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Inspection on 08/09/05 for The Close Nursing & Residential Home

Also see our care home review for The Close Nursing & Residential Home for more information

This inspection was carried out on 8th September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The home is welcoming, despite its large size and the disruption caused by the current building work on site, and staff are friendly and caring. Relatives wrote `we cannot speak highly enough of the staff and those who guide them and manage this place of caring`. Another wrote that their relative `has blossomed since she has been at the Close`. Care managers were also complimentary about the atmosphere in the home: one commented `I have found the home to be open and responsive to clients` changing needs. Visitors welcomed and encouraged particularly during difficult period when redevelopment of site taking place`. The gardens are well maintained and attractive. The standard of cleanliness and upkeep is good, so that residents have a pleasant and comfortable environment to live in. There is a good range of group and `one-to-one` activities organised throughout the week that provides residents with stimulation and interest and the opportunity to get together socially.

What has improved since the last inspection?

The new laundry, kitchen, staff and administrative office facilities; and the residents` accommodation in single en-suite rooms, sitting/dining rooms and assisted bathrooms, provided in the completed first phase of the redevelopment of the home, are great improvements. The new car park at the rear of the home has replaced the gravelled and uneven surface and improved the access to the home. The new building, and landscaping and planting around it is attractive and give residents and visitors a good indication of the standard of the whole home, once the redevelopment is completed. The standard of record keeping, particularly in residents` care plans, continues to improve. The teamwork and communication between staff appears to be better: this is reflected by families` and visitors` comments about the helpfulness and friendliness of staff, and their confidence in the manager of the home.

CARE HOMES FOR OLDER PEOPLE The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP Lead Inspector Delia Styles Announced 08 September 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Close Nursing & Residential Home Address Burcot, Abingdon, Oxfordshire, OX14 3DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01865 407343 01865 407734 closenhome@aol.com Cavendish CLose Limited Nyembezi Sithole Care Home with Nursing 65 Category(ies) of Old age, not falling within any other category registration, with number (65), Dementia - over 65 years of age (7) of places The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Maximum of 52 persons with nursing needs. 2. The total number of persons accommodated must not exceed 65. Date of last inspection 18 & 22 November 2004 Brief Description of the Service: The Close was origianlly a Tudor-style Victorian country house with two single storey wings, situated close to the market town of Abingdon and approximately 6 miles south of the city of Oxford. The home is set in 4 acres of grounds with access to the banks of the river Thames. In the past 12 months, an extensive new building project has started to replace outdated and unsuitable facilities. The first phase of this project was completed in August 2005 and comprises a purpose-built two storey building, with 19 en-suite bedrooms, offices, and new kitchen and laundry facilities serving the whole site. The second phase of the project is underway, and involved the demolition of the original 2-storey house. The current registration for the home is for a reduced total occupancy of 65 beds, 52 of which may be for nursing care. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken by 2 inspectors and lasted for 8 hours. A total of 17 comment cards were received: 2 from residents; 5 from care managers/reviewing officers; 1 from a visiting professional; and 9 from relatives/visitors. The views of these respondents are reflected in the report. The inspectors were made to feel welcome by both staff and residents and appreciated the cooperation they had from all the staff. The inspectors spoke to the registered provider, nurse manager, administrator, activities organiser, nursing and care staff. The inspectors toured the building, and sampled records of residents’ care, staff recruitment, finances, and medication. One inspector focused mainly on care provision and facilities for residents in the new building – Riverview. At the end of the inspection, the inspectors fed back to the registered provider and manager. The second phase of the building development was underway, with the start of demolition of the old original two-storey house (‘St Peter’s). The continuing building work inevitably causes some disruption to the home and the inspectors made some recommendations in relation to site safety, and signposting for visitors using the temporary entrance path and entry to the home. Residents, staff and visitors were looking forward to the completion of the next phase of building work and were very pleased with the standard of the accommodation and facilities in the new building. What the service does well: The home is welcoming, despite its large size and the disruption caused by the current building work on site, and staff are friendly and caring. Relatives wrote ‘we cannot speak highly enough of the staff and those who guide them and manage this place of caring’. Another wrote that their relative ‘has blossomed since she has been at the Close’. Care managers were also complimentary about the atmosphere in the home: one commented ‘I have found the home to be open and responsive to clients’ changing needs. Visitors welcomed and encouraged particularly during difficult period when redevelopment of site taking place’. The gardens are well maintained and attractive. The standard of cleanliness and upkeep is good, so that residents have a pleasant and comfortable environment to live in. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 6 There is a good range of group and ‘one-to-one’ activities organised throughout the week that provides residents with stimulation and interest and the opportunity to get together socially. What has improved since the last inspection? What they could do better: Some things, such as the small size of some rooms in the existing building, and inadequate sitting and dining space in St Michael’s wing, can only be improved by the proposed new building work that will replace the existing rooms. Residents’ care plans should be improved further, to make sure that the effects of any treatment or care, or changes in residents’ condition, are always recorded. A more detailed assessment of residents’ nutritional needs and diet should be made. The Medicine Administration Record (MAR) sheets should always be fully and accurately completed. Minor improvements should be made to the staff recruitment files, so that they are detailed enough to show that the home has gone through a thorough process when employing new staff. The home should provide formal supervision for all care staff and keep records of these sessions. It is good practice as employers, and for staff members’ development and training, to have the opportunity for ‘one-to-one’ talks about their progress and any training needs. The home has not yet appointed a deputy manager: though the proprietor has been actively advertising this post, there have been no suitable applicants. The Close is a large home and the manager should have the support of a deputy to help in the management and leadership. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 7 During the building redevelopment, the provider, manager and staff should be careful to spot any additional potential hazards to residents and visitors, and work with the building site manager to take preventative action - for example, making sure temporary entrances are properly signposted and lit, and that the building site is adequately fenced off to prevent unauthorised people accessing it. Residents’ comfort and safety should be protected, by making sure that communal rooms are not too hot, that there is enough ventilation. Window opening restrictors should be kept in place on windows on the first floor as a safety measure. 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 Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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 standard(s) 1 & 3 The home’s Statement of Purpose and Service User’s Guide provide adequate information about the home and services provided. The systems in place for assessment of prospective residents’ needs are satisfactory. The manager takes responsibility for making a proper assessment prior to people moving into the home. EVIDENCE: The Statement of Purpose and Service User’s Guide have been updated to reflect the changes in the accommodation due to the new building work. Some minor amendments are still needed, for example, the description of the home includes reference to the original building (St Peter’s) and a weekly activity that takes place in the lounge there, though this part of the home has now been demolished. Also, the home’s Complaints procedure should be included in the information and should make it clear that complainants can contact the CSCI at any stage of a complaint investigation. Most of the people who completed comment cards before the inspection knew about, or had access to a copy of the most recent CSCI inspection report about The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 10 the home (this should be with the Statement of Purpose and Service User’s Guide). The manager visits prospective residents if possible, and completes an assessment of their care needs before they are admitted. Information from family, medical, nursing and social workers is included in residents’ assessments. The home uses a standard printed assessment form. This gives the basic information needed for staff to make sure the care they give to residents is appropriate and is used as the basis for writing their individual care plans. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 9 The standard of record keeping has improved overall and the care plans give enough information to enable staff to meet residents’ physical care needs. The procedures for the storage, administration and recording of medication in the home were sound. EVIDENCE: Care plans The care plans for 6 residents were looked at. They had been updated and reviewed and there was evidence that the staff had sought additional specialist nursing or medical advice where this was needed. The 3 care plans seen in Riverview were satisfactory with the exception that one resident had not been weighed monthly, although s/he was assessed as being underweight and ‘at risk’ of malnutrition. Another resident in ‘St Michael’s wing who had lost weight, did not have a care plan to show how staff were treating his/her poor nutritional state. The inspectors recommended the home uses the nutritional assessment and dietary care plans that are being introduced by the community dieticians throughout NHS and community care settings in Oxfordshire. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 12 The care plans chosen for review on St Paul’s and St Michael’s wings showed there is room for improvement in the way in which nurses assess and record resident’s wound care and healing. There is little information in the care records to show whether the care has met the aims set out in the care plans and has met the resident’s care needs. The Activities organiser has started to keep a record of residents’ participation in various activities. This could be further developed so that a social profile and care plan for residents’ social and recreational care is drawn up. Medication The systems for the storage, administration and recording of medications were looked at. These were satisfactory overall, but there were some omissions from the Medication Administration Record (MAR) sheets, for example, when a resident had missed a dose of prescribed medication the reason was not always accurately indicated by the use of a code letter on their MAR sheet. One resident had refused to have a prescribed antibiotic eye cream, but nursing staff had not informed the doctor of this and requested a review of his/her treatment. Eye drops should only be used for a month after opening: some containers had not been marked with the date they were opened, so staff might continue to administer them beyond the recommended safe date. The drug fridges are fitted with the manufacturer’s own integral thermometers and the staff use measurements from these to check that the medicines are being stored at the right temperature – between 2 – 8 degrees Celsius. There is a new drug fridge on Riverview for drugs needing cool storage. The fridge temperature recorded 7.9°C on the inspector’s digital thermometer, whereas the fridge thermometer recorded the temperature as 3°C. The manager said the fridge was new and she would contact the manufacturer and ask that the fridge thermometer be checked for accuracy so that staff can be confident that the temperature is maintained at the correct range for medicines that need cool storage. Controlled Drugs (CDs) were stored appropriately and a CD register is kept that shows the balance remaining for each product on a separate page for each resident. The controlled drugs prescribed for 3 residents were checked against the register and in each case the remaining amount was correct. There were 2 medicines in use that were being stored correctly as CDs. The legislation governing CDs does not require a record of the balance of these particular drugs (identified to the manager during the inspection) to be kept, but it is good practice to do so in addition to the record of administration on the MAR sheet. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 13 A number of residents were prescribed a laxative preparation medicine that is supplied in half litre bottles, with each bottle named for a specific resident. The medicine trolley on Riverview is not large enough to carry all the bottles needed, and to overcome this problem one bottle is carried in the trolley that is then used to supply all residents taking the medicine. The CSCI pharmacist was contacted for advice and said that this practice was not strictly legal, and suggested the manager discuss with the doctors the possibility of prescribing a bulk prescription, with either the name of the home on the label, or the names of those residents prescribed the medicine. The pharmacist said, “The legal limitations are that the home must have at least 10 residents cared for by the GP; and of these 2 must be prescribed the product”. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 There is a good range of group and one-to-one activities organised throughout the week to provide residents with opportunities to maintain an interest and socialise with other residents. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: On the day of inspection a lively entertainment session was taking place in the lounge on St. Paul’s wing. A guitarist was playing and singing, with residents joining in with enthusiasm shaking tambourines the musician had given out. There was a very happy atmosphere in the room and residents were clearly enjoying the entertainment. The activity programme is displayed on each of the three wings and showed a range of activities to choose from, including dates when entertainers had been booked to visit, and dates when trips to places of interest had been planned. The activity organiser arranges to spend time with individual residents from 11 am until lunchtime, to help them with individual tasks such as opening and reading mail, reading a newspaper, discussing topics of interest etc. Group work usually takes place in the afternoons. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 15 The inspector spoke with a relative whose mother had recently transferred to Riverview from St. Paul’s. He said he was able to visit whenever he wished and always found staff friendly and helpful. He was pleased that staff took his mother across to St. Paul’s to enable her to maintain the friendships she had made. The relative expressed complete satisfaction with his mother’s care and the environment on the new wing. Separate dining rooms are provided on St. Paul’s and also on Riverview and these dining areas are pleasant providing seating for small groups. Residents can choose where to eat, and although most choose to go to the dining rooms, meals can be served to residents in their rooms. A resident asked to have his lunch in front of the TV in St. Paul’s lounge because he wanted to continue watching the Test Match, and this was arranged. Lunch was roast lamb, potatoes, fresh carrots and frozen sprouts, with ‘Spotted Dick’ and custard for dessert. Cold desserts, such as ices or yoghurts, are available on request. The chef manager said that staff checked with residents at approximately 11.00 each day to find out if the planned lunch menu was acceptable, or if an alternative was needed, and the information was sent to the kitchen. This also happens in the afternoons for the supper menu, and the inspector saw this information collected and taken to the kitchen. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) NA Standards not assessed on this occasion. EVIDENCE: The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 25 & 26 Recent investment has very significantly improved the standard of the environment in the new building, and when the planned new rooms are completed, will also be improved for those residents who live in the older accommodation. EVIDENCE: There are some inevitable restrictions and limitations to space and access for residents and staff whilst building work is in progress, and temporary room changes for those residents who lived in the original 2-storey part of the home that is now demolished and to be rebuilt. Several of the relatives’ and residents’ comments reflected their appreciation of the standard of the new rooms and facilities in Riverview, and the limitations in space in some of the older accommodation, particularly where residents share rooms. The communal space for residents is temporarily reduced during phase 2 of the building work – a large ground floor lounge, small dining area and sitting room were part of St Peter’s wing that has been demolished to make way for a new The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 18 purpose-built wing. St Michael’s wing communal sitting/dining room area has always been unsatisfactory, because it is a long narrow room: residents’ armchairs have to be arranged around the edge of the room, leaving little space in between. Staff have too little space to sit beside residents who need help at mealtimes and so were seen to sit on chair arms between residents, or to stand, whilst helping residents at lunchtime. A resident was seen being transferred in a hoist and because of the cramped space, this was not carried out in a way that protected the resident’s dignity. The home’s laundry has moved to the lower ground floor of Riverview and provides excellent facilities. The laundry assistant works 8 am – 3 pm Monday to Friday, as well as alternate weekends. A vacancy currently exists for a second laundry assistant. Small items of personal clothing are separated after laundering and are put into individual baskets named for specific residents. Clothing is ironed before it is returned to residents. Residents are asked to arrange for all clothing to be labelled before admission to ensure items can be returned to the rightful owner. It was observed that the name on one item of clothing did not correspond with the name on the basket. The laundry assistant explained that the clothing had belonged to a previous resident. Clothing named for one person should not be given to another person, as this has potential to compromise the dignity of the person who is wearing clothing that does not belong to him/her. The laundry was clean, tidy and well organised. The only exception to this was in a cupboard where clean linen was stored, and where a cleaning bucket and mop had been left. This was brought to the attention of the manager on the day and was dealt with at the time. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The number and deployment of staff available to meet the needs of residents is just adequate. The procedures for the recruitment of staff have improved since the last inspection and provide the safeguards to offer protection to people living in the home. EVIDENCE: Residents and their relatives said that the staff are kind and caring but that they were very busy. Six of the 10 comment cards received from relatives and visitors stated ‘not always’ or ‘no’ in answer to the question ‘in your opinion, are there always sufficient numbers of staff on duty?’ A resident said that s/he was washed on his/her bed and that s/he was wheeled along the corridor whereas s/he felt that they could walk more on their own. A staff member’s comment about ‘toileting’ residents, indicated to the inspector that staff may revert to routine institutional practices and care ‘rounds’: if they have too few staff it is quicker for them to ‘do care’ for residents rather than encourage the residents to participate and do what they can for themselves in their own time. The home has again experienced a large turnover in staff – a total of 18 full time staff had left since the last inspection, 6 of whom are registered nurses, and 7 care assistants. Six of the 7 care assistants had Level 2 or 3 National Vocational Qualification (NVQ) in care. However, 8 new staff had been appointed in the past 6 months, including 2 new RNs and 4 carers. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 20 Because of the new building work, the home has reduced the number of residents who can be admitted to the home, and the manager confirmed that the staffing numbers and skill mix are maintained as stated in the Statement of Purpose. The home has been able to maintain the ratio of qualified staff without the use of agency staff. The home had still not appointed a deputy manager, though on the day of inspection the manager said that they now had two applicants for this post. The home has not had a deputy manager for several years. The Close is a large home and it is very difficult for one person to provide all the management and clinical leadership required without the support of a deputy. A sample of 5 staff files was looked at. Overall, these showed that the home had undertaken all the necessary recruitment checks – references and Criminal Records Bureau (CRB), professional and training information - to ensure protection of residents. The manager holds a separate file of checks made with the Nursing & Midwifery Council (NMC) to ensure that registered nurses are on the current Register and so are able to work as nurses in the UK. It was recommended that this information is transferred to the individual employee’s file to make sure that all the relevant checks and information are in one place. The process for recruitment appeared to be systematic, but the files would be improved by adding a checklist, so that the employer could ensure that all the necessary information about a prospective employee had been received before offering an interview. The records did not consistently show that 2 people had interviewed prospective employees: it is good practice to have 2 interviewers and keep a record of the interview questions and brief account of the decision to employ an applicant or not. Some staff files did not show evidence that staff member had signed an agreement about their maximum hours of work under the Working Time Regulations. It is important that staff are aware of their right to not to work in excess of the maximum 48 hours per week if they choose not to and that they sign an ‘opt out’ agreement if they do wish to work more hours. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 & 38 The financial systems in place in the home protect the residents’ interests. The system of formal supervision of staff is not fully in place. The systems in place for protecting the health, safety and wellbeing of residents are good. However, additional attention to health and safety for residents, staff and visitors is needed during the period of rebuilding on site because of the temporary changes to access to the home and relocation of residents to different rooms and additional use of communal areas. EVIDENCE: The home’s administrator maintains accurate records of residents’ monies and expenditure for additional services such as podiatry and hairdressing. There is a separate Residents Fund listing donations and withdrawals made for trips and activities for residents. The home’s accounts are audited annually. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 22 Staff turnover and changes in senior staff have affected the home’s progress in achieving the percentage of care staff who have a recognised training award (NVQ) and in making sure that all staff have regular formal supervision meetings at least 6 times a year. ‘Supervision’ is important because it gives the opportunity for all care staff to have a ‘one to one’ meeting with their mentor/manager and to discuss any training needs they may have and their progress in their job. At the time of the inspection, demolition work had commenced on the original 2 storey house that had been St Peter’s wing, and the old laundry and kitchen. Metal fencing screens had been erected across the access pathways to the old building. However, these would not be effective in blocking off the site to unsupervised children, or wandering residents. There was a steep dip down to a manhole cover, with a metal spike protruding from it, from the link pathway between Riverview and the existing building. There was no fencing alongside the path to warn people of the change in ground level. There were no clear direction signs to the temporary main entrance to the home from the rear car park so that visitors could go into the home via a rear corridor door off St Michael’s wing. This is a concern for the security of visitors or unauthorised people who may enter the home unnoticed. The proprietor said new signs were going to be erected. The link pathway has a roof, but no protection along the sides, so that rain will make the pavement wet and slippery for staff transferring laundry and food trolleys between Riverview and the original buildings. The link pathway is on a steep slope and staff have to manoeuvre heavy loaded trolleys along it. The proprietor and kitchen staff said that they had not found this to be a problem. The conservatory room at the rear of the home is used as a temporary main entrance for visitors. The conservatory windows are not shaded and on a hot day this area gets very warm. Out of the sun the inspector recorded a temperature of 29C and in full sun, 39C. The inspector observed that one resident was wearing a cardigan, sitting in the full sun and looked very hot. This was brought to the manager’s attention and the resident was moved to a cooler area and given a drink. Staff should be aware of the discomfort of residents who may not be able to move or get staff attention. The temperature of the sitting/dining room in Riverview was also very warm – 24.5C at 11.30 am and 26.4C an hour later. There is no air conditioning. The windows were wide open - the safety window opening restrictor catches had been taken off by staff to get more air circulating. The window opening restrictors must be left in place in line with Health and Safety guidance, particularly where there are residents who may be confused, or visiting children, who may fall out. Alternative means of cooling rooms by the use of fans, window blinds etc should be provided. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 23 One fire exit from the upper floor of Riverview leads out onto an external metal fire escape staircase. The door is not alarmed and there is a potential for confused residents to access the stairs without staff being aware, and falling. A laundry chute is used to transfer dirty laundry from the residents’ accommodation to the laundry in Riverview. The chute door was not locked and again, there is potential risk to residents or visiting children of accidents if they accessed this. Three oxygen cylinders were free-standing in the clinical room in Riverview and for safety it is recommended that these be secured to a wall to prevent them falling over, or that oxygen cylinder stands are provided. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 2 x 2 The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 25 NO 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 Regulation None. Requirement Timescale for action 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. Refer to Standard 1 Good Practice Recommendations The Statement of Purpose and Service Users Guide documents should be reviewed and updated to contain the current information about changes to the home and facilities made by the new building, and the complaints procedure (including the right of complainants to contact the CSCI at any time during a complaints investigation). * Maintain and further improve the standard of record keeping in residents care planning with more detail about wound care, and evaluation of care. * Consider implementing the M.U.S.T nutritional assessment tool. * Develop the assessment and care plans in relation to residents social and recreational needs. * Ensure that any handwritten alterations on MAR sheets are checked and countersigned by the doctor, or a second nurse as soon as possible after the requested amendments are made. * Review the system for provision of bulk medications to ensure that the home operates within the regulations. H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 26 2. 7 3. 9 The Close Nursing & Residential Home * Ensure that the doctor is informed of a residents noncompliance with prescribed medication and requested to review their condition promptly. * Ensure that the code letters used on MAR sheets for the reason for non-administration of medicines to residents are defined. * Mark eye drop containers with the date of opening and discard after 28 days of opening. * Ensure that medication administered at times other than the regular medicine rounds is recorded and that gaps between administration times are appropriate. * Any bladder washout solution prescribed should be listed on the MAR sheet. * Maintain a record of the balance of Schedule 5 medications held in the CD cupboards. * Ensure that the temperature of the drug fridge is maintained within the correct range for storage of medications that need cool storage. 4. 5. 26 27 Ensure that residents clothing is appropriately labelled and that only their own items are used for them. Review the staffing levels and skill mix and ensure that they consistently meet the needs of residents to allow sufficient time for staff training and supervision, and enablement of residents. * Provide a tracking list/index for staff files to evidence a systematic process. * Include NMC professional register checks in nurses files. * Maintain a record of staff interview questions and interviewers summary in staff files. * Provide evidence that staff have been informed of Working Time Regulations and have signed opt out agreements if they wish to exceed the maximum hours of work per week. Implement the programme of regular formal staff supervision and maintain records. *Ensure that staff are alert to changes in room temperature and take appropriate action for residents who are unable to express discomfort. * Ensure that window opening limiters are not disabled, to protect the safety of residents and visitors. * Ensure adequate temperature control in communal areas and take action to reduce the temperature if it is excessive. * Ensure that adequate fencing and protection is in place around the building site. * Improve the signage from the car park to the main H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 27 6. 29 7. 8. 36 38 The Close Nursing & Residential Home (temporary) entrance to the home. * Fit an alarm to the fire door leading to the external fire staircase on Riverview. * Secure the oxygen cylinders to avoid them being knocked over and causing injury to staff, or accidently discharged. * Ensure that the laundry shute door is kept locked between uses. The Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford OX4 2SU 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 Close Nursing & Residential Home H57-H08 S27175 The Close V238722 080905 Stage 4.doc Version 1.40 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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