Inspection on 31/05/06 for The Adelaide Nursing Home

This inspection was carried out on 31st May 2006.

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

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

Other inspections for this house

The Adelaide Nursing Home 27/06/07

The Adelaide Nursing Home 24/10/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Adelaide Nursing Home 203 - 205 New Church Road Hove East Sussex BN3 4ED Lead Inspector Jennie Williams Unannounced Inspection 31st May 2006 10:00 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 The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 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. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Adelaide Nursing Home Address 203 - 205 New Church Road Hove East Sussex BN3 4ED 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) 01273 410530 01273 423413 Adelaidenh@btconnect.com Seaway Nursing Home Limited Mrs Kusumawattee Heard Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That service users should be aged sixty-five (65) years or over on admission The maximum number of service users to be accommodated is thirtyfive (35) Only older people requiring nursing are admitted to the home. Date of last inspection 13 September 2005 Brief Description of the Service: Adelaide Nursing Home is a care home providing care for up to thirty-five (35) residents over the age of sixty-five (65) and requiring nursing care. Although the home is registered for thirty-five (35) places, the home currently only accommodates thirty (30) residents due to some double rooms now being used for single occupancy. It is located in a quiet residential area of Hove. Local amenities and the seafront are within walking distance of the home. There is nearby access to public bus routes and rail links to Brighton. The home provides parking for approximately four cars and further car parking is available in adjacent roads, which is unrestricted. There is a garden area that is accessible to wheelchair users. Rooms are located over two floors and are accessible by stairs. A passenger shaft lift is available for those residents unable to independently mobilise. There are twenty-four single rooms of which twenty-two have ensuite facilities and three shared rooms of which all have en suite facilities. There are three assisted bathing facilities located throughout the home. There are two communal toilets located near communal areas, all other toilet facilities are within the individual’s en suite. There is limited space provided in the communal lounge/dining area, however this did not appear crowded. Weekly fees range between £471 and £700. There are additional fees including hairdressing (£9 to £25), Chiropody (£9) and newspapers/magazines, and personal toiletries. This information was provided to the CSCI on the 12 May 2006. Prospective residents/representatives are provided with a Statement of Purpose and Service User Guide that offer information on the services and facilities provided at the home. Residents/relatives know about the service through social service referrals, word of mouth and from living in the area. Information about the home is also obtainable on the CSCI website. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Adelaide Nursing Home will be referred to as ‘residents’. New owners took over the running of the home on the 1 March 2006. This unannounced inspection took place over nine and three quarter hours on the 31 May 2006. Nine residents, of both genders, were spoken with throughout the inspection. Five staff were spoken with, including the Registered Manager, a trained nurse, the cook, two cleaners and two relative/visitors. Ten relative/visitor comment cards were sent, of which seven were returned. Six out of twelve staff surveys sent were returned. Eleven resident surveys were sent, of which four were returned. Five GP comment cards were sent. One was returned incomplete due to the GP having not visited the home for two years and no other comment cards were returned. One resident’s care plan was looked at in detail. Specific areas were looked at in nine other care plans. A pre-inspection questionnaire was received prior to the inspection. Four staff files were viewed. Previous requirements at the home were assessed to ensure compliance. The environment and a number of individual rooms were also seen. The lunchtime meal was observed. The Statement of Purpose/Service User Guide and staff rota were inspected. No health and safety records were viewed as this information has been provided in the pre-inspection questionnaire, however fire records were checked. There were 21 residents residing at the home on the day of this inspection. What the service does well: What has improved since the last inspection? The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 6 The home has undertaken work to comply with requirements made at the last inspection; however further work is still required. Seventeen (17) out of the twenty-four (24) requirements made at the last inspection have been met. The procedures for medication stock control and administration processes have improved, ensuring residents are safeguarded from errors being made. Liquid feeds, treated as a medication is now being stored appropriately and not within the staff room. Flooring in some areas have been replaced with more suitable materials. Residents are now provided with lockable facilities to safeguard their belongings. Communal bathrooms are now being kept clean and free of clutter and staff no longer carry soiled laundry throughout the home, assisting managing infection control better. The cook confirmed that all people working in the kitchen have now received food and hygiene training. Training is being arranged for staff in adult protection to promote the safeguarding of residents. Most staff have now received Protection of Vulnerable Adult (POVA) and Criminal Record Bureau (CRB) checks applicable to their current employment and not relying on checks that had been undertaken in previous employment. Hazardous substances are now being locked away in accordance with Control of Substances Hazardous to Health (COSHH) guidelines and therefore residents, staff and visitors to the home are now better protected. Suitable measures have been implemented for those residents wishing their doors to remain open, whilst protecting them in the event of fire. What they could do better: The Statement of Purpose and Service User Guide needs to contain a copy of the most recent inspection report or at least provide information that a copy is available. It is an outstanding requirement that residents/representatives be involved in the reviewing process of care plans to ensure that preferences and choice are taken into account. This is the second inspection where it is required that consent is obtained and suitable risk assessments be implemented for those residents needing bed rails. It is now the fourth inspection where it is required that suitable activities be provided to fulfil residents interests and needs. The recruitment procedures require being more robust to ensure residents are safeguarded and in safe hands at all times. Residents’ monies must be available at all times for inspection. Urgent work is required to ensure a suitable quality assurance and quality monitoring system is developed and implemented to ensure the home is run in the best interest of residents. Supervision must be commenced for all staff and the home must continue to work towards the 50 ratio of care staff with National Vocational Qualifications (NVQ) level 2 in care or equivalent qualifications to demonstrate there are suitably qualified staff on duty at all times. Fire drills are required to be undertaken to ensure all staff and residents are familiar with action to take in the event of a fire. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 7 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. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 8 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 The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 9 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, 3, 4 & 5 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home provides sufficient information available for prospective residents/representatives regarding the facilities and services provided to make an informed decision if their needs can be met at the home. EVIDENCE: The new owners have amended the Statement of Purpose and Service User Guide, this was observed during the registration stage. A copy of this document was forwarded following this inspection for the CSCI to keep on file. This document does not contain a copy of the most recent inspection report or provide information to the reader on how to obtain a copy. The Registered Manager or a registered nurse assesses all prospective residents prior to admission. A pre-admission assessment veiwed was not dated or signed, however it provided suitable information for the home to assess that all the individual’s needs could be met. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 10 The Registered Manager confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. Prospective residents/representatives are encouraged to visit the home prior to admission. The first four weeks are considered as a trial period to ensure both the home and the resident are happy with the care and facilities provided at the home. Two residents confirmed that they were unable to visit the home due to health needs, however one had their partner visit. One resident confirmed that they had visited the home prior to admission. Two residents spoken with confirmed that they or their relative received information about the home prior to moving in. The home does not have dedicated accommodation to provide intermediate care. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 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 & 10 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents health and personal care needs are being met with the clear guidance for care staff being provided in care plans, however the reviewing process should include resident/representative input to ensure that preferences and choice are taken into account. EVIDENCE: Care plans generally provided clear guidance to staff on the assessed needs of the residents, however some needs of individuals were not reflected. A resident was noted to have a plaster cast on their arm; this was not reflected in the care plan. Other specialist needs of individuals were noted to be reflected in their care plan, such as oxygen in use, clear guidelines were in place for special tube feeding regimes and clear guidelines were in place for another resident who has specialist communication needs. There was evidence that care plans are being reviewed on a monthly basis, however no evidence was seen to show that this is done with the individual or a representative. A registered nurse confirmed that care plans are generally reviewed in the office and not with the residents. Most residents spoken with The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 12 stated that staff do not discuss their care with them or have involvement in the reviewing of their care plans. All relative/visitor comment cards received demonstrates that if their friend/relative is unable to make decisions, they are consulted about the care. There is pressure-relieving equipment available at the home and a tissue viability nurse is accessed when needed. A resident observed to be wearing glasses confirmed that they were having their eyes checked and arranging new glasses next month. One resident confirmed that the home arranges new batteries for their hearing aid when needed. One resident commented that they don’t receive hearing/sight tests or visit the dentist by choice. Resident comment cards received demonstrated that three residents always and one usually receive the medical support they need. Six relative/visitor comment cards received showed that they are satisfied with the overall care provided at the home. There were no risk assessments or consent forms in place for some residents who require bed rails. Some bed rails were noted not to be protected and some protectors in place were old and tatty. It was confirmed by the Registered Manager that there are policies and procedures in place for all aspects of dealing with medication. The content of these were not read. Sample signatures are kept of all staff who administer medication. Registered Nurses administer medications. On inspection of Medication Administration Record (MAR) charts, it was noted that one medication had been signed for but was not administered. The Registered Manager will address this with the individual involved. The overall signing and administration process was appropriate. The Registered Manager confirmed that the disposal of medication complies with current guidelines. Medication is stored securely within the home. Hand written amendments to MAR charts were not signed by the person making these changes. It is recommended that any hand written prescriptions are double signed by two staff who have received medication training to safeguard themselves and the residents. Of the residents that were asked, all confirmed that they felt their privacy and dignity are respected. Staff were observed to have a good professional rapport with residents and were heard to call them by their preferred term of address. Staff were noted to knock on residents bedroom doors prior to entering. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 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): 12, 13, 14 & 15 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents are encouraged to live a lifestyle within the home that is their own choice, however residents are not provided with sufficient stimulation to fulfil their interests and needs. Residents are not aware of the choices available on the menu, restricting their choices and preferences being taken into account. EVIDENCE: There is no activity person employed at the home and residents are not provided with suitable activities to fulfil their interests. One resident commented that they would like board games kept at the home for residents to use. The Statement of Purpose and Service User Guide reflects what activities are provided at the home. There was no evidence of these activities regularly occurring. There is no activity programme in place and no activities were observed on the day of the inspection. One relative/visitor comment card identified that more stimulation is needed at the home. Of the residents that were asked, all felt that the lifestyle within the home is their own choice. They can choose when to go to bed and when to get up etc. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 14 Residents are able to receive visitors in private and choose whom they see and do not see. There are no time restriction for visitors. The visitors spoken to confirmed that they are always made welcomed at the home. All relative/visitor comment cards received confirmed that they are always welcomed at the home and can visit their friend/relative in private. Residents are provided with a choice of meals, however on discussion with residents, some were not aware of the choices available for the main lunchtime meal. Residents did confirm that they had a choice of suppers. There was a notice board on display in the dining room that identified what meals were being served for the day. Comments received about the food ranged from ‘three days it is good and others it is not so good’, ‘quite good’ through to ‘very good’. There is no list provided to the cooks on the likes/dislikes/preferences/allergies in food for residents. For those with special dietary requirements, there were clear guidelines in place. The cook was briefly spoken with who confirmed that they are familiar with the preferences of the residents. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents feel comfortable to complain and feel that their concerns will be acted on. Residents will be better protected with appropriate staff training in adult protection and written procedures to support this. EVIDENCE: The home has a complaints procedure in place, however there is no central record of complaints kept. Complaints are kept within individual’s correspondence. The Inspector would need to read through all residents’ files to access complaints. The pre-inspection questionnaire demonstrates that there has been three complaints made about the home since the last inspection. One of these was made to the CSCI who referred this back to the home to investigate, which demonstrated that the complaint was investigated appropriately. The complaints were generally about the suitability of care for certain individuals. One was upheld and two partially substantiated. The Registered Manager confirmed that any action required was undertaken. Records/correspondence relating to these complaints were not inspected. Most residents spoken with confirmed that they would be happy to make a complaint and felt that their concerns would be listened to and acted upon. Resident surveys received showed that two always, one usually and one sometimes know who to speak to if they are not happy. The Inspector requested a copy of the adult protection policy to be forwarded on to the CSCI. This has not been received at the time of writing this report, The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 16 so the suitability of the policies and procedures in place for dealing with Protection of Vulnerable Adults (POVA) cannot be assessed. The Registered Manager confirmed that there was training being provided for staff in POVA the week following the inspection. A second training session is to be arranged. There has been one POVA investigation since the last inspection. This was found to be not up held and no further action was taken. This alert was made to the lead authorities by a third party. The home was co-operative throughout this investigation. Other concerns were investigated through the complaints procedure. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 17 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, 21 & 26 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents live in a homely environment and are provided with comfortable indoor and outdoor communal facilities, however additional work is needed to ensure cleanliness is maintained. EVIDENCE: Individual rooms are comfortable although some furniture is due for replacement and the use of hospital type lockers in some rooms gives an institutional air. Most residents spoken with were happy with their individual rooms and some were noted to be personalised to reflect the individual’s choice and preference. On the tour of the home, it was noted that additional attention to cleaning is required in some areas. Extractor fans need to be cleaned and some bed linen is required to be replaced, as some sheets were noted to be stained. Some en suites need to be free of clutter and toilet roll holders were noted to be broken and toilet rolls were being placed on the cistern. This may reduce the The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 18 independence of some residents due to being unable to reach behind them to independently access toilet rolls. There are call bells located in individual rooms and within communal areas so residents are always able to ring for assistance when required. The Inspector noted that there were some offensive odours noted in some areas of the home. This was also commented on in a relative/visitor comment card. Resident surveys received demonstrated that two always, one usually and one never finds the home fresh and clean. A comment card from a relative/visitor stated ‘standards of hygiene are very poor’. Two cleaners were spoken with who confirmed that they have suitable equipment and sufficient time to undertake their duties and that COSHH information is kept within the cleaner’s cupboard. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 “Quality of this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” Lack of robust recruitment procedures and staff training place residents at risk of harm and at risk that their health, personal and social care needs not being met. EVIDENCE: The majority of residents spoken to were complimentary about the staff working at the home. The majority felt that there were always sufficient staffing numbers on duty at all times. The rota provided to the Inspector demonstrates that there is always a registered nurse on duty and generally three to four care staff working in the day time hours and two carers working a waking night. Three staff surveys received demonstrated that additional staff is needed. Two of the resident surveys received confirmed that staff are usually available when needed and one stated staff are always available and one said staff are sometimes available when needed. Three relative/visitor comment cards demonstrated that in their opinion there are not always enough staff on duty. Staff spoken with confirmed that they are provided with opportunities to undertake training sessions relevant to their roles and are kept up-to-date with mandatory training. The pre-inspection questionnaire demonstrates that some training provided in the last 12 months has included; manual handling, dementia/mental health issues in older people, record keeping, continence The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 20 care. There are additional training sessions provided for the trained nurses, such as wound care, syringe drivers and leg ulcers. The pre inspection questionnaire demonstrates that the home has not been active in achieving the required 50 ratio of staff that have undertaken the National Vocation Qualification (NVQ) level 2 in care training. There is still only one carer with NVQ level 2 qualification. This is equivalent to 5 of staff being NVQ level 2 trained. There are currently three staff undertaking NVQ level 1 and level 2. The home is required to provide the CSCI with a programme identifying their proposals to ensure that at least 50 of care staff are NVQ level 2 qualified and the timescale in which they propose to achieve this by. There continue to be shortfalls in the documentation required to be kept on all staff. The home ensures that all registered nurses are registered with the Nursing and Midwifery Council. An additional visit was made to the home in November 2005 to ensure compliance with the requirements made previously regarding the documentation in personnel files. It was observed that the majority of files had Criminal Record Bureau (CRB) and POVA checks undertaken for employment at Adelaide Nursing Home, however some staff still did not have appropriate checks in place. An additional requirement was made at this additional visit that evidence is produced that CRBs’ have been sent for. Of the staff files examined there was evidence that additional work is still required in the recruitment procedures. The employment history should contain more information and there was evidence that a staff member commenced employment prior to a POVA check or completed CRB having been returned to the home. The Registered Manager and Responsible Individual needs to ensure that they receive confirmation that any agency staff used have had satisfactory recruitment checks undertaken. The Registered Manager confirmed that there had recently been a high turnover of staff, but nearly all vacancies have now been filled. There was no evidence within an individual files that new staff members had undertaken any induction upon commencing employment. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 “Quality of this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” A more structured quality monitoring system would enable management to monitor the success of the home in meeting its aims and objectives. Residents will be better protected with improved accessibility to individual finances. EVIDENCE: The Registered Manager is a registered nurse with current registration with the Nursing and Midwifery Council (NMC). She does not have any management training and does not propose to obtain any managerial qualifications, as she prefers to do clinical work. The Registered Provider is aware of this and will be addressing this issue. The Statement of Purpose and Service User Guide demonstrates that views from residents/representatives will be undertaken every three months to The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 22 evaluate the satisfaction of care and services provided at the home. There is no quality assurance and quality monitoring systems in place, so there is no evidence that the home is run in the best interest of residents. There are no staff or resident meetings held. Residents personal allowances could not be inspected on this occasion as the previous owners are still in the process of arranging the new providers to take over this responsibility. Staff are not currently receiving supervision. Staff providing supervision should be trained for the supervisory role. All staff surveys received also confirmed that they are not receiving supervision. Hot water temperatures sampled showed that hot water is being delivered between 37°C and 47°C. The electrical wiring certificate was not located on the day. This is required to be forwarded to the CSCI. Fire records demonstrate that there has not been a fire drill undertaken for over a year. Weekly fire alarm testing is undertaken. The Registered Manager confirmed that a fire risk assessment had been undertaken as previously required, however this could not be located on the day of inspection and has not been forwarded to the CSCI as requested at the time of writing this report. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 23 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 1 X 2 The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement That the Statement of Purpose/Service User Guide provides the reader with information on the recent inspection report. That evidence be provided of service users/representatives input into the reviewing of care plans. (Timescale 30.09.05 not met) That consent forms and risk assessments are implemented for those service users requiring bed rails. (Timescale 10.10.05 not met) That service users are provided with suitable and fulfilling activities. (Outstanding from last three inspections) That a central file and clearer records be maintained of all complaints and available for inspection. That a copy of the Protection of Vulnerable Adults procedure is forwarded to the CSCI. That toilet roll holders are fixed. That a cleaning schedule is drawn up to ensure all areas of DS0000065729.V291709.R01.S.doc Timescale for action 15/08/06 2. OP7 15 31/08/06 3. OP7 13(4)(c) 31/07/06 4. OP12 16(2) (m & n) 17(2) Schedule 4 (11) 13(6) 23(2)(b) 23(2)(d) 15/08/06 5. OP16 15/08/06 6. 7. 8. OP18 OP21 OP26 15/08/06 15/08/06 31/08/06 The Adelaide Nursing Home Version 5.1 Page 25 9. 10. OP26 OP27 16(2)(c) 18(1)(a) 11. 12. OP28 OP28 18(1) 18(1) 13. OP29 19 Schedule 2 18(1) 14. OP30 15. OP33 24 16. 17. 18. 19. OP35 OP36 OP38 OP38 17(2) Schedule 4 18(2) 23(4)(e) 17 the home remain clean. That bed rails covers and bed linen are clean and replaced as required. That the dependency level of service users be regularly reviewed and staffing numbers to be adjusted accordingly. That 50 of staff obtain NVQ level 2 or equivalent qualifications. That a programme is provided to the CSCI with a programme identifying their proposals to ensure at least 50 of care staff are qualified and the timescale within this will be met. That the recruitment procedure is more robust and all relevant checks are undertaken prior to a prospective employee commencing work. That all staff receive induction and foundation training that complies with the NTO specifications. That the home implements a robust quality assurance and quality monitoring process, as identified in the Statement of Purpose. (Timescale 01.11.05 not met) That service users monies be available at all times for inspection. That supervision of staff be commenced.(Timescale 01.10.05 not met) That all staff receive regular fire drills. That a copy of the home’s fire risk assessment and electrical wiring certificate be forwarded to the CSCI. 31/08/06 15/08/06 31/12/06 31/08/06 31/07/06 31/08/06 31/08/06 31/08/06 31/08/06 31/07/06 31/07/06 The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 26 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. Refer to Standard OP3 OP9 OP9 OP15 Good Practice Recommendations That all pre-admission assessments are dated and signed. That hand written amendments on medication charts be signed. That handwritten prescriptions on MAR charts be checked and double signed by two staff who have undertaken medication training. That there is a list made available to the cook of individual’s preference/allergies with food. The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 The Adelaide Nursing Home DS0000065729.V291709.R01.S.doc Version 5.1 Page 28 - 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. 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