast. Breakfast is served to residents in one of the dining rooms or in their own room. This may vary on a day-to-day basis. Residents said that "it is very nice here" and that they "felt safe and content".

What has improved since the last inspection?

The manager prior to admission visits prospective residents and the information obtained at this time is used to form the basis of their individual plan of care. The format for assessing any potential risks for residents when bed rails are used to prevent residents falling out of bed has been revised. The new Provider has taken the existing 4-bedded bedroom out of use and it is currently being converted into two double rooms .

What the care home could do better:

The new Provider needs to review the written information about the Home, the facilities and service it offers. This information needs to be available in the Home at all times for prospective residents and a copy needs to be given to all existing residents. Care planning needs improving to ensure that staff know what to do for each resident. The individual care plans need to be reviewed more often and changed when the residents care needs change. Guidance from specialist people such as the dietician needs to be sought when residents are losing weight or having problems eating. Activities and interests for residents need to be provided by the staff. Staff need to 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 needs to 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 need to be reviewed. Residents should be asked the type of food that they enjoy and need to be offered a choice of meal at each mealtime that is suitable, wholesome and nutritious. Areas of the Home need extra care to keep them clean. The Home needs to employ more staff. Staff need to be employed correctly to protect the residents at the Home. An official letter was left at the Home to tell the owner and manager that this must happen immediately and staff that had been incorrectly employed must be supervised at all times when working at the Home until the correct checks had taken place. The Provider needs to review the numbers of staff that are needed to care for the residents living in the Home. Another serious concern was that the laundry chemicals were not secure when not being used. An official letter was left at the Home telling the owner and manager to secure these chemicals. The manager has told the Commission that this has been done. There were other areas about safety of people in the Home that need to be put right. These include reviewing the level of risk offire when bedroom doors are left open, making sure that the footrests are fitted to wheelchairs before use, and that wheelchairs are cleaned and checked regularly. Staff need to be reminded not to leave trailing wires across corridors and doorways when cleaning the Home and to use notices to tell people that they are working in that area. The laundry floor needs repairing to stop any dirt sitting in the gaps between the concrete tiles. The owner needs to consider putting a new type of flooring down in the laundry so that it is easier to clean and to stop any possible cross infection.

CARE HOMES FOR OLDER PEOPLE Stretton Nursing Home Manor Fields Burghill Hereford HR4 7RR Lead Inspector Sandra Bromige Unannounced Inspection 30 June 2005 06:45 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 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 E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Stretton Nursing Home Address Manor Fields, Burghill, Hereford, HR4 7RR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01432 761611 Stretton Care Ltd Mrs M E Powis Care Home 50 50 50 50 50 50 50 Category(ies) of Dementia registration, with number Dementia over 65 years of places Old Age Physical disability Physical disability over 65 years Terminally ill Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 2. The registration categories for the Home will be transferred as existing on the condition 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 four months of registration. 3. During the 4 month review period referred to in Condition 2 above, service users with care needs associated with dementia illnesses may only be admitted to the Home where these are secondary to the persons physical care needs. 4. The Responsibvle 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 Coordinator). 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 fo 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 identifed, 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. 8. Stretton Care Ltd will review progress on requirements details in the inspection report for the inspection carried out during September and October 2004. The review, together with an action plan to rectify any deficits identified will be submitted ot the Commission for Social Care Inspection within 3 months of the date of registration. 9. Stretton Care Ltd will carry out a reivew of the premises (including fire safety arrangements) adaptations and quipment 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. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 5 10. Stretton Care will carry out a review of the heating, surface temperatures of radiators and papes, water temperature controls and Legionelle precautions at Stretton Nursing Home. The review, together with an action plan to rectify any deficits identifed, will be submitted to the Commission for Social Care Inspection within 3 months of the date of registration. Date of last inspection 7th February 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 E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started at 06.45 am on the last day of June 2005. The inspection lasted for 10.5 hours. 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 & staff records, and other records held in the Home. A number of staff, residents and relatives were spoken with. A staff questionnaire has been left for all staff to complete and relatives seen during the visit also agreed to complete comment cards regarding the service. Due to the timing of receipt of the responses it may not be possible to include any comments in this report, but they will be used to inform the next inspection visit. The Commission has received two complaints since the new Provider took over the Home at the end of February 2005. The complaints are about aspects of poor care practice, staffing levels and employment issues. The Home was visited on the 24th May 2005 in addition to this visit as part of the Commissions investigation into the elements of the complaints. The manager has also been sending information to the Commission in order that the staffing situation at the Home can be monitored, such as copies of the staff rotas and notifications when the numbers of staff on duty are falling below the numbers needed. The complaints regarding employment issues have been passed to the Provider to investigate and to write to the complainant. The new Provider and manager have been very co-operative in assisting the Commission in investigating these concerns. 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. A good choice of food is available at breakfast time including cooked breakfast. Breakfast is served to residents in one of the dining rooms or in their own room. This may vary on a day-to-day basis. Residents said that “it is very nice here” and that they “felt safe and content”. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 7 What has improved since the last inspection? What they could do better: The new Provider needs to review the written information about the Home, the facilities and service it offers. This information needs to be available in the Home at all times for prospective residents and a copy needs to be given to all existing residents. Care planning needs improving to ensure that staff know what to do for each resident. The individual care plans need to be reviewed more often and changed when the residents care needs change. Guidance from specialist people such as the dietician needs to be sought when residents are losing weight or having problems eating. Activities and interests for residents need to be provided by the staff. Staff need to 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 needs to 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 need to be reviewed. Residents should be asked the type of food that they enjoy and need to be offered a choice of meal at each mealtime that is suitable, wholesome and nutritious. Areas of the Home need extra care to keep them clean. The Home needs to employ more staff. Staff need to be employed correctly to protect the residents at the Home. An official letter was left at the Home to tell the owner and manager that this must happen immediately and staff that had been incorrectly employed must be supervised at all times when working at the Home until the correct checks had taken place. The Provider needs to review the numbers of staff that are needed to care for the residents living in the Home. Another serious concern was that the laundry chemicals were not secure when not being used. An official letter was left at the Home telling the owner and manager to secure these chemicals. The manager has told the Commission that this has been done. There were other areas about safety of people in the Home that need to be put right. These include reviewing the level of risk of Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 8 fire when bedroom doors are left open, making sure that the footrests are fitted to wheelchairs before use, and that wheelchairs are cleaned and checked regularly. Staff need to be reminded not to leave trailing wires across corridors and doorways when cleaning the Home and to use notices to tell people that they are working in that area. The laundry floor needs repairing to stop any dirt sitting in the gaps between the concrete tiles. The owner needs to consider putting a new type of flooring down in the laundry so that it is easier to clean and to stop any possible cross infection. 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 E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 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 standard(s) 1, 2, & 3 The Homes Statement of Purpose and Service User guide was not available within the Home to enable prospective residents to make an informed choice about where to live. Pre admission assessments are undertaken by the manager prior to admission to ensure that the care needs of the prospective resident can be met by the Home. EVIDENCE: There was no Statement of Purpose or Service User guide on display in the Home. On the morning of the inspection the manager visited a prospective resident in the local hospital to establish their care needs. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, & 10 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. 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 resident’s medication needs are met. Practice and procedures are in place in order to maintain the privacy and dignity of the residents. EVIDENCE: • • • • • • • Care plans are not being reviewed monthly Where residents have been identified as being nutritionally at risk, there is no information that any specialist dietary advice has been sought. Residents weight (particularly those nutritionally at risk) are not being monitored. Continence assessments are not being completed. Residents skin assessments do not stipulate the type of pressure relieving aids required to be input into use. The frequency and duration of an identified residents epileptic seizures had not been recorded. No evidence of consideration of residents dental care needs. E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 12 Stretton Nursing Home • Medication Administration Records show gaps where medicines should have been given. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 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 standard(s) 12, 13, & 15 Activities are not being provided for the enjoyment and stimulation of residents. Visitors are made welcome enabling residents to maintain strong links with their family and the local community. A varied menu is not provided at lunch or suppertime to enable residents to exercise choice and control over what they eat. EVIDENCE: There are no individual or group activity programmes available for residents in the Home. Two identified residents were observed left seated at the dining table from breakfast to lunchtime without any social stimulation. Many visitors were seen visiting residents throughout the day. A good choice of food is available at breakfast. The correct menus for the week were not on display. Residents spoken to were not aware of the menu for lunch. Beef lasagne was served for lunch on the day of the inspection. A number of residents spoken to did not like the meal and an alternative was not provided. One resident when asked if they had a choice of food responded, “No not really, if I don’t like it I get them to take it away”. The temperature of the food served was described as “not as warm as one would like it”. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 14 The manager and catering staff have recently attended a study day provided by the Primary Care Trust called “Good Nutrition in Care Homes”. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 15 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 standard(s) 16 & 18 From evidence seen, complaints are recognised, received and investigated by the Home as this is seen as a means to improve the service offered by the Home. The Home has a vulnerable adult procedure in place to ensure that a proper response to any suspicion or allegation of abuse. EVIDENCE: The Home has a complaints procedure and records of recent complaints show that these procedures are being followed upon receipt of a complaint. The Commission has received two complaints since the new Provider took over at the end of February 2005. The complaints are currently being investigated by the Commission and include concerns of poor practice, staffing levels, and employment issues. The latter have been referred to the Provider for investigation. Staff spoken with were aware of the Homes procedures for the Protection of Vulnerable Adults and would go to the manager if they had concerns. Robust recruitment procedures are not in place for the protection of the residents living at the Home. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25, 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. Areas of the Home’s cleanliness need attention 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. A four-bedded room is currently being converted into two double rooms. Staff complete a repairs request book when the need is identified. A problem was identified with a bed rail and entered into the repairs book, but the maintenance man was on holiday and the problem was not addressed for a further 4 days. Trailing hoover leads were seen on a number of occasions across the corridor from one room to another and across resident’s doorways. The standard of hygiene in some of the toilets need attention and a communal hand towel was provided in the visitor’s toilet. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 17 Resident’s wheelchairs need to regularly maintained and cleaned. The laundry floor is not impervious and there are deep cracks between the concrete tiles. Good practice was also seen, as staff were using aprons and gloves, which were changed for each resident and ensuring that the bath was clean prior to each use. 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. This is being sought through separate correspondence with the Provider. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The deployment and number of staff available during the daytime is not sufficient to meet the needs of the residents. 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 regarding the adequacy of staffing levels in the Home. The Commission have been monitoring the staffing levels in the Home with the co-operation of the manager through the periodic submission of staffing rotas, unannounced visit to the Home and the through notifications from the manager to the CSCI when the staffing levels have fallen below the required numbers. From talking to a relative and looking at previous recent history of the Home prior to the new Provider taking over, the adequacy of the staffing levels has been of prior concern. Staffing levels are improving and the manager is continuing to try and recruit staff of all grades. Staff sickness and holidays are also contributing to the shortfalls in staffing. Staffing levels on the day of the inspection had improved since the last visit, although they were still not sufficient to meet the needs of the residents. Poor outcomes were seen, as at 11.45 am there were still three residents to be assisted to wash and dress and there were no activities or stimulation being provided in the Home. Upon change of ownership of the Home the new Provider agreed to undertake a full review of staffing arrangements and submit the outcome to the Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 19 Commission. This has been requested through separate correspondence. Two staff files showed that recruitment procedures were poor and two immediate requirement notices were issued in order to protect the residents living in the Home. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 In order to promote and safeguard the health, safety and welfare of the residents using the service, there are areas of health & safety practice that require attention. EVIDENCE: Staff confirmed that there is sufficient equipment provided to assist in the moving and handling of residents. The hoists are next due for inspection in September 2005. One resident was seen being transported in a wheelchair with only one footrest in place. The maintenance file contains forms for service and inspection of the wheelchairs, but none were completed. Records show that bed rails are checked each month to ensure that they are fitted correctly. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 21 Hot water temperatures on baths are checked each month and prior to immersion of a resident and recorded, to ensure that they do not exceed the maximum permitted temperature. There is no information showing that the storage temperatures of hot and cold water are being monitored for the prevention and control of Legionella. Fire records show weekly and monthly internal checks of the system and servicing by an authorised contractor. Many bedroom doors remained open. A generic risk assessment was in place with additional assessment forms to identify individual risk. The risk assessment had not been reviewed and the individual risk assessments had not been completed. Not all staff had attended fire training despite being requested to by the manager. The manager was addressing this and staff have been told that this training is mandatory. Staff confirmed that all staff working in the kitchen are currently updating their food hygiene certificates. The fire risk assessment was not available on the day of the inspection. Chemical safety sheets were not available in the laundry and the laundry chemicals were accessible to residents when the laundry is out of use. An immediate requirement notice was made to secure the laundry. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 1 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 1 Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 23 Yes 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 1 Regulation 4 Requirement Timescale for action 30/06/05 This was submitted on the 6th July 2005. 2. 1 3. 7, 8, 15 4. 7, 8, 15 The Statement of Purpose must include all the information set out in Schedule 1 of the Care Homes 2001 and must be collated into one document. (The incoming provider has agreed to undertake a full review of the Statement of Purpose within 4 months of registration) BROUGHT FORWARD 5 The registered person must provide all residents ( or their relatives where this is more appropriate) with a copy of the Service User Guide and complaints procedure. (See Regulation 5 (as amended) and Standard 1 for required contents) BROUGHT FORWARD with a revised timescale. 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 31/03/05 NOT MET 12, 13, 15 The care plan for each person must be reviewed to ensure that all information is up to date. E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc 31/08/05 30/09/05 30/09/05 Stretton Nursing Home Version 1.40 Page 24 5. 8 12, 13 6. 12 12, 16 7. 15 12, 16 8. 26 23 9. 19, 38 13 10. 27 18 11. 29 19 TIMESCALE OF 31/03/05 NOT MET. (Brougth forward amended) The Home must seek input from specialist healthcare professionals such as the dietician when residents care needs indicate this (e.g due to being high risk nutritionally). TIMESCALE OF 31/03/05 NOT MET Activities must be provided in the Home on a group and individual basis. Residents must be consulted about the type of activities they would like and this must be recorded in their individual care plans. Menus must be provided that are suitable, wholesome and nutritious and a choice of food must be available for residents each mealtime. Arrangements for keeping the building clean and tidy must be improved. TIMESCALE OF 31/03/05 NOT MET. 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. A review of staffing arrangements , including staffing levels, must be carried out. The Commission must be informed in writing of the outcome of this review. TIMESCALE OF 31/05/05 NOT MET. 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 31/05/05 NOT MET. 30/09/05 31/10/05 30/09/05 30/09/05 Immediate & Ongoing 31/07/05 Immediate & Ongoing Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 25 12. 29 19 13. 29 19 14. 15. 26, 38 38 13 13 16. 38 13 17. 38 13 18. 38 13 19. 38 13, 23 20. 38 13 Staff must not be employed to start work in the Home unless all documents required under Regulation 19 & Schedule 2 have been obtained. AN IMMEDIATE REQUIREMENT WAS MADE. Staff must not commence employment until a minimum of a Protection of Vulnerable Adult first clearance has been obtained alongside all other elements of Regualation 19 & Schedule 2. The identified staff must be supervised at all times until receip of Protection of Vulnerable Adult first clearance. AN IMMEDIATE REQUIREMENT WAS MADE The space between the concrete tiles of the laundry floor must be repaired. Chemicals in use in the laundry must be stored securely when not in use by staff. AN IMMEDIATE REQUIREMENT WAS MADE. Chemical information sheets must available for all chemicals in use and a copy kept where they are stored or in use. Individual risk assessments regarding residents bedroom doors being held open during the day and night must be completed and reviewed on a regular basis. The general risk assessment regarding bedroom doors being held open must be reviewed on a regular basis. The registered Provider must ensure that the fire risk assessment for the building addresses the safety implications of holding doors open with wooden wedges. Both footrests must be fitted to all wheelchairs and be used Immediate & Ongoing Immediate & Ongoing 30/09/05 By 5.00pm on 1st July 2005. MET 31/07/05 31/07/05 31/07/05 31/08/05 31/07/05 Page 26 Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 21. 33 22. 38 when transporting residents at all times. 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. BROUGHT FORWARD WITH SAME TIMESCALE, NOT ASSESSED. 13 Hot and cold water storage temperatures must be monitored and recorded as part of the control and management of Legionella. 31/05/05 31/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 19 26 26, 38 Good Practice Recommendations Procedures should be reviewed for the day to day maintenance of the Home when the maintenance person is away for a period of leave. It is strongly recommended that the laundry flooring should be replaced with a non slip, impervious type floor covering. A maintenance programme should be set up for cleaning, and checking the safety of the wheelchairs in use. Stretton Nursing Home E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford, HR4 9HN 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 E52 E02 S62332 Stretton Nursing Home V235516 300605 Stage 4.doc Version 1.40 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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