Inspection on 08/12/05 for The Crown Nursing Home

This inspection was carried out on 8th December 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.

Other inspections for this house

The Crown Nursing Home 03/02/09

The Crown Nursing Home 21/05/08

The Crown Nursing Home 26/11/07

The Crown Nursing Home 29/06/07

The Crown Nursing Home 27/04/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Crown Nursing Home High Street Harwell Didcot Oxfordshire OX11 0EX Lead Inspector Philippa MacMahon Unannounced Inspection 8th December 2005 13.00 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 Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Crown Nursing Home Address High Street Harwell Didcot Oxfordshire OX11 0EX 01235 820010 01235 834050 thecrown@schealthcare.co.uk 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) Trinity Care (Crown) Limited Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16), Terminally ill (3) of places The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of persons that may be accommodated at any one time must not exceed 16. On admission persons should be aged 60 years and over. Date of last inspection Brief Description of the Service: The Crown Nursing Home is a purpose built home located in the village of Harwell, Oxfordshire, close to local shops and amenities. The Crown is home to 16 older people who require nursing care. The accommodation is on two floors and all the rooms have en-suite facilities, but only three have a bath. There is a lift to provide access to the first floor. Twelve of the rooms overlook the garden and some have a small balcony. The garden, which is largely paved, was designed to be easily accessible for wheelchair users. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the second in the inspection year. The manager was on annual leave at the time of the inspection and a senior nurse from one of Southern Cross homes in Oxfordshire was in charge of the home. A warm welcome was afforded to the inspector and the staff on duty were all co-operative. The inspector spent a good deal of the time in observing activity within the home, and talking to the residents, staff and visitors to obtain a view of the service provided. Care plans were examined, and meeting the individual resident to ascertain if the care needs were being met followed this. The medication system was examined, and all records required by regulation. What the service does well: What has improved since the last inspection? What they could do better: Care planning for people who have recently been admitted must be in place to ensure that their immediate care needs are met. The understanding and storage of Schedule 2 controlled drugs needs to be updated and implemented. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 6 The activities and social interaction for the residents is very limited and makes for a long day for the residents. Ways of improving this need to be explored. The charging of the batteries on manual hoists should be carried out in an appropriate place and without trailing leads through doorways. 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 Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these objectives were assessed on this occasion. The key standards were addressed at the previous unannounced inspection. EVIDENCE: The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9. There are some inconsistencies in the quality of care planning and recording of how care needs will be met. Overall the medication system is in good order apart from the storage and recording of a Schedule 3 controlled drug, Temazepam. EVIDENCE: The inspector examined a sample of care plans. One of the care plans was very well documented and gave a very clear picture of the resident’s health care needs and how they were met. This included very good wound care mapping and measurement until the wound was healed. Another set of patients’ notes belonging to a resident with complex care needs who was recently admitted to the home was very poor indeed in that there was no care plan, just a daily record. No risk assessments had been carried out even though the assessment clearly showed that this person was at risk regarding nutrition, pressure wounds and falls. This is poor practice and an immediate requirement was made that every resident must have a care plan showing assessed care needs and how these will be met. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 10 The medication system was examined and overall the systems in place were found to be appropriate. However, the Schedule 3 controlled drug Temazepam was stored in the appropriate cupboard but there was no record of the number of tablets stored. This is not safe practice and an immediate requirement was made that a record of the running total of Temazepam tablets must be kept, and regular checks of the number of tablets against the total must be undertaken. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. There is little evidence of any activity having taken place, other than the half day a week. It is recommended that a review of the activities plan should be made to look at ways of providing a programme that includes more than one day a week. Families and visitors are made very welcome at all times. The meals and mealtimes are enjoyed by the residents. EVIDENCE: There was no evidence of any activities taking place at the time of this visit. The activities co-ordinator visits the home once a week. The residents were observed in the communal sitting room for a period of approximately 30 minutes, during which time there was no interaction from staff and the only entertainment was the television, and only a small proportion of the group could see the picture from where they were sitting. There was a poster on the front door inviting friends and relatives to join in the home’s Christmas party, and another advertising a nativity play that is being performed by the local primary school. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 12 Families and visitors are always made to feel welcome, and can visit at any time. One resident told the inspector, “My daughter comes every lunchtime to see me”. This same resident told the inspector that there had been a number of visitors to other residents that morning, and that it was really nice to have visitors. Residents are offered choice over what time they wish to rise in the morning and go to bed at night. Those spoken to felt that they were always given choices and never pressured into doing something they would not want to do. The menu for the week and previous month were examined and showed that a wholesome, nutritious diet was offered to the residents. A resident spoken with said, “The food is pretty good here”. The kitchen and food store were in good order, and the records required to be kept regarding temperature control of the food presented and the cold storage were found to be appropriately kept. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 13 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. There is a good system in place for dealing with any concerns or complaints. The staff are all aware of the protection of vulnerable adults issues. EVIDENCE: A copy of the complaints procedure is posted in the entrance hall, and a further copy is in the service users’ guide. The procedure is clear, and the company takes all complaints very seriously. Training in protection of vulnerable adults is included in all new staff induction training, and evidence of this was seen earlier in the year at the previous company head office. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these outcomes were addressed on this occasion. EVIDENCE: The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 15 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 The number and skill mix of staff is appropriate to meet the needs of the residents. EVIDENCE: There were sufficient numbers of staff and skill mix on duty at the time of the inspection. The rotas were examined and found to have sufficient numbers and skill mix of staff on each shift. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 16 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): 21, 33, 38. The home is well managed by the present manager who is supported by the operations manager. There is little evidence of obtaining the views of the residents and relatives in order to develop the service. There are good systems of maintenance checks, and all records required by regulation are kept in good order. EVIDENCE: There has been a long delay in the application of the manager to become the registered manager. It is hoped that this will shortly be completed. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 17 There is no recent consumer satisfaction survey available. The company has a quality assurance programme for all its homes and will be introducing it in the near future. The manager operates an open door policy and residents, relatives and visitors are able to meet with her at any time. Letters of commendation are shared with all the staff. The fire log was examined and found to be up to date and complete. The staff have mandatory training in fire safety, moving and handling and food hygiene, and records of this training were examined earlier in the year at the previous company head office. Service records for the hoist, boilers and fire equipment were examined and found to be up to date. Risk assessments for all general working in the home were examined and found to be relevant to the home’s operation. The laundry was found to be clean and orderly, and all hazardous substances were appropriately stored and the accompanying documentation up to date. The inspector observed a battery charger for one of the manual hoists that had been left plugged into a socket in the corridor with the lead trailing into the bathroom, and the charger was not attached to the hoist. This, in the inspector’s opinion, is a hazard and it is a requirement that the charging of the manual hoist must not take place in the bathroom, and that trailing leads through doorways must not occur. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 18 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(1) Requirement It is a requirement that every resident must have a care plan showing assessed care needs and how these will be met. It is a requirement that a record of the running total of Temazepam tablets must be kept, and regular checks of the number of tablets against the total must be undertaken. It is a requirement that the charging of the manual hoist must not take place in the bathroom, and that trailing leads through doorways must not occur. Timescale for action 08/12/05 2 OP9 13(2) 08/12/05 3 OP38 13(4)(c) 23/12/05 The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 20 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 OP12 Good Practice Recommendations It is recommended that a review of the activities plan should be made to look at ways of providing a programme that includes more than one day a week. The Crown Nursing Home DS0000065924.V271964.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Oxford Area Office 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. 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