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Inspection on 24/09/07 for The Carnarvon Nursing Home

Also see our care home review for The Carnarvon Nursing Home for more information

This inspection was carried out on 24th September 2007.

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.

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

Canarvon provides a safe and comfortable environment for residents who have a variety of nursing needs. Each person has a detailed care plan where information about how they are to be cared for is recorded. Where residents are capable of doing so they are involved in the process for planning care and relatives are encouraged to provide input. Residents looked well cared for and have access to health and medical care in line with their individual needs. Residents and their relatives who were spoken with during the inspection were generally happy with the home and the care and support provided. Staff working at the home ensure that residents receive the medical treatment including medication, which is prescribed for them, and that regular medication reviews are carried out. The home is generally well managed and staff are recruited in a robust way which protect residents. All staff undertake a period of induction and supervision when they commence work at the home. The home has an ongoing training programme for all staff and staff are supervised regularly so as to maintain standards of care provided to residents. Most of the people who were spoken with during the inspection said that staff working at the home are `caring`.

What has improved since the last inspection?

There have been improvements made in the way in which information about each person`s needs are recorded.

What the care home could do better:

More could be done so as to ensure that there is a full assessment carried out for a person before they are offered a place in the home. The home has the documentation to record information when a persons needs are assessed however this is not used consistently. People who spoke with the inspector felt that there could be more activities and particularly more access to activities outside of the home. Some relatives commented that some of the recent outdoor activities had proved to be inappropriate for wheelchair uses and their carers. The home has a high number of people who would wish to access activities outside of the home. However the there is insufficient means of suitable transport to facilitate this. Staff should offer more choices to residents at mealtimes, for example offering the choice of gravy or not and condiments. The home is in need of some redecoration in some areas and some relatives commented on individual`s bedrooms where paintwork and carpets were scuffed and worn. There is redecoration and refurbishment work planned for the next financial year. A number of residents and their relatives feel that there are not enough staff on duty to meet the needs of residents. The people who are more dependant and who require more support from staff live on the first and second floor of the home and staff who were spoken with said that they do not always have time to spend with these residents doing the` little things that matter such as applying make-up or styling hair` for female residents. Some residents complained at having to wait for long periods for staff to assist them. The manager needs to review the staffing levels and staff deployment at the home. The home has a detailed and ongoing training plan for staff however it was not clear from some staff files when staff had undertaken training and more could be done so as to evidence that all staff are up to date with training.

CARE HOMES FOR OLDER PEOPLE The Carnarvon Nursing Home 22-24 Carnarvon Road Clacton on Sea Essex CO15 6QF Lead Inspector Carolyn Delaney Unannounced Inspection 24th September 2007 11:00 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 Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Carnarvon Nursing Home Address 22-24 Carnarvon Road Clacton on Sea Essex CO15 6QF 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) 01255 426628 F/P 01255 426628 BUPA Care Homes (ANS) Ltd Ms Carol Anne Johnson Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (14), Physical disability of places over 65 years of age (57), Terminally ill (3), Terminally ill over 65 years of age (3) The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 57 persons) Persons of either sex, aged 45 years and over, who require nursing care by reason of a physical disability (not to exceed 11 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 20 persons) Persons of either sex, aged between 60 - 65 years, who require nursing care by reason of a physical disability (not to exceed 3 persons) Three persons, over the age of 45 years, who require nursing care by reason of a terminal illness The total number of service users accommodated in the home must not exceed 57 persons 01/09/2006 Date of last inspection Brief Description of the Service: The Carnarvon Nursing & Residential Home is in the seaside town of Clacton on Sea and is accessible via public transport that passes the front of the premises. The home is a former Victorian hotel that has been extended and modified. The nearest railway station is Clacton, which is within easy walking distance, as is the seafront. The home has a small amount of car parking spaces to the front of the home. The home provides care for older people of both sexes, who need both personal and nursing care. The home is also registered to provide nursing care, for up to 14 service users, aged 45 years and above with a physical disability, within the total bed compliment of 57. There are three floors accessible by stairs and a lift. All rooms are well furnished and pleasantly decorated. Bedrooms are all 10sqm or over. There is a large combined lounge/ dining room leading out onto a small, but well maintained garden. Various outings and shopping trips are organised for service users and regular entertainment is provided. The proprietor of this home is BUPA Homes Ltd. Current fees range is: £395 to £680. The home has a statement of purpose and service users guide available. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was routine key inspection. As part of the inspection process an unannounced visit was made to the home. During this visit residents, relatives and staff were spoken with and a number of records such as care plans, staff records and information about how the home is managed and maintained were assessed. A brief tour of the home was carried out and communal areas such as dining rooms and lounge areas were viewed as well as a number of residents bedrooms. All of the key standards were assessed during this inspection. What the service does well: Canarvon provides a safe and comfortable environment for residents who have a variety of nursing needs. Each person has a detailed care plan where information about how they are to be cared for is recorded. Where residents are capable of doing so they are involved in the process for planning care and relatives are encouraged to provide input. Residents looked well cared for and have access to health and medical care in line with their individual needs. Residents and their relatives who were spoken with during the inspection were generally happy with the home and the care and support provided. Staff working at the home ensure that residents receive the medical treatment including medication, which is prescribed for them, and that regular medication reviews are carried out. The home is generally well managed and staff are recruited in a robust way which protect residents. All staff undertake a period of induction and supervision when they commence work at the home. The home has an ongoing training programme for all staff and staff are supervised regularly so as to maintain standards of care provided to residents. Most of the people who were spoken with during the inspection said that staff working at the home are ‘caring’. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: More could be done so as to ensure that there is a full assessment carried out for a person before they are offered a place in the home. The home has the documentation to record information when a persons needs are assessed however this is not used consistently. People who spoke with the inspector felt that there could be more activities and particularly more access to activities outside of the home. Some relatives commented that some of the recent outdoor activities had proved to be inappropriate for wheelchair uses and their carers. The home has a high number of people who would wish to access activities outside of the home. However the there is insufficient means of suitable transport to facilitate this. Staff should offer more choices to residents at mealtimes, for example offering the choice of gravy or not and condiments. The home is in need of some redecoration in some areas and some relatives commented on individual’s bedrooms where paintwork and carpets were scuffed and worn. There is redecoration and refurbishment work planned for the next financial year. A number of residents and their relatives feel that there are not enough staff on duty to meet the needs of residents. The people who are more dependant and who require more support from staff live on the first and second floor of the home and staff who were spoken with said that they do not always have time to spend with these residents doing the’ little things that matter such as applying make-up or styling hair’ for female residents. Some residents complained at having to wait for long periods for staff to assist them. The manager needs to review the staffing levels and staff deployment at the home. The home has a detailed and ongoing training plan for staff however it was not clear from some staff files when staff had undertaken training and more could be done so as to evidence that all staff are up to date with training. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 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 Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the assessment process mean that residents cannot always be assured that the team at the home will be able to meet their needs. EVIDENCE: BUPA has detailed information in the form of a statement of purpose, which describes the services provided by the home, a service users guide and welcome pack which describes what it is like to live in the home and provides information about mealtimes, activities, arrangement for laundry etc. This information is readily available for people who live in the home. BUPA have an assessment document in which the needs of people who are looking for a place in the care home should be recorded following an assessment of the person’s needs so as to determine that the home will be suitable. However this assessment was not available for two people who had The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 10 recently moved into the home and there was no recorded information available as to the assessment of their needs carried out by staff working at the home prior to their admission. A full assessment had been carried for both these people once they had moved into the home. Residents and their relatives who were spoken with during the day of the inspection said that they had been provided with information about the home either when they moved in or when BUPA bought the home. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst some areas of care planning are good and show that resident’s needs are met, gaps in recoding and review of information are potentially affecting outcomes for some residents. EVIDENCE: The home has a detailed document for recording the assessment of each person’s needs according to their abilities. This includes any conditions, which may affect the person such as problems with memory, impaired sight or hearing, difficulties in mobilising, eating and drinking or maintaining personal hygiene. From this assessment staff develop a plan, which describes the care and support for each individual’s needs. The care plans for four people living in the home were examined. Generally there was detailed information recorded in each persons plan as to the care and support that they required on a daily basis. However for some people The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 12 where needs had been identified there was no plan of care in place. For example, where it was identified for one resident that they suffered from pain there was no plan in place as to how this was to be managed. There was no plan in place for one person’s needs in respect of visual and hearing impairment and for maintaining personal hygiene even though the assessment identified that the person required support and assistance. Care plans are reviewed on a regular basis however when staff review plans they do not always indicate as to what changes have occurred since the last review so as determine the effectiveness of the care provided. An example of this is where there was a plan of care for someone who was experiencing anxiety due to bereavement. The plan of care was reviewed each month and staff recorded ‘no change’ and there was no indication from the review as to the effectiveness of the plan. This was the case for the majority of care plans, which were examined on the day of the inspection. The documentation allows for resident’s relatives to be involved in the planning and review of care and to record their expectations. However this had not been completed for those whose care plans were examined. Where risks to the health and safety of people living in the home had been identified, such as risks of injury from falls, risks of developing pressure sores due to reduced mobility or the risk of weight loss as a result of poor appetite or difficulties in eating and drinking there were detailed plans in place so as to monitor and minimise the level of risks to the person. Plans in respect of managing and treating pressure sores were very detailed and reviewed appropriately. Detailed assessments are in place for determining the risks associated with the use of bedrails as a measure to prevent people from falling from bed. However, where bedrails were used it was not always clear from the assessment that the person was at risk of falling from bed. One of the risks is that of injury or entrapment. A measure to prevent this is the use of protective covers. It was recorded that some residents chose not to use these covers. Where this was the case it was not clear as to how the risks of injury and / or entrapment were to be managed. Resident’s healthcare needs are well met and there was evidence that residents have access to general practitioners, dentists, chiropodists and other healthcare professionals as needed. The manager has a policy for the safe receipt, handling, storage and administration of medicines. When a person is admitted to the home they are assessed as to their ability to safely retain and administer their medicines. The majority of people who live in the home depend upon nursing staff to administer their medicines. A sample of medication administration records were examined and these were well maintained. The senior nurse on duty at the time of the inspection said that a pharmacist from the local Primary Care The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 13 Trust (PCT) had reviewed each resident’s medication and altered dosage and frequency as appropriate. There were no issues identified in respect of the administration of medicines. However it was noted that some medicines had been left on a table in the manager’s office. This was brought to the attention of the senior nurse on duty who dealt with the issues immediately. Staff have received training in providing care to people who are dying and support to bereaved relatives. Residents wishes for how they would wish to be cared for as they approach the end of their life are recorded. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a programme of activities carried out in the home. However not all residents feel that the activities reflect their choices for how they wish to spend their time. EVIDENCE: As part of the documentation used by BUPA the staff team has a means for recording resident’s preferences for how they spend their time in a resident’s lifestyle profile. However these profiles were not completed for all of those residents whose care plans were examined. Two activities coordinators are employed to cover a total of 48 hours per week between Monday and Friday. There was little evidence that there are any activities planned or provided at weekends. Activities are planned a month in advance and residents are provided with a list of activities for the coming month. Activities included bingo, music, board games and some limited opportunities for trips outside of the home. The activities coordinator who was on duty on the day of the inspection said that the home has access to a minibus once a fortnight which can accommodate up to three wheelchair The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 15 dependent people. The activities coordinator said that there were up to twentyfive people would be capable of and would choose to access activities outside of the home. It was clear that the current arrangements for transporting residents is not sufficient for the needs and wishes of people living in the home. Some residents and their relatives who were spoken with during the course of the inspection commented that more opportunities to access activities outside of the home could be provided for the more able bodied residents. Some relatives commented that recent trip to a local amenity had proved to be difficult due to the hilly nature of the place which caused problems for those people assisting residents with wheelchairs. There is an open visiting policy and relatives who were spoken with during the day of the inspection said that generally they were made to feel welcomed in the home. Those people who were spoken with during the inspection said that they could go and speak to the manager or other staff at any time if they wished. This was also observed on the day of the inspection. There are regular meetings held where residents and their relatives can discuss any issues and areas where things may be improved etc. The majority of people who were spoken with said that the food provided by the home was good. The serving of the lunchtime meal and the suppertime meal were observed during the course of the inspection. There was a choice of gammon served with chips, peas, carrots and gravy or salmon and herb crust served with vegetables and chips. In addition omelettes and other alternative meals were provided and there was evidence that the homes chef meets with residents when they are admitted to the home so as to discuss any particular dietary requirements. A number of relatives were visiting residents on the ground floor and some assisted and supported them with the meal. The atmosphere in this dining area was noted to be unrushed and congenial. On the first floor some staff were observed to take meals to residents in their bedrooms without covering the plate, which is not hygenic. Some but not all residents were offered a choice of gravy and condiments such as salt and pepper. However some staff were observed to serve the meal with gravy without offering the resident a choice. Two residents on the first floor commented when they spoke with the inspector that they would have preferred not to have gravy on their meal. These issues had been raised at previous residents/ relatives meetings and it was disappointing that staff did not offer choices to residents. One resident complained that they could not eat the meal as it ‘was too greasy.. it is not nice’. This person said that usually the food is good. It was noted that a number of people on the first floor did not eat their main course The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 16 and that staff took plates away without asking if residents wanted an alternative or making a note that the person had not eaten their meal. It was also disappointing to observe one of the home’s cleaners vacuuming the communal area where residents were seated while they were eating their lunch. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place that help to ensure that residents are protected and their concerns are dealt with appropriately. EVIDENCE: The manager has a policy and procedure for receiving and dealing with complaints. Records indicated that there has been one complaint made since the last inspection. The complaint had been made by the family of a person who had been admitted to the home for a period of respite. This person’s family complained that staff working at the home had failed to meet this person’s needs and that staff had not followed instructions or use the information provided by the family in respect of the residents needs. There was evidence that the complaint had been investigated thoroughly and the complainant had received a response. During the day of the inspection residents and relatives who were spoken with said that they were aware of who to speak with if they needed to make a complaint. Those spoken with said that they had not made complaints about the home. However a number of people indicated that they were not always satisfied and that there were issues regarding activities, the environment, meals and staffing levels and the attitude of some staff. Some of the people who were spoken with said that some staff were uncaring, that they felt that there were not enough staff on duty at times which affected the care and The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 18 support that residents receive. Those people who were spoken with were advised to make their concerns known to homes manger and the nurse in charge at the time of the inspection was advised of the comments made by residents and relatives. There are procedures and systems in place so as to safeguard people living there form abuse, harm and neglect. This includes training for staff regarding how to recognise signs of abuse and how to act and report any suspected abuse or inappropriate behaviour by staff. Staff who was spoken with during the day of the inspection demonstrated that they were aware of the safeguarding policy. Staff who were on duty during the course of the inspection were observed to treat residents well and to be polite and caring. There have been no allegations or referrals made to the safeguarding unit or the Commission since the last inspection. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally safe, clean and comfortable and meets the needs of residents. EVIDENCE: A brief tour of the building was undertaken as part of the inspection process and a number of resident’s bedrooms were viewed. Most bedrooms were personalised with items belonging to residents. Some bedrooms particularly those on the first and second floor were noted to be in need of redecoration and some relatives pointed out where paintwork was badly scuffed and where the ceilings were in need of repair. Some relatives complained that staff took residents to the toilet situated adjacent to the dining room during mealtimes and this was ‘unpleasant for other residents’. Relatives told the inspector this was the only toilet available The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 20 however staff said that there were a further two toilets which residents could access when they were in the dining room. The toilet in question was noted to be very dimly lit and dark and the nurse in charge was informed. Communal areas were nicely furnished and looked comfortable. There are plans for redecoration of the lounge areas and some resident’s bedrooms and this has been factored into the homes budget for maintenance and redecoration. All areas of the home were noted to be clean and there were no unpleasant odours detected throughout the building. The manager has a programme for general maintenance and records indicated that repairs etc were carried out promptly so as to minimise any affect on residents living in the home. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home do not feel that there is always sufficient staff employed in the home. Staff are recruited robustly. EVIDENCE: Staffing levels for the home are two qualified nurses per shift supported by eight carers in the morning, six in the afternoon and three at night. People living in the home are accommodate over three floors with the most physically dependent people living on the second floor. Some staff commented that the majority of people living on the first and second floor require the support and assistance of two members of staff for transferring and delivery of personal care and that quite often staff struggled to meet resident’s needs. Some members of staff feel that they do not have the time to ‘do little things that matter such as applying make –up or styling hair’. The majority residents and visitors who were spoken with during the inspection commented that there was not enough staff working at the home. Two residents commented that the home was ‘short staffed at lunchtimes’. One resident said that have on a number of occasions ‘had to wait for hours to go to the toilet’ because they needed assistance of two staff to be hoisted. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 22 The most senior nurse on duty at the time of this inspection visit said that residents had recently been assessed in terms of their dependency on staff for support and assistance with aspects of daily living such as washing and dressing, mobilising and maintaining personal safety. It was not evident that the staffing levels had been reviewed so as to determine that the numbers and skill mix of staff working in the home were appropriate for the needs and levels of dependency of residents. The staff recruitment files for two members of staff who have been employed to work at the home since the last inspection were examined. There was evidence that the home has a robust process for recruiting staff and that all the required checks had been undertaken including references from previous employers, Criminal Records Bureau (CRB) disclosures and PoVA First checks and that candidates had been interviewed so as to determine the persons suitability to work in the home. There was also evidence that staff undertake a period of induction when they first commence employment at the home, which are in line with the Skills for Care Common Induction Standards. Staff who were spoken with and who had been employed at the home since last inspection said that they had undertaken induction and training. A nurse tutor is employed for fourteen hours per week. This person is responsible for ensuring that staff working at the home receive regular updates for core training such as safe moving and handling training. Each person working at the home has a personal training record. There was evidence in respect of training undertaken by staff including fire safety, safe moving and handling, catheter care, wound management and first aid. However many of the training records, which were examined, were incomplete and did not evidence that staff had received recent training. There were no other records available on the day of the inspection (such as a training matrix which is used in other BUPA homes) to evidence that staff working at the home receive training in respect of the work they are to perform and the needs of the people living at the home. Staff who spoke with the inspector confirmed that they receive regular training and support. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed but shortfalls in some aspects of the service are affecting the outcomes for residents. EVIDENCE: There have been no changes to the management structure of home since the last inspection. The home’s manager was on holiday at the time of this inspection. Staff working at the home who were spoken with during the inspection indicated that there are clear lines of management and accountability within the home and that staff feel that they are supported. Generally people who were spoken with felt that the home was well managed. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 24 Throughout the inspection it was noted that residents and relatives could discuss any issues they had with nursing staff. The current issues with regards to staffing levels and deployment of staff is a concern and it is disappointing that these have not been reviewed in light of resident’s dependencies and level of needs. Residents may keep monies and valuables in their rooms should they choose. Alternatively the home provides a safe and secure place to hold monies and small items on behalf of residents and detailed records are kept in respect of this. Residents cannot access their monies at weekends or at any time where the homes manager or administrator is not on duty. The arrangements for access should be clearly stated in the homes service users guide. There was evidence that staff working at the home receive regular supervision so as to monitor and maintain quality in staff practices. Staff spoken with confirmed that they receive regular supervision and support. A full time maintenance person is employed for forty hours per week with an additional person who covers 10 hours per week as and when required. Records evidenced that regular checks are carried out in respect of the maintenance, repair and renewal of equipment and systems within the home and there were no issues identified during the inspection visit. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 25 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 X 3 The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 Requirement Timescale for action 30/03/08 2. OP9 13(2) An assessment of each persons needs must be carried out before they are offered a place / move in the home so as to determine that the home is suited to the individual. Medicines in the home must be 30/03/08 stored safely and securely in accordance with the homes policy so as to minimise risks to residents. This requirement is outstanding from the previous inspection and the timescale of 31/10/06 was not met. The range of activities provided should be reviewed taking into account the needs and wishes of residents so as to ensure that residents can spend their time how they would choose to. Staffing levels at the home should be reviewed so as to ensure that there are sufficient numbers of staff available to meet the needs of residents. 3. OP12 16(2) (m) (n) 30/04/08 4. OP27 18(1) (a) 30/03/08 The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP8 OP15 OP19 OP30 OP35 Good Practice Recommendations Improvements need to be made in recording risks to residents as a result of the use of bedrails. Staff should offer choices of sauces and condiments to residents at mealtimes and offer alternatives or snacks where residents do not eat meals. Redecoration is needed in some areas of the home. Records to evidence training undertaken by staff need to be kept up to date. The arrangements for resident’s access to monies held for them by the home should be clear and included within the service users guide. The Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Carnarvon Nursing Home DS0000015320.V342151.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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