Inspection on 27/10/05 for Taymer Nursing Home

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Taymer Nursing Home 13/10/06

Taymer Nursing Home 26/04/05

Taymer Nursing Home 23/08/04

Taymer Nursing Home 18/06/04

Taymer Nursing Home 09/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Taymer Nursing Home (Dr Saraogi) Barton Road Silsoe Bedfordshire MK45 4QP Lead Inspector Ansuya Chudasama Unannounced Inspection 27th October 2005 10:38 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 Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.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. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Taymer Nursing Home (Dr Saraogi) Address Barton Road Silsoe Bedfordshire MK45 4QP 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) 01525 861833 01525 861889 Pressbeau Ltd Linda Jordan Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability over 65 years of age of places (33) Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Up to 4 Adults 50 - 64 years Old age, not falling within any other category (OP) 33 Physical Disability over 65 years of age PD (E) 33 The provision of bathing and communal space must be kept under regular review between the CSCI and the home, to ensure that these facilities are provided in adequate quantities in order to meet the assessed needs of service users. Hand basins must be fitted to the two new sluice areas as detailed in the plans provided to CSCI dated 22/9/04, prior to these facilities being used. 21st June 2005 5. Date of last inspection Brief Description of the Service: Taymer is a purpose built Nursing Home situated in the Bedfordshire village of Silsoe, which lies off the A6 road between the towns of Bedford and Luton. The home is situated in rural grounds overlooking the Bedfordshire countryside. The home has been extended to accommodate 33 service users. The home provides care for elderly people with physical disabilities and medical conditions. The home is staffed with qualified nurses and carers who provide a range of services to aid and improve the physical wellbeing of the service users. The home provides eight single bedrooms with en-suite facilities, 17 single bedrooms without en-suite facilities and five double bedrooms. Each room was fitted with an electronic nurse call system. The home had a Parker bath, an Arjomechanaids air bath and standard baths. The three main reception areas consisted of a TV lounge, a quiet study room and a conservatory. The home had attractive surrounding gardens with parking facilities available. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours. The inspector spent the majority of the inspection observing practice and speaking to service users, staff, and visitors. The care records of service users and other documents were also examined, and a tour of the communal areas took place. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that recruitment procedures are followed in all cases. The home must ensure that all the information stated in the standard is obtained prior to new staff being employed and kept on file. The manager must ensure that any concerns raised are followed up by the homes policies Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 6 and procedures and all action taken is recorded. All the care staff must receive supervision at least 6 times a year. The home also needs to complete a quality audit and develop an annual development plan. 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. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 The home had a statement of purpose and a service users guide which provided perspective service users and their families with information they need to make an informed choice about where to live. EVIDENCE: One service users file inspected had a pre admission assessment form, which needs to be signed and dated by the person completing the form. Families completed the social assessment of the service user and this was good. The family of one service user spoken to stated that they had received a copy of the statement of purpose and a service user guide. It was stated that they choose the home because it smelled nice and let in a lot of natural light. They had also signed a contract with the home on behalf of the service user. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 9 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): 7,8,10 The care plans illustrated that service users received good standards of care with a need for further development in some areas. The health needs of service users are well met with evidence of regular monitoring of health care charts being reviewed on a regular basis. EVIDENCE: The service users file inspected had care plans. Some of the information not available in the plan was available in the other sections of the file. It was stated that a new care plan format, which covered all the areas discussed in the standard, was being developed. The form seen was good, and it was stated that the old care plans were to be replaced by this format soon. The manager stated that all care staff were going to be involved with this process. A family member spoken to was not aware of care plans. A placement review plan seen did not have much information, and the form was not dated or signed by staff. The service users internal care review form was also not completed fully. The monitoring charts seen for health care needs showed that the service users needs were being met and the charts were reviewed Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 10 regularly. This was also confirmed by talking to a family member. The weight charts were also monitored on a monthly basis. The fluid charts were kept in the service users room. Those seen were being recorded regularly with the amount of fluids given. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 11 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): Service users were offered excellent home made varied and nutritious meals to ensure they remained healthy. The home provided a weekly programme of daily activities and monthly social events so this ensured service users could enjoy a normal range of activities. EVIDENCE: Families spoken to stated that they found staff very nice and they respected the service users. It was also stated by one family member that the service user had made lots of progress since being at the home. The service users and families spoken to stated that the food was very good and Shaun the cook was “fantastic”. The writing on the menu boards needed to be bigger and in a colour that was easy to read. The weekly activities list was displayed. The activity hours were increased from two to three hours per day. A whole years event list was also displayed. Service users were observed having a conversation with each to each other or with their family member. Two service users were observed playing cards with staff. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 12 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 Some of the arrangements for protecting service users are not satisfactory, placing them at possible risk of harm or abuse. EVIDENCE: The home had a complaints policy and a copy was displayed in the home. Information on this was also available in the statement of purpose. The home had received two complaints, and the manager dealt with these concerns in a satisfactory manner. On the 20.6.05, following a Protection of Vulnerable Adults referral and strategy meeting, the CSCI carried out an inspection at the home as part of the investigation into allegations by a relative of a service user being admitted to hospital with malnutrition and dehydration. These allegations were subsequently unsubstantiated in November 2005. The inspection on the 20.6.05 identified an unacceptable standard of practice in relation to recording of a service user’s weight, recording of fluid and food intake, administration of medication and completion of service users care plans. Requirements were made and action has been taken by the home to address these matters. However further development is needed and recommendations are made following this inspection regarding some recording practices. Another complaint was received by the CSCI in September 2005; the complaint had two aspects. a) regarding a member of staff being employed without a CRB or POVA first check, and Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 13 b) the person was not given any reasons for his dismissal from his employment at the home. In relation to point a) at the time of the inspection on checking the staff files the manager was unable to evidence that a POVA first check and /or a Criminal Records Bureau disclosure had been carried out for the member of staff concerned. In fact it was later established that the staff member had been employed with a POVA first check but before the full CRB disclosure had been received. At the time of the inspection the necessary information was not seen on the staff file. However confirmation of both checks were later seen by the CSCI. The guidance issued by the Department of Health regarding safeguarding adults advises that the employment of staff prior to a full CRB disclosure having been carried out should only take place in exceptional circumstances. The manager is reminded of this best practice guidance. In relation to point b) the reasons for the dismissal of the staff member concerned were not recorded on his file. The manager informed the inspector verbally of the reasons the staff member was dismissed. This information must be recorded in the home, as the concerns discussed by the manager were serious and may have warranted a referral to protect vulnerable service users. This matter was not reported to the CSCI at the time of the dismissal. In failing to keep a proper record of the reasons for dismissal the manager failed to take appropriate action in line with the home’s recruitment procedure and this also led to a breach of the regulation to report such matters to the CSCI. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 14 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 environment was well maintained, homely and comfortable and met service users needs. EVIDENCE: The home was pleasantly decorated and very clean. Family of a service user spoken to made positive comments that the home was nicely designed and let in lots of natural light. Whilst they commented that the bedroom “could have been larger” they went on to say that they felt that it was “very nice”. The manager had developed a consent form for all residents with consultation from their relatives to find out if they wanted to lock their rooms. One service had expressed this wish and the manager was waiting for a lock to be fitted. There were adequate number of assisted toilets, and bathing facilities provided for service users. At the last inspection the hoist was kept in the corridor and needed to be stored in a suitable and safer place. The inspector was informed that the hoist was stored in the bathroom, as this room was not used Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 15 regularly. However the hoist had to come out of the room for charging the batteries. The manager stated that they were waiting for the electrician to put a socket in the bathroom. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 16 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 The staff have a good understanding of the service users needs and this was evident from the positive way the staff and service users were working together. Some of the homes’ recruitment practices did not conform with their own procedures and could therefore put service users at risk. EVIDENCE: One of the registered nurses, who had worked at the home for a number of years, was promoted to the position of deputy manager. She was due to take up her position next week. The manager stated that they were going to be fully staffed after one member of staff had received their CRB check. Service users and families spoken to stated that the home needed more staff. It was stated that some of them worked very long hours and were rushed off their feet. The staff and families spoken to stated that the staff were very nice. This practice was observed on the day of the inspection. The staff spoken to had received the statutory training in safe practices. However some of them had not received training on aggression, dementia, mental health, and death and dying. One member of staff stated that she had not received a copy of the whistle blowing policy. The staff induction programme seen was good for new staff. The manager stated that she had booked staff to receive dementia, and death and dying training in November 05. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 17 Over 50 per cent of the staff were doing NVQ level 2 or 3 in care. All service users had a named nurse and a key worker. Records in relation to one staff member were not complete at the time of the inspection. One reference for a staff member was faxed back from the referee but was incomplete. Also there was no record on file of the reasons a member of staff had been dismissed. The inspector was shown a file that was well laid out and was informed that all staff files were to be organised in this format. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 18 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): 32,33,36,38. The home have not concluded the quality audit or annual development plan to measure the aims and objectives of the home. These, when completed, will contribute to the home being run in the best interests of the service users. The manager has a good understanding of the areas in which the home needs to improve. All staff did not receive supervision and there fore all aspects of practice was not being monitored. EVIDENCE: At the last inspection the manager had started work on completing information on quality assurance, and had completed 85 of the information. However at this inspection the manager stated that the quality audit was not completed because the organisation was changing their quality assurance systems and some of their policies and procedures this week. The home did not have an annual development plan. It was stated that service users questionnaires were Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 19 sent out randomly to service users’ families on a three monthly basis. The analysis was displayed in the front entrance of the home. The information was written in very small writing, which was difficult to read. The information needed to be presented in a clear and easy to understand language. The manager informed the inspector that the organisation had recently sent questionnaires to families; service users, professionals, and soon these were to be sent to care staff in the home. The manager had started a relatives and service users meeting, which was held in September 05. It was stated that these meetings were going to be held twice a year. The manager undertook monthly open surgery at the home. It was stated by families spoken to that they found the staff and the manager easy to approach. One member of staff spoken to was not sure when she had received supervision or if she had received a copy of this. Another members of care spoken to had not received supervision. The manager stated that she had started having appraisals with most staff. She had also started having supervision with the nurses, but this was not happening with most of the care staff. However it was stated that all care staff would receive this. Fire alarm testing, emergency lighting, and fire drills were being carried out regularly. All staff had received training on safe practices Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X 2 X 3 Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 21 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 OP36 Regulation 18(2) Requirement The registered provider must implement the system for supervision for all care staff Target date of 30/10/04 was not met. The registered provider must provide staff training on dementia, aggression and dying and death. Target date of 31/8/05 not met. The registered person should ensure two references are obtained for all staff. This recommendation was not met from the last inspection. The registered person must ensure that all information stated in the standard is kept on file. The registered person must ensure that any concerns raised are followed up by the homes policies and procedures and all action taken is recorded. Timescale for action 31/01/06 2. OP27 18(1c) 1 31/01/06 3. OP29 7,9,19. 22/11/05 4 OP29 7,9,19 22/11/05 5 OP18 7,8,12(1) 22/11/05 Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 22 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. 4 5 6 7. Refer to Standard OP7 OP12 OP22 OP37 OP27 OP33 OP33 Good Practice Recommendations The registered person should provide evidence that the service user or their representative have been fully involved in the care planning process. The registered person should introduce service users meetings. The registered person should provide suitable storage space to accommodate the hoist The registered person should ensure that staff sign and date and complete all forms properly. The registered person should undertake a review of the staffing ratio to service users. The registered person should provide service users surveys out come in a user friendly language. The registered person should ensure that the development plan and quality assurance processes are fully completed and continued on an annual rolling programme. Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Taymer Nursing Home (Dr Saraogi) DS0000042234.V258832.R03.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!